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Now it's starting to happen at school. This is really what is concerning. And what is strange is that it's frequently happening during activities he likes (art class or reading time or during lunch).

Do you have the opportunity to spend time with him at school? I try to eat lunch at school with DD6 on a regular basis. That would allow you to be able to see first hand some of what is going on.

I liked the story I'd heard once of a woman with an older child who was having behavioral issues at school. She went to every class with him and sat at the back of the room. The problems went away shortly after that.