My little guy, diagonsed at 6 and is now 8 years old, also had outbursts, (from about 3 years old on) we called them "meltdowns" with extreme harmful behaviors, like: throwing himself down on cement, hitting, pushing over furniture, biting (himself and others), removing all his clothes, cursing, threatening, kicking, throwing anything he could pick up; he was just so mad he did not know how to express it. He had a lot of irritability, no patience at all, and was very quick to anger for seemingly small problems.   it was all from the ADHD, and he is no longer having these outbursts, either at home or at school since on the Strattera. 

 The behaviors -- that feeling "out of control" and with the impuslivity of the ADHD, and no learned coping mechanisms can make some of the ADHD behaviors look a lot like oppositional defiant. It seemed like each and every direction we gave him instigated a tantrum or at the very least- on a good day -an argument.  Sometimes he had 6 (pretty violent) outbursts a day. the psychologist thought we were seeing oppositional defiant disorder, and depression (which runs in the family).  I was not convinced of this. 

we were not happy with the first psychologist, we saw for help with behaviors, as he recommended a lot of negative reinforcement - taking away favorite toys, electronic games, TV time, for every thing. this made everything worse and escallated the anger. Plus, pretty soon he had nothing to play with.  We found a different one, by going to the CHADD website, that is much more positive, and worked for us; and worked with us as parents.

We tried Adderal first with him (worked ok at first, but really damped down his appetite, and he is already very thin and small), then Focalin, but he had sleep problems with the Focalin, and was just not himself, he seemed "sad" and did not talk as much.  Better " focus " at first, but still occasional "meltdowns".

So- back to Adderal, but when on it the second time - after a few weeks he had a strange reaction of nearly constant fear (hiding under his desk at school and crying), saying about every 3 or 4 minutes, "I'm scared - there might be monsters around".) This caused the psychologist to say maybe he is scizophrenic- as he thought he might be really seeing monsters.) It was a side effect of the adderal.  He also held onto the hair on top of his head while he slept, and he never did that before the Adderal (and does not do it since the adderal stopped - this caused some  hair thinning before we stopped it, and it grew back). 

Then finally Strattera.   The psychiatrist was reluctant to try Strattera as it does not work in many kids this young, but it worked right away on a small dose.  We get it in liquid from a compounding pharmacy, since he cannot swallow pills, and this makes the dosages easier to titrate.  he was on only 10 mg for about 9 months, then up to 15mg, and is now on 20mg - taken before bed.  He sleeps well, has control of himself, can focus, can sit at school to complete his schoolwork, and can sit in church for almost an hour (quietly- with only a pen and paper for his amusement).  He is able to complete his work on time at school, Reading clicked for him the second half of second grade and he is doing much better with Math too, and is very proud of himself.  He has also learned to "derail" his anger by changing the subject when he becomes angry, or doing something silly; and if he does not - we have learned that he cannot resist "knock'knock" jokes.  When we say knock-knock, he will always ask "who's there" and then any silly thing i say breaks that bad mood and anger.  a good trick, at least for now.  He is a really happy kid, he still has trouble with "transitions from a perferred activity, to a non-preferred activity" sometimes, but when given some advance notice, (in 5 minutes its time for ___) usually handles it OK.

it was a very tough 2+ years with med changes, behavior support and counseling, all took time, but we are on a good track now. I am glad we did not get any additional diagnosises.   My little guy also has Mosaic Down Syndrome, but a normal range IQ. 

I hope you find something that works for you -- as well as Strattera and "knock-knock" jokes work for us! 

Hi SM,  Yes, it is good to hear what others are going through and know we are not alone. Please take advantage of your local CHADD chapter, interact with the other parents, and ask for a referral for a behavioral counselor that other parents really like.  the one we had at Fairview Counseling, Miss Kate, really helped with our little guy, with play therapy.  She also helped up as parents work out what we needed to do to support him during his difficult times, and helped us to be on the "same page" with realistic expectations, and setting limits, and supporting each other.  Difficult days and nights can really take a toll on a marriage.  I found that my EAP (employee assistance program) could make the referral and most of the cost was covered by my health insurance, with me paying a co-pay.  this had two benefits: the referral, of course, and the added benefit of my employer knowing that i was doing all i could to handle things, with the tools they provided.  this, i think was beneficial in their tolerating the occasional calls from school, and leaving early when it was necessary. 

I wish you luck in your efforts for a good diagnosis(s), and treatment.

yaya