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It is possible that his medication is not working for him as well as it should. Ritalin LA should last at least 8 hours and it sounds like it is wearing off much sooner. If he has been on the same medication for several years this is really possible.
I also wondered when you said that, “the noise of everyone talking makes his head want to explode.” if he also might have SPD or sensory processing disorder. It is somewhat common for kids with adhd. Are there other things that bother him like bright lights, textures,
tastes, noises, etc? This is something that an OT can diagnose and treat when you get back to the states. More on that here.
And, I do agree with the others. You do not punish him for something that he cannot control. You do practice, practice, practice things at home that he can then carry over to school.