Expert: Dr Billy Levin - 2/14/2008

Question
I have a three year old son from a previous marriage in which he lives with me and my x has him every other weekend for 48 hours. We (myself and current wife) have a two year old daughter together and my wife has a 8 yr old son and a 10 year old daughter from a previous relationship.
The three year old boy was recently diagnosed with ADHD after we decided to have him evaluated at a psychologist. We witness him having no ability to focus on one thing for more than 25 seconds, throwing complete temper tantrums when he does not get what he wants, claiming every toy in our home to be his own and not sharing, including the more advanced toys of the older children, completely defiant moods and behavior. The counselor he sees only sees the normal side of our son because he is on his best behavior but when he is in his normal enviroment he is a completely different child. He has been prescribed and is taking Aderall 10 mg every morning in a capsule which we dispense into some applesauce so he will take it, it seems to do little for the mood swings, little for the possessiveness, and little for the concentration problems, he is a very bright little boy that has alot of potential if we could just straighten him around to be able to focus, concentrate and be obedient towards us. If we could accomplish that we will be able to move forward with teaching and mentoring him. Every method of punishment including placing him in time out for a few minutes in the corner or on the chair, spanking you name it only seems to calm him for a very short time and then it is right back to whatever he can get into, whatever he can do. If there is anything you could recommend doing or changing or implementing please HELP us!

Answer
I assume you mean Adderall XR(extended release)10mg.
Most important punishment especially hidings MUST be stopped. You will only make him worse and teach him aggression. His bad behaviour is a symptom of the condition and not his fault. The condition is an inherited  immaturity of certain areas on the left brain. His current pattern is of a two year old, not a three year old( terrible two's)  It is a waste of time doing any therapy until his medication makes him more teachable. At the moment it is obviously not working. Under 6 years might not do well on stimulants and need either an add-on medication like Respidol or Serenace(Haloperidol) or a change to Methylphenidate. The dose needs to be increased until either it works or it is too much(zombified) and reduced. An optimal dose is needed and rating scales should be used to monitor the dose till effective.
Some doctors will not use stimulants in the under 6 year olds. I feel if the doctor knows what he is doing and parents are not ónly fully informed but given advice about managemant the treatment will succeed with minimal risk if given enough time.Become experts for the sake of the child! In the next year he will behave like a three year old, a much easier age.(contented trees) even though he will be four. (immaturity).