Aggression is not a symptom of ADHD. Please review the criteria for ADHD:
Your son must exhibit the behaviors described in this definition to be considered ADHD. I think that it is wise to have a behavioral specialist. However, your post mentions nothing about discipline imposed. It sounds fairly obvious that your son requires structure, limit setting, and discipline. This is where you need to be focusing your efforts, not medicating him.
The problem is, is that we have done all that. Discipline (things taken away, time outs etc.)rewards for good behavior, positive reinforcement etc. He's been seeing a pediatric developmental specialist out of children's hospital of Philadelphia for two years. He is going to have behavioral therapy definitely but his teachers in his specialized preschool class say that he's hyperactive and can't pay attention. My question isn't if he's ADHD because his doctor already went through the criteria and everything so we already know he is. Agression isn't his only symptom. The doctor explained to me that aggression can in fact be seen in younger children with ADHD. I've read articles written by psychologists on the subject as well. I stated in my post that I do not want to medicate him,however, I don't want him to suffer academically because he can't sit still and can't pay attention. He's already behind due to a severe language disorder.
Also, autism had been ruled out along with ODD. I guess I am just seeking support for those that have gone through it. Medication scares me especially since he's so young. His specialist recommended behavioral therapy first which we are going but told me in the future (most likely in kindergarten) it is probable that he may have to move up to medication along with getting therapy. Guess my dilemma is that I don't want to deny him the medicine if it will truly help him.
Sure, you can have an ADHD child who is aggressive. But aggression isn't part of the diagnosis. So if your son sees a pediatrician who diagnosed him with ADHD specifically because of the aggression, you may need to get a second opinion. One cannot be diagnosed with ADHD unless they meet the criteria.
I think that in your situation, your son may need to be seen by a behavioral therapist. If the behavior becomes too intolerable and uncontrollable at home, you might want to consider having your son hospitalized in a psychiatric hospital. I know this sounds scary, but at least they should be able to get to the root of the problem and determine if meds are needed. The typical stay is 2 weeks or less.
Ok, while Mark is kind of right in that aggression is not mentioned specifically in the guidelines it definitely is a by product of:
Often has trouble waiting his/her turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games.
Which are in the guidelines. Furthermore, I can attest from years of working with ADHD kids and being on this forum, it is a very typical ADHD symptom. My guess is that Mark is seeing the worst possible case when you mention aggression to you, as you weren't very specific. You don't hospitalize a 5 year old child. Especially when he is being seen by a developmental specialist
Put simply, kids of this age with ADHD, don't have the filters to think twice before doing something. Hence, the aggression. Unfortunately, you might be part of the problem in expecting him to do something that he is not capable of doing. And since he has not learned how to express himself. The frustration results in aggression. In my dealings with undiagnosed ADHD kids, this sense of frustration, was always a strong tip-off to what might be the major problem.
But, to answer your question, yes the medication will help him. All studies have shown that the best solution is a combination of medication and behavioral therapy. Too many parents make the mistake of thinking that the meds are a magic pill that will make everything right. It doesn't work that way. Once the proper dose is found, it will help him focus in class and will help during recess etc.. But, it only helps (basically) with attention and thus impulsiveness. Hence, the importance of the behavioral therapy. But what is super important is that you are also a PART of this. You need to know what ADHD will do to kids and to be able to expect what they can realistically do.
The tricky thing with the medication is to make it last long enough to help you at home. This will take some trial and error. You need a doctor that will (and you must too) have the patience to go low and slow. You must get back to the doctor weekly and tell them how the meds are working. You must be prepared to switch meds. No children are the same. What works for one may not work for another. You do not want a cookie cutter approach.
And by the way, his therapist has exactly followed the guidelines in not medicating him first, but trying behavioral therapy.
If you could expand on why you are fearful of the medication, I might be able to help you with that (if you want another opinion besides your therapist). But, what I can really help you with are a lot of links on ways to work with ADHD kids. If you want to spend the time with a few specific problems you are having - I can probably help. Best wishes.
Thank you! It's been a long road and my husband and I have been involved with his treatment the whole way. He also has mixed receptive-expressive language disorder and has trouble processing so having ADHD on top of that makes everything a 100 times worse. Trust me when I say we have been patient and understand that sometimes he just doesn't understand and can't help it. As far add the meds go, my main concern is giving a stimulant to a 5 year old. They're still developing mentally and physically and I don't know the toll it can take on his little body. Personally, I've taken both concerta (in high school because I was diagnosed with ADHD but blew it off and thought they misdiagnosed me) and Adderall XR as an adult because I am a narcoleptic. I stopped taking Adderall because of the side effects.
Concerta never made me feel weird line Adderall did. Any experience with concerta? Is it less stimulant-like compared to adderall?
I'm not in the habit of challenging or debating the opinions of others in this forum, but I also worked extensively with ADHD kids working in a multi-therapeutic mental health center that housed a psychiatric hospital specifically for kids. As a mental health therapist, I referred kids to the hospital. To my understanding, there wasn't an age restriction as this would make no sense. Typically, if a child of any age (or anyone for that matter) who presents as a danger to themselves or others, which is a criteria for a psychiatric hospitalization, can be admitted Hospitalization is used to get to the root of the issue and stabilize the behavior in preparation for long term counseling if needed. It certainly sounds as if this child, even if he is just 5 years of age, would qualify.
Let me try to clear up What I mean as far as agression. Imagine a 2 year old throwing a fit. Sometimes 2 year olds hit and kick when they're told no or when they don't get what they want, mainly because they cannot yet self regulate or channel their emotions appropriately. They don't know why they feel like they do so they freak out. This is my son still at the age of 5. He gets upset when he has to sit down for dinner or when he has to get dressed for school. Everything distracts him and when I take those distractons away or try and make him sit down to eat without any distractions he gets upset. I believe it's because he literally can't not be moving or doing something..so in turn he let's me know how it affects him by showing anger and aggression. I'll also tell him not to do something because he can get hurt but because he's so impulsive he will try to do it anyway. He really just can't help himself. He got near the stove yesterday And I told him not to go near it because it's hot and will burn him; he tried to touch it anyway. When I caught him before he did it and told him no again he got aggressive and had to have a time out in his room. I hope this gives you more insight as to what's going on and what I mean as far as agression. He's a really sweet kid and feels horrible and cries after an aggressive fit. He gets so frustrated with himself and that's why I am trying to gain facts about a mix of therapy and medication. I'm at my wits end because I'm not only tired of his behavior after trying every recommendation but I'm tired of watching my child suffer and feeling helpless because nothing is helping him.
Thank you for your clarification on the term 'aggression'. It definitely doesn't sound as if hospitalization is warranted. However, every parent needs to know that this is an option that can only be ordered by a physician.
To be honest with you, it sounds like you are going through all the correct channels by getting your son evaluated by a variety of professionals. This really is the only way to get to the root of the problem. They should be able to determine the best course of treatment based on the origin of the problem. Obviously, you cannot implement an intervention unless you know the cause of the problem. I would leave the diagnose/intervention/treatment up to the professionals.
In my practice, I worked with parents extensively on issues of discipline. This intervention alone reduced child behavior problems significantly. I know that you stated that you tried everything when it comes to discipline, But has anyone worked with you and/or observed you disciplining him for these behaviors and made disciplinary recommendations to curb these behaviors? Implementing discipline is easier said than done. I have witnessed many parents who thought they were properly disciplining their child, but in fact unknowingly made the behaviors worse. Tweaking certain parenting skills can make all the difference in the world.
Please understand that I am not saying that I think you are not disciplining your son correctly. I am merely asking whether this issue has been examined.
When it comes to diagnoses in the USA, there really isn't any 'kind of right' about it. Either one meets the diagnostic criteria or they don't. We can't add onto the criteria to meet our needs. These diagnoses are meant to as objective as possible.
I don't know if you are aware of this, but just recently, the CDC reported that 1 out of 10 kids in the USA is diagnosed with ADHD and that number is increasing. I guess we need to ask ourselves, are our kids really that sick or are we lumping all behavior problems under the ADHD diagnosis? I honestly don't know the answer to this question, but I am leaning toward the latter. I have seen too many kids diagnosed with ADHD and prescribed medication without any formal testing which is cause for concern. Not to mention, the testing for ADHD can be rather subjective on its own.
What I have seen in my practice is many kids conditioned to not take responsibility for their behavior because they were diagnosed with ADHD and on meds for it. I also dealt with my share of parents who refused to discipline their kids because they felt that disciplining a child diagnosed with ADHD doesn't have control over their behaviors and therefore shouldn't be disciplined.
In my opinion, it seems to me that we, as a society, are focusing more on excusing behavior than holding kids accountable for it.