My four year old son (will turn 5 in January) participates in an early childhood program in our local school system. He has a speech delay--uses some short sentences but has good receptive language--and is having some problem behaviors. He has been very active since he was about 18months old. Despite his behavioral challenges and speech problems, he is very bright--knows his alphabet, and can count to 10. He does play appropriately with cars and blocks and will maintain eye-contact for short periods of time when prompted. He likes to play rough and will give hugs. He smiles a lot but does respond adversely to loud sounds. His PCP referred us to our local MHMR provider due to his hyperactivity and my inability to manage his behavior well in new environments. I have observed that my son is very resistent to change, tantrums often, can be aggressive--although he is usually only aggressive towards me--, and is reluctant to play with other children. He insists, for example, on removing his shirt or pants if they become wet regardless of where he might be--on playground or in the cafeteria. He resists any redirection and will tantrum if anyone tries to stop him. He will interact with adults but prefers to play along side other children than with them. Our homelife is very structured, necessarily. My son will fill downtime with loud vocalizations, darting to and fro. He needs lots of praise and positive reinforcements. I use time out for inappropriate behavior and taking away of priviledges as consequences for inappropriate behavior. I use immediate positive feedback for appropriate behavior at home. He sees a psychiatrist who has prescribed Seroquel for his hyperactivity. The meds help him to sleep but he is gaining weight and his negative behaviors at school--tantruming, non-compliance have worsened. The psychiatrist has refered him to a pediatric neurologist for further evaluation. My son's teacher believes, that although he does have some difficulties with speech, his behavioral challenges are typical of his age and that his problems stem from poor social skills training. I agree--I'm a single, working mom with limited family support. He is strongwilled and raising him has been difficult, although I am trying to do my best for him. My son has been enrolled in structured, registered day care settings since he was 6wks old and I have tried to provide stimulating social experiences for him. My question is, should I continue to seek medical advice regarding this situation or continue to address parenting and social skills training for my son. Thank You!