Expert: Christine D. DeLoatch, MA CCC-SLP - 6/22/2006

Question
I am a concerned mom who lives in Colton California.  I have a son who is 4 years old.  I was recently told by his doctor that he had adhd but I don't understand how she came to this conclusion she didn't examine him just went from notes from his preschool and myself.  How can you be sure he has adhd.  He is no longer going to preschool as they couldn't handle him.  they wanted me to put him on medication.  I am concerned about the medication.  Can he get addicted to it?  Should I put him on medication when he is so young?  I don't know what to do.  His Doctor said he is to young but the preschools here won't take him unless he is on medication?  Can you help me.  I really need information on this and advice.

Answer
Dear Cindy,

Thanks for asking me your questions.  Let me take each question one at a time.  How can a doctor diagnose AD/HD without an examination?  Just like depression, AD/HD is diagnosed by observable behaviors (self-reports in adults, parent & teacher reports for children).  

All children are active to some degree, however when activity and impulsivity prevent learning and developing friendships, then it is not considered 'normal' development.  

One of the criteria to get a diagnosis of AD/HD there has to be the same types of behaviors in 2 environments - therefore if you reported that you were seeing the same type of impulsive, driven like a motor kind of behaviors like the pre-school teacher did then the doctor may be appropriately diagnosising AD/HD.  Rating scales are typically done - a questionaire, by both teacher & parent.  

Before you decide whether or not medication is right for your son at this time frame, it is essential that you find a good child psychologist.  If you do choose to look into medication, then perhaps he could recommend a good child psychiatrist. Medications are prescribed by MD's and they need to have a good understanding of children's little bodies.  Many doctors do not like to put children under the age of 5 on stimulant medication; one reason is because it only works about 50% of the time.  It is not as reliable with children under 5.  

Can your son get addicted to the medication?  There is no evidence that children become addicted to stimulants if they have AD/HD- that is because it supplies something that is missing, it doesn't give something extra.  Studies acutally show that boys with AD/HD who take medication have fewer risk-taking behaviors, including experimenting with recreational drugs.  

Whether or not you choose to try medication is a family decision. There is no hard and fast rule.  Some families choose never to try medication, others wait a while, until the child is in Kindergarten or first grade and others will try it straight away.  It really depends on how much the behaviors of impusivity and over-activity are causing a problem to your family and your child.  If you are going to bed exhausted and it is a daily fight, then I suggest treatment - but not necessarily medication until you fully understand the pros and cons.  

A child psychologist can help you find tools that work best for your son.  Your son may not be able to sit for time out, but may understand a 3 strikes & your out approach or a program called 1-2-3 Magic.  Then again, all of these things may be of some help & support, but not enough & you may decide to try medication then.  

You do really need to work on behavioral changes whether or not you try medication.  If the behaviors are such that the preschool has asked him to leave - it would seem that some intervention is needed. Most professional feel that a combination of medication & behavioral changes yields the best results.

If you want more specific suggestions to help with behaviors, I'd need you to write back about the situations that have caused the most distress.  

Conserning a pre-school placement, you may want to see if your son would qualify for a pre-school placement in the school system. You can go to your nearest public elementary school and ask to speak to the exceptional children's or special education teacher. There maybe some classes that would work with him if he meets the criteria in your area.  You would need to explore this further after you have a diagnoses on paper by an MD or psycholgist.  

I hope I have helped some.  

Christine