Can You Help my 2 Year Old Son?

QUESTION:

Dear Dr. Heller,

My two year old son’s behavior has become very intolerable. He is hurting playmates and siblings. It has come to the point where my babysitter can no longer take care of him if he hits anybody else. He can stay still long enough to have a very short story read to him and he don't play with anything longer than 45 sec -1 ½ min if I'm lucky. He's constantly on the move, and it is really starting to worry me. I really desperately need some input and all my doctor does is suggest books for me to read which is not going to help much because I've tried being firm and it get worse.

ANSWER:

There’s clearly more than just ADHD going on, as in and of itself, it doesn’t cause violent behavior. The most likely explanation is depression, with or without ADHD. Small children, especially aggressive ones, often responds to a combination of antidepressants and Risperdal. This is the approach I take first before treating ADHD.

The criteria for ADHD are very specific, although diagnosis remains a challenge in younger children. One of the most effective techniques I’ve used is having both biological parents take the screening test, and I look for diagnoses that both parents have. Since most of these diagnoses are genetic or have a strong genetic base, I’ll often base my initial diagnosis on diagnoses that both parents have first, and then see how the child responds. Controlling violence, out of control behaviors, and depression are usually my highest priorities - and sometimes children need very high medication doses due to their rapid metabolism of medications.