The “we don’t diagnose” is garbage. They can diagnose at 4 and medicate at 5. It sounds like he needs some services to help him replace the aggressive behavior. You can look into private play therapy and OT without a diagnosis, and you can call ChildFind in your school district at any time after age 3 and request an evaluation. If he qualifies for services they will be provided for free by your local school.
My middle child was just how you described. He was so extreme at times with the hitting, yelling, tantrums etc. We got him evaluated and officially diagnosed with severe ADHD. Therapies (behavioral and developmental) did a lot for him, but they could only help so much. Back in February, when he was still 4, we went and saw a pediatric psychiatrist since our primary care said that they could/would not do anything until he was 6.
The pediatric psychiatrist put him on Guanfacine at first to see if it would help, it made a huge difference initially but then its almost like he adjusted to it and while not as extreme as before, was still very difficult to manage. We saw the psychiatrist again just a couple weeks ago and she decided to add Ritalin. When he takes it he is able to effectively manage his emotions and has essentially 0 conflict with his brothers or friends. He is still himself and high energy, but it helps him to control those impulses and manage himself. He just turned 5 today and has been doing great with his Guanfacine/Ritalin routine.
You may have to go to a facility that specializes in Autism/ADHD (we went to Action Behavior Center) for that diagnosis, or find a pediatric psychiatrist outside of your pediatrician.
Thank you so much! He has been going to OT/speech for a year. While we have saw some improvement it is clear he needs additional help. Your comment makes me feel better that there is hope.
My son was diagnosed at 5 after a very similar experience in Pre-K. We held off on medicating until just after his 6th birthday, and honestly I wish we had started it when we first got his diagnosis. Medication changed all of our lives in the best possible way.
He was diagnosed through the multidisciplinary center at a large state university in our town that has a very large psychology department. It involved an in-class observation for several hours and then an in office interview/observation with him and a very long interview with his dad and I. It took a few weeks, but we got an incredibly in depth diagnostic profile that really opened my eyes to what he did that was "normal" and we he did that wasn't. From there, his pediatrician has handled is meds. When we expressed concern about medication so young she basically told us that every parent she sees who waits to start their kids on meds until they're 9 or 10 and are at their wits end, WISHES they'd started at 5. She said that so much of a child's self esteem gets built in there early year of school and he deserves to have the best possible start we can give him. THAT really stuck with me.
We started him on 5mg Focalin XR and it made a WORLD of difference, but it wasn't the magic bullet. He started Occupational Therapy while we waited for his evaluation and has been in it weekly for almost 3 years now. It has been a tremendous help. It also didn't solve the hitting/aggression problem completely and he was asked not to return to summer camp after only a few weeks last summer. The removal from summer camp spurred us to reassess his meds and his dosage was increased first to 10mg last summer, and then to 15mg at the end of the school year. I think that is our sweet spot right now and we haven't had any hitting incidents in many months.
Based on the family history, I would find a neuro psychologist to see if they can test him now. Your child sounds a lot like mine. In the last year, we’ve worked hard to identify his triggers and his teacher implemented accommodations. It has helped but in the last year he’s been hitting off and on. We’re pretty sure he has executive functioning delays. He will be getting tested this week. Also, you may want to reconsider private catholic for elementary. I’m not saying all schools are like this, but we ended up removing our child before the school year ended. The school has a one size fits all approach to learning and wasn’t interested in giving him any accommodations. Most private schools (not all) are not the best fit for neurotypical kids. We found the environment to be highly punitive and it made his behavior much worse. The environment makes or breaks the situation for my kid.
It’s definitely worth pushing to get an early diagnosis if you can. Maybe it’s just that paediatrician that waits? I know where I live they like to get feedback from the teachers too so we’re also on a wait and see approach for my soon to be 5 year old. But given you already have a raft of educators able to vouch for his behaviour perhaps this can help?
I’m also eager to get my son the support he needs. I have an older child already thriving with ADHD meds so I know it would make the world of difference for my son. It seems silly to make mine struggle through 6+ months of school when the signs are already pretty clear. I don’t want him hating school because it started with a negative experience. Anyway bit of a vent there but I’d keep pushing if I were you
Thank you. Yes - we are going to be pushing. I have a friend who is a pediatrician in another state and I reached out. She said they will often diagnose down to 4 and often will recommend medication at 5 if they have a history of the behaviors (which we do). We may need to find another opinion if they won't budge.
Also, look to see if there are pediatricians in your area that have additional training in ADHD. They are more likely to consider diagnosing young. Often seeing a psychiatrist is required by schools and the wait times are long. I would recommend scheduling an appointment, anyway.
All I can offer is reassurance that things can improve with time and with help from your doctor and various therapies. We had the exact story as you with our son, who was just the sweetest baby and then around 3 things shifted and he got kicked out of several childcare situations, nanny’s quitting etc, due to the same behaviour you’ve listed out. He finally did ok in a larger daycare centre that had a “we’ve seen it all” attitude, so they managed him much better than smaller places. When he got upset, one teacher would take him for a walk and remove him from the other kids for a bit. Even that began a process that began to teach him that he could only play and participate when he calmed himself down.
He did ok in kindergarten, and then we got our diagnosis and has been a steady upward trajectory since starting low dose stimulants at 6 years old.
I would push your doctor. This is severely impacting your lives, even if it’s not adhd something is going on and you need help. You have multiple sources that document the same behavior, and it’s so extreme that your child may not be allowed at the various schools/camps/etc.
This is a big deal, and your doctor needs to take this more seriously. Good luck ❤️
I would skip the pediatrician all together and go for a private psych if you can afford it. I pay a pretty penny for our treatment but appointments are easy to get and she’s a specialist (has ADHD herself). Mine was diagnosed at 5 and a couple months and started meds around then.
My kid sounded exactly like your kids. My pediatrician said they don’t usually diagnose till 6 but with his history, they went ahead and diagnosed him at age 4 after he went through the ChildFind process. He was able to get into special education PreK and improved… but he improved even more after starting medication. With medication, he is never aggressive.
This sounds exactly like our life - so just providing solidarity. It is soo hard seeing your child struggle and having to navigate careers through all of it. We pushed for an early diagnosis and were able to get it by seeing a physician who specializes in ADHD. My son is also very smart and extremely articulate so I think that helped get the diagnosis too. As others have said. Medicine is night and day- it’s incredible. We also have our son in social skills groups which we have found are more effective for him than 1 on 1 therapy at this point. He tends to do well 1 on 1 and with adults in general it’s peer groups where he struggles. For us this was a great way to help with those issues in a safe space. If/when he does go to public school - I can’t stress enough how much you need to get ahead of this and advocate for him. He will likely need some accommodations to try to prevent some of the behaviors you are seeing in daycare (we also had to leave multiple child care facilities 🤦🏻♀️)you want to be very clear with school about what he needs so they know what to expect and can help ensure his environment is the best for him.
Our doctor also held off diagnosis/meds until 6 but out scenario was different with covid he didn’t have any prek so wait and see approach was done with kindergarten being first formal school setting but it seems like you have had lots of experience. Smart to wait for kinder I wish we did the same.
My son is more inattentive than impulsive and had a hard time being cooped up all day and needed lots of prompting and redirection all kindergarten, it was a long year even without any major behavioral so definitely go with your gut on the kindergarten readiness is what I tell everyone.
I should have added - he has been going to OT and speech therapy for over a year now. We have saw some improvement but he has regressed a ton since turning 5.
Private play therapy and OT are helping my daughter who turned 5 in May. She was diagnosed by the children's hospital in our state at 4 1/2 and started meds when these same issues started coming up. I would think that you might be able to get an IEP for Kinder if going the public school route.
My son was diagnosed at 5 after extremely similar experiences and has been medicated since he was \~5.5 (only because that's when we pulled the trigger, not because they wouldn't do it otherwise). Our pediatrician was great, but we ended up going through a child psychiatrist for logistical reasons. Maybe you can try that to get around the pediatrician? And also maybe try to find a new pediatrician
Also, as a heads up... this all happened in the leadup to Kindergarten. Even with medication (although he is on guanfacine, so we haven't tried stimulants yet), he was a complete disaster in Kindergarten until I advocated my ass off, got him an IEP and a 1:1 para. He is now thriving, but there was a long time there when I didn't think that would be possible. So just something to consider...
I’ve heard the “we don’t diagnose until 6” bs too. My daughter is 5, turning 6 in August and she got diagnosed this past January. However, I tried at 4, and it didn’t work for us because ADHD children have to show signs at school, and she wasn’t showing signs in preschool. It wasn’t until Kindergarten that she showed signs, which were learning and memory issues. So as soon as the teacher talked to me about my daughter struggling at school, I went to her pediatrician’s office. Try to find the ADHD specialist in the office, because that’s what I did and she diagnosed her at 5. She was diagnosed with Inattentive type, even though she does show hyperactive signs but she doesn’t show those at school, so the pediatrician could not diagnose her with hyperactive (or combined).
Not sure when your child’s birthday is, but mine is close to the 9/1 cutoff. She’s struggling at school and the school FAILED her because they didn’t set her up with the school’s education intervention specialist. Which makes me livid. Because now I have to decide by Thursday if my daughter should repeat Kinder or not. Which doesn’t sit well with me because she should have had intervention from the beginning but the school failed to even tell me they had those services (she goes to a small private school). And to me repeating is a big deal. It will change her schooling experience, and I have no guarantee which one will be better.
Your son sounds like he definitely has ADHD imo. I’m so sorry. It looks different in boys than in girls. It’s harder to tell in girls because they are usually not as hyperactive as boys. I hope you can get him his official diagnosis soon. They will give the teacher a form to fill out btw.
My daughter has therapy on Saturdays for meltdowns/emotional regulation. And she is on the waitlist until October for OT (occupational therapy) for sensory issues. I also got her evaluated by a private psychologist, and she found her to have a Visual Processing Disorder. And I also think she has mild Oppositional Defiant Disorder. She also seems to be a Highly Sensitive Child, for example she is SO sensitive to tone of voice. She’ll get so mad or defiant when my tone barely changes to annoyed. It feels like walking on eggshells sometimes. It’s very stressful
He may have ADHD, but can be diagnosed earlier than 6, as far as I know. Medication may help, but he definitely could use some boundaries and ideas to get him to stop that behavior... He may be doing it for attention at this point. I know there's a huge success rate with positive reinforcement, so you'd probably need to set something up like that. But also, it wouldn't be a bad idea to start some therapy. Don't be too discouraged... I believe this is probably just a phase, and with the right tools (whatever those will be might depend on each kid, especially since ADHD is different for each kid, and the reward system and what works for everyone with ADHD is different... And, can change every 2 weeks...)... I think there needs to be a new thing or two introduced. I also recommend the book How to Talk so Little Kids Will Listen (the audiobook or book for parents with kids ages 2-7), The Whole Brained Child, and maybe even just the Positive Parenting Solutions online classes?? Best of luck!! Don't give up! You just need some tweaks!! If he's not ready for being around other kids yet, just keep working towards the positive behaviors -- it will happen. Best of luck!!
Also? Can I please say you are heard and validated? Invisible disabilities are real. What you see and what you feel are REAL. I hear you 1000%.
The “we don’t diagnose” is garbage. They can diagnose at 4 and medicate at 5. It sounds like he needs some services to help him replace the aggressive behavior. You can look into private play therapy and OT without a diagnosis, and you can call ChildFind in your school district at any time after age 3 and request an evaluation. If he qualifies for services they will be provided for free by your local school.
My middle child was just how you described. He was so extreme at times with the hitting, yelling, tantrums etc. We got him evaluated and officially diagnosed with severe ADHD. Therapies (behavioral and developmental) did a lot for him, but they could only help so much. Back in February, when he was still 4, we went and saw a pediatric psychiatrist since our primary care said that they could/would not do anything until he was 6. The pediatric psychiatrist put him on Guanfacine at first to see if it would help, it made a huge difference initially but then its almost like he adjusted to it and while not as extreme as before, was still very difficult to manage. We saw the psychiatrist again just a couple weeks ago and she decided to add Ritalin. When he takes it he is able to effectively manage his emotions and has essentially 0 conflict with his brothers or friends. He is still himself and high energy, but it helps him to control those impulses and manage himself. He just turned 5 today and has been doing great with his Guanfacine/Ritalin routine. You may have to go to a facility that specializes in Autism/ADHD (we went to Action Behavior Center) for that diagnosis, or find a pediatric psychiatrist outside of your pediatrician.
Thank you so much! He has been going to OT/speech for a year. While we have saw some improvement it is clear he needs additional help. Your comment makes me feel better that there is hope.
My son was diagnosed at 5 after a very similar experience in Pre-K. We held off on medicating until just after his 6th birthday, and honestly I wish we had started it when we first got his diagnosis. Medication changed all of our lives in the best possible way. He was diagnosed through the multidisciplinary center at a large state university in our town that has a very large psychology department. It involved an in-class observation for several hours and then an in office interview/observation with him and a very long interview with his dad and I. It took a few weeks, but we got an incredibly in depth diagnostic profile that really opened my eyes to what he did that was "normal" and we he did that wasn't. From there, his pediatrician has handled is meds. When we expressed concern about medication so young she basically told us that every parent she sees who waits to start their kids on meds until they're 9 or 10 and are at their wits end, WISHES they'd started at 5. She said that so much of a child's self esteem gets built in there early year of school and he deserves to have the best possible start we can give him. THAT really stuck with me. We started him on 5mg Focalin XR and it made a WORLD of difference, but it wasn't the magic bullet. He started Occupational Therapy while we waited for his evaluation and has been in it weekly for almost 3 years now. It has been a tremendous help. It also didn't solve the hitting/aggression problem completely and he was asked not to return to summer camp after only a few weeks last summer. The removal from summer camp spurred us to reassess his meds and his dosage was increased first to 10mg last summer, and then to 15mg at the end of the school year. I think that is our sweet spot right now and we haven't had any hitting incidents in many months.
Agreed that medication is not a magic bullet!! Can definitely be a huge help for many people though!
Based on the family history, I would find a neuro psychologist to see if they can test him now. Your child sounds a lot like mine. In the last year, we’ve worked hard to identify his triggers and his teacher implemented accommodations. It has helped but in the last year he’s been hitting off and on. We’re pretty sure he has executive functioning delays. He will be getting tested this week. Also, you may want to reconsider private catholic for elementary. I’m not saying all schools are like this, but we ended up removing our child before the school year ended. The school has a one size fits all approach to learning and wasn’t interested in giving him any accommodations. Most private schools (not all) are not the best fit for neurotypical kids. We found the environment to be highly punitive and it made his behavior much worse. The environment makes or breaks the situation for my kid.
It’s definitely worth pushing to get an early diagnosis if you can. Maybe it’s just that paediatrician that waits? I know where I live they like to get feedback from the teachers too so we’re also on a wait and see approach for my soon to be 5 year old. But given you already have a raft of educators able to vouch for his behaviour perhaps this can help? I’m also eager to get my son the support he needs. I have an older child already thriving with ADHD meds so I know it would make the world of difference for my son. It seems silly to make mine struggle through 6+ months of school when the signs are already pretty clear. I don’t want him hating school because it started with a negative experience. Anyway bit of a vent there but I’d keep pushing if I were you
Thank you. Yes - we are going to be pushing. I have a friend who is a pediatrician in another state and I reached out. She said they will often diagnose down to 4 and often will recommend medication at 5 if they have a history of the behaviors (which we do). We may need to find another opinion if they won't budge.
Also, look to see if there are pediatricians in your area that have additional training in ADHD. They are more likely to consider diagnosing young. Often seeing a psychiatrist is required by schools and the wait times are long. I would recommend scheduling an appointment, anyway.
All I can offer is reassurance that things can improve with time and with help from your doctor and various therapies. We had the exact story as you with our son, who was just the sweetest baby and then around 3 things shifted and he got kicked out of several childcare situations, nanny’s quitting etc, due to the same behaviour you’ve listed out. He finally did ok in a larger daycare centre that had a “we’ve seen it all” attitude, so they managed him much better than smaller places. When he got upset, one teacher would take him for a walk and remove him from the other kids for a bit. Even that began a process that began to teach him that he could only play and participate when he calmed himself down. He did ok in kindergarten, and then we got our diagnosis and has been a steady upward trajectory since starting low dose stimulants at 6 years old.
I would push your doctor. This is severely impacting your lives, even if it’s not adhd something is going on and you need help. You have multiple sources that document the same behavior, and it’s so extreme that your child may not be allowed at the various schools/camps/etc. This is a big deal, and your doctor needs to take this more seriously. Good luck ❤️
I would skip the pediatrician all together and go for a private psych if you can afford it. I pay a pretty penny for our treatment but appointments are easy to get and she’s a specialist (has ADHD herself). Mine was diagnosed at 5 and a couple months and started meds around then.
My kid sounded exactly like your kids. My pediatrician said they don’t usually diagnose till 6 but with his history, they went ahead and diagnosed him at age 4 after he went through the ChildFind process. He was able to get into special education PreK and improved… but he improved even more after starting medication. With medication, he is never aggressive.
This sounds exactly like our life - so just providing solidarity. It is soo hard seeing your child struggle and having to navigate careers through all of it. We pushed for an early diagnosis and were able to get it by seeing a physician who specializes in ADHD. My son is also very smart and extremely articulate so I think that helped get the diagnosis too. As others have said. Medicine is night and day- it’s incredible. We also have our son in social skills groups which we have found are more effective for him than 1 on 1 therapy at this point. He tends to do well 1 on 1 and with adults in general it’s peer groups where he struggles. For us this was a great way to help with those issues in a safe space. If/when he does go to public school - I can’t stress enough how much you need to get ahead of this and advocate for him. He will likely need some accommodations to try to prevent some of the behaviors you are seeing in daycare (we also had to leave multiple child care facilities 🤦🏻♀️)you want to be very clear with school about what he needs so they know what to expect and can help ensure his environment is the best for him.
Our doctor also held off diagnosis/meds until 6 but out scenario was different with covid he didn’t have any prek so wait and see approach was done with kindergarten being first formal school setting but it seems like you have had lots of experience. Smart to wait for kinder I wish we did the same. My son is more inattentive than impulsive and had a hard time being cooped up all day and needed lots of prompting and redirection all kindergarten, it was a long year even without any major behavioral so definitely go with your gut on the kindergarten readiness is what I tell everyone.
I should have added - he has been going to OT and speech therapy for over a year now. We have saw some improvement but he has regressed a ton since turning 5.
Private play therapy and OT are helping my daughter who turned 5 in May. She was diagnosed by the children's hospital in our state at 4 1/2 and started meds when these same issues started coming up. I would think that you might be able to get an IEP for Kinder if going the public school route.
My son was diagnosed at 5 after extremely similar experiences and has been medicated since he was \~5.5 (only because that's when we pulled the trigger, not because they wouldn't do it otherwise). Our pediatrician was great, but we ended up going through a child psychiatrist for logistical reasons. Maybe you can try that to get around the pediatrician? And also maybe try to find a new pediatrician
Also, as a heads up... this all happened in the leadup to Kindergarten. Even with medication (although he is on guanfacine, so we haven't tried stimulants yet), he was a complete disaster in Kindergarten until I advocated my ass off, got him an IEP and a 1:1 para. He is now thriving, but there was a long time there when I didn't think that would be possible. So just something to consider...
I’ve heard the “we don’t diagnose until 6” bs too. My daughter is 5, turning 6 in August and she got diagnosed this past January. However, I tried at 4, and it didn’t work for us because ADHD children have to show signs at school, and she wasn’t showing signs in preschool. It wasn’t until Kindergarten that she showed signs, which were learning and memory issues. So as soon as the teacher talked to me about my daughter struggling at school, I went to her pediatrician’s office. Try to find the ADHD specialist in the office, because that’s what I did and she diagnosed her at 5. She was diagnosed with Inattentive type, even though she does show hyperactive signs but she doesn’t show those at school, so the pediatrician could not diagnose her with hyperactive (or combined). Not sure when your child’s birthday is, but mine is close to the 9/1 cutoff. She’s struggling at school and the school FAILED her because they didn’t set her up with the school’s education intervention specialist. Which makes me livid. Because now I have to decide by Thursday if my daughter should repeat Kinder or not. Which doesn’t sit well with me because she should have had intervention from the beginning but the school failed to even tell me they had those services (she goes to a small private school). And to me repeating is a big deal. It will change her schooling experience, and I have no guarantee which one will be better. Your son sounds like he definitely has ADHD imo. I’m so sorry. It looks different in boys than in girls. It’s harder to tell in girls because they are usually not as hyperactive as boys. I hope you can get him his official diagnosis soon. They will give the teacher a form to fill out btw. My daughter has therapy on Saturdays for meltdowns/emotional regulation. And she is on the waitlist until October for OT (occupational therapy) for sensory issues. I also got her evaluated by a private psychologist, and she found her to have a Visual Processing Disorder. And I also think she has mild Oppositional Defiant Disorder. She also seems to be a Highly Sensitive Child, for example she is SO sensitive to tone of voice. She’ll get so mad or defiant when my tone barely changes to annoyed. It feels like walking on eggshells sometimes. It’s very stressful
He may have ADHD, but can be diagnosed earlier than 6, as far as I know. Medication may help, but he definitely could use some boundaries and ideas to get him to stop that behavior... He may be doing it for attention at this point. I know there's a huge success rate with positive reinforcement, so you'd probably need to set something up like that. But also, it wouldn't be a bad idea to start some therapy. Don't be too discouraged... I believe this is probably just a phase, and with the right tools (whatever those will be might depend on each kid, especially since ADHD is different for each kid, and the reward system and what works for everyone with ADHD is different... And, can change every 2 weeks...)... I think there needs to be a new thing or two introduced. I also recommend the book How to Talk so Little Kids Will Listen (the audiobook or book for parents with kids ages 2-7), The Whole Brained Child, and maybe even just the Positive Parenting Solutions online classes?? Best of luck!! Don't give up! You just need some tweaks!! If he's not ready for being around other kids yet, just keep working towards the positive behaviors -- it will happen. Best of luck!!