Would you medicate a 4 year old?

Discussion in 'General Parenting' started by 1234567, Oct 16, 2008.

  1. 1234567

    1234567 Guest

    My four year old daughter very likely has ADHD. I'm not diagnosing her, of course, but all the signs are there. It's in the family (myself, mom, grandma), she is very verbal, but has the attention span of a gnat, she's all over the place and has trouble being still. At home, it's not an issue, really. She gets in trouble occasionally, and she's a bit of a smart mouth, but it'd doable, especially if we stay on her schedule.

    She started preschool this year and has had some behavioral issues, mainly things like getting in other kids' business, not paying attention during circle time, running when she's not supposed to, etc. It's something almost every day. She also has trouble working independently.

    I'm considering taking her in to get a diagnosis and see if they will start medication. She is already telling me that she's bad in school, and I really don't want to start a negative association to school this early. I know most people want to wait to medicate until 6 or 7, but by that point she could already hate school and be labeled as a bad kid.

    Her teacher this year is wonderful and very patient with her. She makes sure to always tell me daughter she likes her and every day is a new day. I just hate to see her continuously get in trouble for something she (may not) be able to help.
  2. smallworld

    smallworld Moderator

    Sometimes therapy centered around behavior modification works for kiddos this young if you don't want to go the medication route at this point.

    What kind of doctor are you considering for the diagnosis?
  3. susiestar

    susiestar Roll With It

    I would see a psychiatrist and consider it. I would also strongly consider getting and Occupational Therapy evaluation - sometimes that can make a HUGE difference. But if it is causing problems for her at her work (school is a child's job) then YES, I would consider medicating.
  4. 1234567

    1234567 Guest

    How do you go about getting an Occupational Therapist (OT) evaluation?
  5. smallworld

    smallworld Moderator

    You could ask your pediatrician for a referral to a pediatric occupational therapist.
  6. Wiped Out

    Wiped Out Well-Known Member Staff Member

    Yes, I would and did decide to medicate our son when he was four but each child is different so taking her to the doctor is a good idea.

    When we first decided to medicate our difficult child he was four. At the time I didn't want to, I wanted to wait and see if his symptoms would improve. husband was of a different mind. He felt the same as you about wanting to get off to a good start at school. Even though the medications we started with weren't the right ones for our difficult child I know we made the right decision for our difficult child.
  7. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I'd get a neuropsychologist evaluation instead. It's more intensive. You do not know if she has ADHD and it is probably not a good idea to not consider that her behavior may be caused by other things as well. Hypernness and inattention is a symptom in many childhood disorders.
    I would be cautious about medicating a child unless she had had a complete evaluation because if she has an ADHD mimicker then stimulants for ADHD could actually make things worse, and she may not be getting the right type of interventions. How does she do with her peers? How is her speech and potty training and motor skills? Does she make good eye contact with strangers? Are there any possible mood disorders in the family? Does she rage? ADHD doesn't stand by itself too often. usually other things are going on as well. Could be Learning Disability (LD) problems too. A neuropsychologist evaluation would catch it all. Just seeing a therapist won't because they don't do testing. My own personal opinion is that an Occupational Therapist (OT) isn't a good enough diagnostician for our little ones. My son went to Occupational Therapist (OT) for years. They really aren't trained to evaluate disorders. Good luck :)
  8. LittleDudesMom

    LittleDudesMom Well-Known Member Staff Member

    Hmmm. Four is very young and I, were I in your position, would be hesitant. However, there are families here whose difficult children were medicated young out of absolute necessity. It's hard for us on the board to make that decision for you since we don't live with what you do.

    You say there is a family history of adhd. Anything else or just "plain" adhd? No comorbid stuff like depression? If the line of females is adhd, there is a pretty good chance your daughter is as well. I would make sure though, that she is diagnosis'd by a doctor who specializes in these issues rather than her pediatrician who specializes in the physical body. I think it is important, especially when seeking a diagnosis for a child as young as your daughter, to start in the right place. If you respect and trust her doctor, give them a call. Let her peddoc know what is going on, what your concerns are, and ask him/her for a referral. He/she may some great suggestions.

    Good luck.

  9. meowbunny

    meowbunny New Member

    I'd be hesitant to medicate a young child but wouldn't be adverse if it really would improve her quality of life and thinking you're a bad girl at school certainly makes for an unhappy child.

    However, I would try a couple of things first. Obviously, getting a good evaluation would head that list. I would also try seeing if certain foods trigger some of the behavior and, if so, eliminate those. Major foods that trigger behavior issues are food dyes (especially red) and gluten. For a week keep a food diary and a chart of behavior. Hopefully, her day care will be willing to be on board for this. Then, try eliminating one food per week and see if it makes a difference. If she does have food triggers, it is much easier to stop these eating habits when they are young.

    Do remember that whatever decisions you make, you are doing the best you can for your daughter. Don't second guess or blame yourself if something doesn't work or if others start judging you unfairly.
  10. Marguerite

    Marguerite Active Member

    Given that you are going to have her assessed and properly diagnosed - which would be necessary anyway, before any medication could be given - then I recognise that you are aware that there are procedures which need to be followed, etc.

    Four is young, but in my opinion not TOO young for medication, if it is considered to be advisable. It really does depend on the child, on the circumstances, how the child presents, what has already been tried - so many things.

    difficult child 1 was clearly having problems from very young, but I kept getting told (by the GP and the district nurse) that nothing was wrong. As a result he was 6 before he was finally seen by a specialist. That doctor required us to jump through some hoops before he would prescribe medications. First we had to see if diet made a difference. It didn't, but it was a worthwhile exercise for us. I also put myself on the low-allergy diet, to see if it made a difference to me and also so difficult child 1 wouldn't feel singled out. We DID find that two things aggravated his behaviour problems - caffeine, and oranges.

    With difficult child 1, once we had demonstrated that there really weren't any alternatives, the specialist prescribed ritalin (Concerta was not available in Australia at that time). We found it brought amazing improvement, but it was not anywhere near a compete fix. However, we were grateful for any change for the better. We did find also, that caffeine would undo the benefit of the medications; difficult child 1 was at a party at school and drank several glasses of cola, which was enough to negate the benefit of the ritalin.
    As time went on, we realised we couldn't give difficult child 1 a holiday from his medications (as was often suggested at the time) because he had difficulties coping with the confusion of whether medications were on board or not. With medications on board, he knew what he could do. Unmedicated it was much more difficult for him, but it was still something he could cope with if he was aware of it and stable. But when he was used to being medicated and on an even keel then we let medications wear off and he had to change what he was used to - then it was the most difficult for him. We also discovered later on that he had problems with rebound - as medications wore off, it was as if all the symptoms that had been kept at bay for the day, all surfaced at once. The pendulum would swing much further back the other way.

    We changed specialists (many reasons) and difficult child 1's medications were doubled. This greatly improved his performance in class but it also greatly increased the rebound problems.

    Then we became aware that difficult child 1 was not an isolated case in the family. Because we needed a specialist who could manage all three of our problem children, we had to change doctors again. This doctor changed difficult child 1 to a new medication - dexamphetamine. No rebound problems. We talked to friends with similar problems and found that rebound could have happened with either medication. This same doctor diagnosed difficult child 3 as on the autism spectrum, revised difficult child 1's diagnosis to Asperger's Syndrome and also diagnosed easy child 2/difficult child 2 as having some Asperger's traits. All three were diagnosed as ADHD as well. Oh, joy...

    difficult child 3 was by this stage three and a half years old. He was non-verbal, apart from some simple words which he could read. He had a good understanding of phonics and could read text aloud but had limited understanding. HIs vocabulary consisted of maybe 20 nouns which he knew and understood, and the entire script of half a dozen movies and most songs on the pop charts. However, he seemed to repeat the words as if he was remembering a very long sequence of sounds, rather than anything with any meaning.

    difficult child 1 was started on dex at 3 and a half. The difference in him was remarkable. Again, no way a cure, but it was enough to make it much easier for him to make the next leap in his language development. In so many ways, his ability to pay attention more consistently to the world around him opened up so much more opportunity to him.

    We copped a lot of flak from family, from friends, from relatives, for medicating him so young. But we had the confidence to keep on with our decision because the benefits were so apparent. Even since then, when well-meaning idiots say things like, "What do you think about those irresponsible parents who drug their children into submission?" I still have confidence to tell them, politely, just how narrow-minded they are.

    But you DO need to be prepared for these people. They will tell you, so you will need to feel sufficiently confident that medicating your child is the best decision.

    IIN order to ensure it IS the best decision, you should cover all bases and also ensure she has been thoroughly, carefully, comprehensively assessed. You also need to look into all treatment/management/support options.

  11. TerryJ2

    TerryJ2 Well-Known Member

    Years ago, I would have said it was way too young. But after living through so much with-our difficult child, I would say go for it! It would have helped us immensely, and would have helped our difficult child focus and absorb so much more information. He was always in trouble and I feel like I'm partly to blame for not pushing harder for intervention. (Of course, since my husband is a chiro, he pushed back just as hard, being anti-drug.)
    Armchair quarterbacking is always fun ... :)
    I agree with-MM that hyperactivity can be a symptom of other things and not necessarily a stand-alone diagnosis. So you need a good diagnosis.
    Take her to a psychiatric or neuropsychologist and get some testing done. (I personally like psychoeducational testing because it helped us see that our son had a slight Learning Disability (LD) and we signed him up for tutoring.)
    She will need therapy (and the idea of Occupational Therapist (OT) is good too) to teach her how to control her impulses.
    Some of the appts take wks and mo's to get so I'd start scheduling right away.
    I hope you have family and friends you can take turns with-so you can ea get a break.
  12. SRL

    SRL Active Member

    Marg, it doesn't take much of an assessment here to get a child on ADHD medications. The regular peds do it all the time, and some without a lot of questioning or considering other possibilities.
  13. smallworld

    smallworld Moderator

    That's why we recommend getting a thorough evaluation by a specialist (neuropsychologist, developmental pediatrician or mutldisciplinary team at a children's or university hospital) to determine if you're looking at ADHD or something beyond. The symptoms of many childhood disorders overlap, and it's impossible to tell what is what without a thorough evaluation.
  14. Jena

    Jena New Member


    I agree with everyone else 4 years old is young, and she is in the process of adjusting to school setting as well. An evaluation i would think would be your first step, than worry about medicating if necessary after that. My oldest who is going to be 16 had a rough start in pre-k as well, even hit a child after the birth of my youngest.

    yes once she began kindgergarten she began to level off. there are times when it is just the adjustment period. yet a good evaluation will give you more insight.

    good luck :)
  15. DDD

    DDD Well-Known Member

    When my youngest was in the same place as your daughter there were no medications available. Ritalin became available by the time she was six but they didn't "know" much about dosages, rebound etc. I sincerely believe those early years of being labled "bad" "naughty" "odd" etc. impacted her entire life. She is the one referred to as GFGmom here because she is in her forties and still makes impulsive selfcentered choices.

    Obviously I am NOT anti-medication. :D on the other hand, I really, really, really, really believe that it is imperative to have a fully qualified physician make that choice. Although many people here have gotten along just fine with their Pediatricians care, personally I think you need to find an expert in early childhood psychology. A well qualified Psychiatrist is on top of all the new medications available and the importance of dosages. When you hear or read of
    people who "medicate their kids into zombies" :( you can count on the fact that they have not had the appropriate professional guidance on choices and dosages.

    Good luck. DDD
  16. Dara

    Dara New Member

    Sammy is 4 and we hae tried a few medications with him. He does not have ADHD that we know of at this point. We too struggled with he is so young and it is very scary...
    We are trying different medications for him with a wathcful eye of the neurologist, psychiatrist and the pediatrition. If you do need to medicate just ask lots of questions about the medications and find out what possible side effects are and just keep her monitered by doctors. and hope for good results! DDD, that was our main concern, turning Sammy into a zombie. Hope all goes well!
  17. JJJ

    JJJ Active Member

    Well, we medicated Tigger at 5. He had just turned 5 and was in preschool. Looking back, I wish I would have taken him out of preschool instead. Some kids just aren't wired for early school experiences. But if that option doesn't sound feasible to you, I would be open to medication.
  18. gcvmom

    gcvmom Here we go again!

    Both difficult child 1 and difficult child 2 started medications the year before kindergarten. difficult child 1 was 5 yrs 10 months old and difficult child 2 was 5 years 5 months old. Had I known this was an option when difficult child 1 was 4, I would have done it. It made a HUGE difference for him both socially and academically. For difficult child 2, whose problems are different, it did not help to the degree it did with my other child -- but that's because he wasn't on the right medications (we now know).

    I'd certainly get a complete evaluation done FIRST by a qualified pediatrician psychiatrist and/or pediatrician neuropsychologist and go from there.
  19. totoro

    totoro Mom? What's a GFG?

    K started medications at 5 1/2 after 6 months of serious ongoing evaluations and us *knowing* something was going on since she was 2.5. We did not medicate any of her *ADHD* signs though.
    I don't know, if K was diagnosis'd with some sort of behaviour disorder, probably not. If therapy had shown a huge improvement definately not.
    I would hold off until after a thorough evaluation and lots of behaviour mods and therapy.

    Neuro-Pshych evaluation and an Occupational Therapist (OT) evaluation would be my first choices.
  20. 1234567

    1234567 Guest

    To answer some questions:

    She walked at 8 months. Ran at 8.5 and hasn't slowed down since.

    She is extraordinarily verbal and communicative. She plays well with her peers, but tends to like kids a few years older than she is. 5-6 is her preferred range of friends. The older kids play with her and enjoy her. She is inpatient with her friends her age, especially if they are not very verbal or phsyically active. Socially, I think she would do just fine with older kids, and would even say she's advanced in this area.

    She has great eye contact and doesn't really fit the criteria for any kind of Autism Spectrum Disorders (ASD), including Asberger's.

    Sometimes she is a joy, and sometimes she is, for lack of a better word, just pissy. She wakes up in a bad mood and is a grump. She crosses her arms and glares at you and just complains. She doesn't hit, kick, etc., but she does roll her eyes and speak in dramatic tones with heavy sighs.
    Sometimes I feel like I'm talking to a melodramatic 30 year old.

    She wants to "play school" all the time, but whenever I try to give her a lesson, she loses interest quickly. She can read some (mainly sight words) but loses interest after about 3-4 pages in the Dick and Jane books. She did finish the other night standing on her head, though, reading upside down. :faint: We don't push it, and don't have her read unless she asks to.

    She is somewhat weak (perhaps average, but weak compared to her other skills) in her fine motor skills. She can write her name and some letters, but still mainly scribbles when it's time to draw a pictures. Nothing recognizable, although she can do a stick man with some hard work.