you take a deep breath and hang in. You can't change everything at once.
I know it's easier to say that AFTER you've already lived through it, but it's true. He is only 4. You can certainly start a behavior plan and change the way you deal with him. Then once you figure out if meds are the way to go this stuff will already be in place. Ogrmas marbel system on this board is a great disciplinary tool. One thing you have to learn as the parent of a 4 year old, is not to engage them It's SO hard to do. We want to be right there in their face telling them the approriate way to behave and explaining everything. Stop doing that. Give him clear and BRIEF sets of rules and conseuqneces and that's it. For example, we do not hit EVER. You hit becasue your angry you go to your room and loss of privelege. When he does it, NO discussion, just put him in his room, even if you drage him there, just don't talk. When he is in a situation that would normally result in hitting and he doesnt do it, praise him like he just became president. The are all methods that can be started without meds and then will become easier for him to do with the right meds.
My DS is 4 and has shown strong signs of ADHD for a long time now (1yr+). He was in HeadStart during the spring and it was a nightmare. He just couldn't sit still, follow directions, or keep his hands off of things. We had experienced these things at home, too. I had hoped that the structure of school would help him, but it only seemed to make things worse. We had talked to our doctor but agreed to wait it out for a bit. Now I am kicking myself. He started Pre-K about two weeks ago and it is quickly turning into a disaster. He, again, doesn't sit still for any length of time, gets into everything, will not listen to his teachers, and now is yelling/screaming. I am at my wits end. I feel like I have failed him in some way. We have tried modifying his diet, sticking to a routine, being very consistent, but absolutely nothing works. I have resigned myself to putting him on meds. What I am worried about is what is to be done with him in the meantime. I have to wait for an appointment, then wait some more for whatever meds they give him to begin to work. We'll be waiting even longer if the dosage needs to be tweaked (I've researched so I know this a very real possibility). So what do I do with him, and myself, in the meantime?
I am so sorry, but I can totally empathize with you. My son is 4 also, and acts exactly like yours. We have an appt. on Sept. 12 and it can't come soon enough.
My best advice is to take it one day at a time, one hour at a time. It's tough but hang in there and soon enough he'll be on the road to better behavior.