Has your son had a complete evaluation looking at all areas of development?
These evaluations are not done by a regular doctor, psychologist or psychiatrist.
A neuropsychologist or a developmental pediatrician with a team of professionals (speech pathologist, occupational therapist,psychiatric, social work for example). do these kinds of very in depth evaluations.
Many of us prefer a neuropsychology evaluation which is quite long, can be done over hours on a day or over several days...
They are specially trained to consider how brains work and analyze behavior. They consider developmental and mental health diagnoses.
I agree he sounds like there could be more going on. I've had many students with those issues and they have had a variety of challenges. Sensory Integration Disorder, General developmental delay, Autism, emotional disorders, among them.
Of course, It could just be that a power struggle has developed but that is pretty easy to figure out if there are no other issues because then things like positive rewards for the right behavior can work wonders.
I would suggest that along with the comprehensive evaluation, you get an occupational therapy evaluation. They analyze motor and sensory skills. A disruption in this area often goes with adhd or sometimes problems in this area can look like adhd but really be a sensory integration problem, etc.
My son too had challenges in these areas. He does like to wash hands though. Now he wipes too much, gets worried about smells and germs.....sigh, from one issue to the next.
Is your son willing to play in sand, dirt, water? Does he play well with other children? How does he do in school?
Lack of empathy and guilt happens to some degree in several conditions including attachment disorder as mwm said. But there can be other reasons for example, Kids with autism can have a hard time taking the perspective of others which can come off as a lack of empathy. There are other reasons too. What do you mean by this? Can you give examples? Is it is in relation to the wiping etc or is he never kind to others (when not self serving)? Some kids need to be taught how to notice and read non verbal expressions and understand how others feel.
Your son is quite young and if there are additional issues (or alternate issues) to the adhd, that is really quite hopeful because there are non typical parenting methods and therapies that can really help.
by the way, my son used to wipe his nose on anything he walked by or sat near. He is 16 and it has only been a few years that he doesn't wipe on me! So nice he finally doesn't do that. Now if we could consistently cover mouths during sneezes our coughs!
Welcome. Glad you found us.