FWIW (not very much), of my 3 kids, my least academically-gifted kid (middle of the pack in his 2-years-ahead gifted classes, does not independently do any academic type stuff) has the most and strongest OEs (only diagnosis is anxiety), and my most academically-gifted kid (PG, hobbies are all impressively nerdy) is the most easy-going and chill.
If I were you and I had a highly-sensitive kid who really seemed to like academic challenges at school, I wouldn't try medication until I saw how the new school panned out. My moderately-gifted kid is doing a lot better this year, his first year of middle school, I think because he has a lot more independence (he likes to do things for himself!). He has a 504, which helps his teachers have a more sympathetic perspective on his behavior. Anyway, I just think highly-sensitive kids are greatly affected by their environments (of course they are!), so you might see a big change next year.
