Give it time. Medication is not the one size fits all that parents so desperately want it to be.

You also may consider looking for someone who specializes in cognitive behavioral therapy. Worked wonders for Thing2 when he was younger.

ADHD medication typically helps mostly with focus, so if he's able to focus enough to get his work done, then it is likely that common ADHD medications will not help him.

My SS takes ADHD medication to help him focus at school and it has not stopped his meltdowns when he doesn't get his way.

Sounds like she thinks this is purely a behavioural problem. SS here used to be on Ritalin. It didn't help and he was on it for a few years. DH stopped giving it to him and he wasnt any worse so we just worked on the behavioural side and him learning to handle his anger. SS was never diagnosed with ADD, his diagnosis was a bit sketchy, PDD NOS. Then they just said he was high functioning auti. A lot of the time I don't think they
really know.

Has anyone (including the school!) done full psych testing on this kid? That would be the logical first step to me. Sure, there's still subjectivity, but it's a bit more structured than just handing the kid some coping strategies.

I'll be honest, my bioDD is nearly 12 and struggling with her behavior at school this year. There was an incident at the beginning of the year that the school handled poorly and DD is really struggling to get passed. And instead of acknowledging how poorly they handled the issue, the school is pointing at DD as the problem.

I've had DD psych tested *several* times. She's highly gifted and struggles with anxiety, and has since she was a pre-schooler. She doesn't throw chairs (anymore), but she's been accused of "menacing" people by looking at them creepily (I've seen what they're talking about, it just doesn't bother me. She's weird.), and being "disrespectful" because she questions EVERYTHING and not always in the "right" way because she's not quite 12. Frankly, she expects to be treated more like an adult rather than a child (which is fully my fault), and they don't know what to do with that.

All that to say that if he's misbehaving at school but not at home, there may be something else going on that's causing him to act out. It's not necessarily a bad thing that the therapist wants to take a minute to figure it all out. Don't get me wrong, that doesn't solve your problem, but it might be a better approach than it seems.

No conscientious therapist will prescribe any meds to a preteen at the very first appointment. She will do a full evaluation before meds are even discussed.

I would suggest you do some research on toxic stress for kids and it's effects on their developing brains. Just because he can control his behavior at home, doesn't necessarily mean he is simply chosing to throw tantrums at school, his mom's or wherever. It's not likely an attention disorder, but a stress disorder. If those environments are stressful for him, or if he feels on edge, it can have a major effect on his reasoning and decision making abilities in those environments. If this is something that has been going on for years, with no changes, it seems that it is beyond just being a choice for him. As I have said before, your SS and my SS sound identical in their behaivors in various environments. My SS has a stress disorder diagnosis. I at first thought it was a load of bull, but after hours of research and just witnessing his behvior amd reactions to things over the years, I wholeheartedly agree that chemically, his brain is off when it comes to reactions to stressful situations/environments.

This link has some good information about maltreatment and toxic stress' effect on the brain.
https://www.childwelfare.gov/pubPDFs/brain_development.pdf

You have a good therapist here if she's not jumping to give him medication. You've stated that he can and does behave in one place and not another? That is a big deal. This is behavior and giving him a pill wont fix it. He has to learn how to behave in all locations and those dealing with him have to learn how to make it better.

For instance SO's son is a "normal" child in our home. Yeah we've dealt with crap but he knows our rules. When he's at mom's he acts up. Is that his fault? Yes technically but lets also consider her role as the parent. She is failing to make him behave where evidence show's he is clearly able to.

Its the same way with school. Yes it's hard but the child can listen under your care. There is something about school that isn't working and that needs to change. Putting him on medication when he doesn't need it can be a HUGE problem.

If you want to help the school your best approach is to ensure you are supporting them. That his behavior has consequences at home and that you are working with them to help him.

A good book for this is "The Collapse of Parenting." It actually looks at the over use of medication for children. That YES ADHD is real and should get treatment BUT there are times where simple parenting changes can help.

Please don't think I'm saying your doing anything wrong because I don't know what's going on but if the problem is at school then that's what it is. It's not a neurological disorder.

If the child is choosing to act out in a specific environment then it might be a good idea to meet with the school and negotiate the rules.

I worked at a children's psych hospital that was very structured-if a situation escalated to a certain point then certain things would happen. The children always knew what would happen if they did ABC and if that didn't work then the next time ABC happened a more strict consequence would be care d out. For example they earned points each day, if they earned above a certain number they got special rewards if they earned below they didn't. If they acted pout because they didn't earn the points they wanted they were sent to a comfort room and when they were calm someone would plan out what went wrong and what they need to do better tomorrow. Of course if they were unsafe to themselves or others they were removed from the unit altogether. We saw some kids with some pretty outrageous behavior but over time with consistency and predictability, ry all got with the program eventually.

If the school is having the problem, I would be curious to know what would happen of they were to adopt a predictable structured set of rewards and consequences and stick to their guns. So when he chooses the behavior he chooses the consequence.

Is SS seeing a psychiatrist? Because if he isn't I would recommend that you take him to one. Dismissing medication for ADHD becuase he is doing well at school does not take into account that he is having aggressive outbursts which could be violent. Sounds like he needs an anti-psychotic more than medication to focus.

He needs to have a complete physical and neurological work up to see if there is any underlying pathology for his behavior - this is something a psychiatrist can look at rather than a behavioral therapist. There IS a problem with your SS's behaviour and your are trying to help him. If this person treating him is not a psychiatrist move on to one. If this person IS a psychiatrist, find a different one: bring home A & B's mean medication will do nothing for him? That's my cue to dump this person. This isnt limited to a school environment. He has had an outburst at church. There is a problem and I really doubt the person you are seeing is the person to solve it. Hopefully it IS behavioral but first rule out any underlying pathology.

I would still look into if he's got Tourette’s, they can be over the top emotional about stuff.

My BS has it and pre-teen years were awful. He would have total meltdowns like you are saying, even going to far as to start hitting himself. DH and I have learned over the years how to handle him, and he still has outbursts on occasion, but he's gotten much better control over himself. His pediatric neurologist advised us against medications since they have far worse side effects than the Tourette’s.