Q. My son is almost seven. I have had behavioral problems with him since he was three years old. At the age of four he was expelled from preschool. I took him to three counselors who after speaking with him told me he was "fine" and "emotionally well-adjusted. In kindergarten, he was physically isolated from the other children in the classroom and at lunch. Now, in 1st grade, he has become violent at home. He has fits that become violent. He tries to hurt me any way he can, punching, kicking, hitting. He has slammed my head in a closet door and tried to push me down stairs. When he is not in a "mood", he is sweet, loving, helpful, cooperative, and kind. He is always apologetic for his behavior and promises that it will never happen again. He has also said that he wants to die during his fits. He is bright academically. After researching several possibilities, the impulsive borderline seemed the closest match. What do you think? Any advice on a plan of action? We have tried Ritalin. It did not help at all. In fact it made him more aggressive.

  A. I would get a medical work up by a good child and adolescent psychiatrist. A child psychopharmacologist would be an ideal place to start, but they are few and far between. While the child may be a borderline, it is way too early to label him as such.

In most cases like the one you describe, serotonergic antidepressants work best. Zoloft (SSRI), Effexor XR (SNRI) and Serzone (synthetic serotonin) are my favorites. Each is distinct from the other with differing properties and advantages. Get a psychiatrists and get the process going correctly.