It sounds to me like your son may have ODD in addition to ADHD. My son has both, secondary to reactive attachment disorder, acquired from trauma in his birth family. He was long impervious to either rewards or consequences. The only thing that really helped him (not medications, not talk therapy) was neurofeedback, which has slowly rewired his brain, giving him much greater emotional control and ability to tolerate frustration. He still has a ways to go, but things are so much better now that we were able to get him off of the 5 psychiatric medications he came to us with at age 12. I highly recommend it and I also recommend investigating the Institute for Attachment and Child Development for articles that might help you figure out what’s going on with your kid. You don’t mention whether he is adopted or not, but if so, there’s a good chance that his behaviors are related to attachment disorder, and if that’s the case, you need a different approach and a lot more support than you’re likely getting from your existing therapist. My experience has been that most therapists don’t have a clue about RAD. Best of luck and know that you are a good parent!