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Where do we go from here?

I have a 7yr old daughter. She has anger issues. Started throwing tantrums at 2yr, we suspected it was normal to her age. They continued. It's hard to say what will set them off, but being tired or over stimulated usually does. The major problems started last year in Kindergarten. Usually during circle time, she would start to hum or make inappropriate noises while the teacher would be trying to talk. When asked to stop, she would say no, and when asked to sit in her chair for time out, she would refuse and start becoming very loud and verbally abusive. I worked at the school and the only thing I knew to do was to physically remove her. I seeked psychiatric help and she was put on Risperdal which helped immensely. The psychiatrist just wrote down her problem as ADD and anger, but I don't feel like that's it. I want to have her evaluated so that her father and I will know how to help her. You can tell by looking at her if she's about to have a fit. It's like a blankness in her face like she's left and someone else has replaced her. She doesn't learn at all in a group. Only one on one or very small group setting. She's starting to feel like she's not smart and has taken on the roll of the class clown. She's had weight gain from her increased appetite with taking the Risperdal and I feel like it's beginning to not work for her anymore because the "fits" are beginning to come back. If you could give me advice on where to go from here I'd sure appreciate it. Thank you!
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  the current recommendations for the psychiatric treatment of young children include implementing a multi-modal approach that integrates therapy and medication as needed. While medication can make a great difference in children's lives, I would recommend you seek psychotherapy with parent guidance (also known as parent management training or parent effectiveness training). Medication does not generally fix problems, though its wonderful for alleviating symptoms. Therapy is where you and she will learn skills you need to make lasting change.

I agree with you that more information is indicated. Psychological testing will give you a diagnosis and insight into why this is happening. Many children with ADD do not demonstrate such significant oppositional symptoms as you are reporting, so it would seem that the diagnostic picture is more complex. I believe it is critical to have an evaluation in order to inform psychiatric interventions. Many psychiatrists and psychologists work together to provide coordinated patient care.

If your daughter does have a disability that has an educational impact, she will qualify for special education services and/or accommodations in the school setting. These will be particularly important for ensuring her ability to make progress at school. Since your daughter is presenting with a complex array of symptoms, I recommend an assessment that includes both psychoeducational testing and emotional testing (often this level of intensive assessment is not provided by school systems, see my Medhelp articles on assessment and ADHD). Your psychiatrist or pediatrician can recommend a psychologist to do the testing and therapy.

Best Wishes
Rebecca Resnik
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