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[quote=Anonymous]The explosive outbursts described my son at that age. He was asked to leave his preschool at exactly that age because he was attacking other children. I witnessed this myself one time. He wasn't provoked that I saw. It was frightening behavior and I wondered for many years If he was schizophrenic or had bipolar disorder, etc. 
He was violent and unpredictable at home. He would be amazingly sweet and empathetic one moment and then throwing furniture through the wall the next.

He was eventually diagnosed with Autism, ADHD and extreme anxiety. Physically,  he had alot of ear infections,  was pale and overtired often, eventually went from fullt potty trained to having constant accidents. He had lower body hypermobility,  very loose and bendy lower limbs and hips.he sleeps in strange positions including on his back with one leg crossed over the other leg which is bent upright. He is sensitive to sounds, tastes,  textures, smells and lights.

He was put on methylphenidate 54 mg and zoloft 200 mg.

Fast forward 10 years- I just started a thread called dialing back zoloft. He has had a complete turn around, does well in school, has many friends,  is involved with sports, etc.

Looking back here is what we did and what we should have done. (We also were with Potomac Pediatrics and neuropsych through childrens)

1. He was taken out of preschool and put in a smaller, mixed age group preschool. This put a stop to the physical outbursts immediately- at least at school.  The all 4 year olds, 20 + kids was overwhelming to him.
2. We learned to identify what set him off at home and tried our best to avoid them but also learned to understand that he absolutely did not understand that when someone did something that bothered him (something unexpected) they were not doing it on purpose. This was a huge piece of the puzzle. So, for example  , if he was given toast cut in squares when he was expecting triangles- the second we saw his disappointment we would say "oh no! I'm so silly. You said you wanted triangles but I cut squares!! I really made a mistake! I am so sorry. Indidnt meant to do that!" And then remove the toast and redo. At that age, he probably had a language deficit that went undiagnosed and he had little methods to express his feelings other than throwing the toast at the wall and screaming.  We tried to voice his thoughts for him "this was not what I was expecting " and gave him alot of control to ease his anxiety. 
It was my sole goal to make him feel he had more control when things went wrong.

This took years,  OP. I'm not going to sugar coat it.

By 3rd grade he started experiencing alor of anxiety at school. This is the age other kids start being mean to each other and jockeying for social position.

By lucky, he was put into a class with quieter more studious kids which cut down on the anxiety tremendously.  Somewhere in here we also started the adhd medicine and zoloft.

Things were pretty smooth sailing after that. At least for us the parents and teachers.  But we also have noticed that he is overly placid and non reactive. No highs or lows.

At the same time,  someone pointed out that his hypermobility was having a huge negative effect on his athleticism.  I had looked into hypermobility years before but it didn't look like much could be done about it. I went back again recently and discovered an article with a new hypothesis about a relationship between hypermobility and an inability to metabolize folic acid. I took him for testing and during the lab work noticed his iron saturation levels was extremely low. He doesn't exactly have anemia according to his cbc. But looking back- his last cbc  5 years ago showed his bloodwork was a tenth of a point away from flagging for anemia.

I now wonder if he has suffered from low iron and borderline anemia for most of his life. I highly,  strongly recommend that you find a pediatrician who is not a large practice and who will actually look at his bloodwork results not just skim for flags from the lab. 
Ask for every test imaginable. Have them repeated every year or more often if any show his is constantly high or constantly low. Go to a genetic testing counselor.

We did not find a therapist who was able to work with him. Talk type therapy doesn't work very well with boys. However, there was a program he was patt of that was offered by the elementary school that was hugely helpful.  I wish I could remember the name of it. It taught them how to identify their feelings and come up with strategies to manage.

Don't be afraid to use medication but keep looking for other physical causes.

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