My 13 year old son has ADHD and is on watch for bipolar...he has a heart arrhythmia, and a lot of the psych meds are on the list of meds NOT to take with this condition.
We recently found out that part of his behavior problems are caused by a sleep disorder...restless leg syndrome...he was waking up over 250 times a night and not going into the REM sleep stage enough. No wonder he has such a temper!! He is now on meds for that (Requip), and he is doing much better, although the temper is still a problem. THIS PROBLEM WAS DISCOVERED BY HAVING A SLEEP STUDY DONE BY A CERTIFIED SLEEP SPECIALIST.
We also recently found out that he has a vision disorder that causes the eyes not to work together...he is only seeing partial words at a time...causing slow reading and refusal to do school work and homework. He has been in vision therapy for several months now, and it seems to be helping...he is getting A's and B's (except for science...failing there, and science is his favorite subject...aces the tests, but won't do his lab notebook). THIS PROBLEM WAS DISCOVERED BY AN EYE DOCTOR WHO SPECIALIZES IN VISION THERAPY.
We also recently have had NEUROPSYCHOLOGICAL TESTING done for him...this revealed some reading and writing disabilities that were previously undiagnosed. The bipolar diagnosis is inconclusive because he is unaware of his own moods...can't recognize them and put a name to them...he goes from incredibly giddy and giggly to angry off the charts to being uninterested in activities that he normally enjoys. We observe these behaviors, but he denies having mood swings, again because he doesn't recognize his own feelings (I was like that myself, even as an adult.)
These tests were not previously recommended by the psychiatrist...he just put my son on ADHD meds, which made him more angry and uncooperative. When the heart arrhythmia was discovered, he had to be taken off of the Adderall, and Ritalin and other stimulants are also on the list of drugs NOT to take. Because of finding all of these problems for which testing was not recommended to us by the psychiatrist, we have changed to a new pdoc.
The new pdoc put our son on PROVIGIL for the ADHD, and it also helps with depression. So far, it is working pretty well, but we still have anger issues, but at a lower level. We are still working with the new pdoc to get to the bottom of the problems...we will be requesting a daytime study to see if there is Narcolepsy involved, as I have it, as well as our oldest son. Our oldest son was also on ADHD meds for years, until the sleep study revealed the Narcolepsy...now that he is on Provigil, his grades have shot up to A's and B's.
I would highly recommend screening for learning disabilities, vision problems, sleep problems, and neuropsychological problems...even at age 4, a lot can be revealed by the testing. Our insurance has covered all of the testing. Our 8 year old was also discovered to have restless leg syndrome (inherited from my husband/their dad.) Start by a having a visit with his pediatrician, as many kids are just still immature at age 4, and they are reluctant to have the testing done until somewhere between age 5 and 7. Be sure to emphasize just what a big problem you are having...be specific, and tell the doctor everything.
When my 13 year old was 5, he would kick and scream (literally) if he didn't get to sit where he wanted to in the car...I had to buckle him in while being kicked by him (took his shoes off of him too)...then, he would unbuckle, and we would have to stop the car and start over again...all the way home from school. Giving in to the tantrums is not the answer...just makes them repeat the behavior later to get their way.
Our kids have IEPs...the school is reluctant to follow our requests, but after years of fighting for the kids rights, we are finally seeing results.
Good luck...sorry to be so long-winded...Becky