Our DS (now 7) was pretty angry, impulsive, etc around that age. He spent a lot of time doing his own thing and resisting doing anything anyone else wanted, or following a schedule of any kind. He would be unable to keep himself from pushing buttons he was explicitly and nicely told not to. A very trying time. (We found The Difficult Child Workbook helpful, or at least it made us feel like we had a plan). For those years the best thing was focusing on anything positive he did, and trying to be understanding about all the rest. He mostly feels close to us and I didn't always think he would.
He has slowly improved over the last few years so that now much of the time no one would notice he's pretty different, more quirky. Teachers see him as anxious or perfectionist or having this or that minor behavioral thing, as exhausting maybe, but no one has come to us and said he needs evaluation for ASD. We have had comments on ADHD but that is usually adjustment and he figures out the routine and what to keep track of given a little extra time (ie at the beginning of the year most kids can organize their desk and know where things are after say the first 2 weeks, and DS takes 5 or 6 weeks of daily help from the teacher to get it down, but then he does).
Now we get more comments about the giftedness, teachers notice a child who remembers facts well and has things to add to the classroom discussion. Socially he's a mess but teachers don't care because he clearly tries hard and he's good at apologizing once his attention is drawn to a problem. Teachers also don't seem to listen too much to the actual content of the dialogue so if he seems to be chatting to other kids they assume he has no social issues with them.
For him being ill or tired or hungry are things that make him swing over the line that separates functional from not. It's just not much of a trip from one side of the line to the other. (He is tired right now -- yelling and throwing pencils away from his homework as I type, but it's Thursday night so to be expected for him).
So long term for us taking those 3 things very seriously has helped him maintain a "normal" child experience. Other kids maybe you can play catch up and feed them a cookie and have them ready to go out to some after school activity when they come home and shed a few tears about something that happened at school, but not DS. I just don't send him to school if he wakes up and seems like he's having an ASD/ADHD sort of morning, because I know that he's more prone to meltdowns on those days. I don't send him to school Monday am if he doesn't seem recovered yet from the previous week. We limit after school activities. We only have playdates on Sundays and Mondays when he's the best rested.
His schools have never complained about attendance, I think they can see what happens if I send him too tired, he has a meltdown and that's the last thing they want in class.
So it can be a struggle, but he likes school and goes all day and that makes us parents very relieved as we weren't sure that was a given when he was 4 or 5 or even 6.
He used to have to change all his worksheets mentally into whatever his interest was. He would pretend it was adding dinosaurs. It worked mostly. Now he finally just this year seems to have moved beyond that and can actually just do it without the rearrangement of it into his personal safety zone. That seemed to happen right around the time he turned 7.
I see school getting easier for him because: in a few years they will finally move to having their own desks and he struggles with the interpersonal issues created by rubbing elbows with random kids you didn't choose to sit next to at a claustrophobic tiny work table; there will be a little more academic content to focus on; there will be less emphasis on blurry group cut and paste projects, less get-to-know-you group activities, etc.
We did OT for over a year, I saw no difference. In fact the extra focus on fine motor skills seemed to make him hate writing even more. Maybe it just wasn't the right OT for him.
