Quote From: midwest34My 4 yr old was kicked out of preschool for her behavior. She would not do as the teacher instructed and always tried to do or take part in the other childrens work. She is extremely social and very intelligent. This behavior just started one day and has escalated into a major family problem. We have been seeing a Psychologist and followed all the advice and after 5 mos- still no improvement. Actually, things have gotten worse. Has anyone taken their child to a Psychiatrist and had them evaluated? I feel that may be my next step. The thought of medicating her makes me sad and makes me feel as if I have failed her as a parent.  
She has slapped me in the face , spit at me in public, ran from me, hit me, scratched me, etc... I am open to any suggestions.  
If in 5 months your current psychologist has not improved things you need to go elsewhere. There are several books that all apply Dr. Phil's technique in different ways but the main theme is the same. If I were in your shoes I would go to extremes with behavior modification now before she is big enough to do real damage and prior to trying medication. This will be difficult for the first few weeks but should pay off. If you can afford it hire some help or recruit family or friends to provide support during the initial period.
Strip her world of everything but what she needs (3 healthy meals and water(no juice or milk)) , mattress pillow and blanket and one outfit per day plus pjs and undies. No snacks, No Juice. Meals should be a form of protein and some veggies. Stay clear of refined carbohydrates and sugar in any form including fruit for a while. She should have a bare room that just contains her bedding and a big clock or a timer. She should be restricted to that room and your attention to her should only be when she is in a clam pleasant state. You should be able to focus a great deal of your time with her during this time. Your attention (or attention of any calm adult) is her first payoff for being good. While she is good she should not be left alone for more then 5 minutes except when she is a sleep. Bringing in a book or game or a single toy to play with her at a time is fine but it should be removed when you leave. Any misbehavior means you leave the room (withdraw your attention) and she is left alone for 5 minutes of her being in a calm pleasant state. Never enter the room if she is not in a calm pleasant state unless you fear for safety. Get a baby cam so you can monitor without giving her attention. If she is good for a specific amount of time (say 1 hour) then she can leave the room but must remain with you at all times. Any negative behavior should return her to her room. This room remains bare until she is living in the house with out problem behaviors for a period of 1 week. She does not leave the house until she has been good for a month. Any bad behaviors you step back room restriction and let her work her way back. Then you slowly return things to her. The first thing she earns is freedom from the room and then freedom from being at your side then her stuff back and then treats and goodies like TV. You will need lots of help during this first period because you need to be calm and not react to any of her behavior.
You need to be very clear with her what good behavior is and but is negative behavior.
You should monitor and record bad behavior so you know your starting point.
To make this work you have to not yell or punish or show anger in any way other then to return her to the room in a calm way. If necessary put a chain lock at a high point on the outside of the door so she can’t reach it but can still open the door. Ensure the room is safe.
If after 3 days you don’t see improvement in her behavior (expect it to get worse for the first day or two) then get a preschool behaviorist to work with you. Don’t continue without help if you are not seeing improvement within 1 week. Once you are in a more normal state with her then you will need to chart her progress and ensure she stays on track.
I would recommend once she is on track following How to behave so your Preschooler will too or the book for older kids.
Don’t even consider medication until you've done some form of extreme behavior modification.
To do this you will need a second adult in the house at all times for the first week at least to support you. You need buy in from that adult and you need other assistance for at least a month if not two because she won’t be leaving the house until she is under complete control. It takes 3 months to form a habit so you should have 3 months of proper behavior before you put it to the test in a situation where you do not have complete control and can’t just pick her up and leave as soon as you see a problem.