Kids with ADHD work very hard to keep it together in environments where it’s expected. Some can do that well and then fall apart in a more loose environment; others can’t totally meet expectations in environments like school, no matter how hard they try.
In your story I noticed a pattern of different behavior in environments that are very structured (school and doctor visit), versus environments that are not that structured, like home and the grocery store. That tells me the more structure you can add to your home life, the better.
I also immediately thought of occupational therapy. In OT, they can work on the hyperactivity, as well as the emotional awareness and regulation skills he’s deficient in.
The bottom line is that his brain is going very fast. He may not be able to slow down to learn lagging skills and coping mechanisms without ADHD medication. There’s a saying in the ADHD professionals community: “Pills don’t teach skills.” So medication alone is never enough, but sometimes it’s needed to be effective with all the other interventions, and to help a child meet expectations.
ADDitude Community Moderator, Author & Mentor on Parenting ADHD, Mom to teen w/ ADHD, LDs, and autism