Here's my perspective: I have an 8-year-old, he has suffered terribly and the whole family has suffered with him from ADHD-related symptoms since he learned to walk and talk. He was DXed at 5 years old by a developmental pediatrician, but has not been medicated for the disease until about a week ago - because trials of medications made the symptoms worse, or produced new symptoms that were more troubling than the ones he naturally manifested. This current trial seems is going well so far, but I'm not confident yet that he's ready for medication. Ask me again in a month.
If Straterra prescribed by a nurse practitioner successfully controls the violence and impulse-control deficit at age 4, then the OP and her son are very lucky. I don't care if it was prescribed by a witch doctor or Santa Claus - the question is, does it work? Is her child better when he is on the meds?
BTW, we did the ECG and it was a total waste of time and money - we saw the exact same healthy heart we'd seen on the third-trimester ultrasound. I think that there are some cases where ECGs are a smart choice before starting ADHD meds - but they are edge cases, where there is no prenatal history and/or a suspected physiological issue in addition to the neurological issue.
Follow Mothering