Hi Jen,
It is so tough to see your child struggle with frustrations!
It is hard to determine the root cause of his outbursts from a few short paragraphs so I'll share various scenarios regarding this kind of behavior and you can use the info to "peel back the onion" while working with your doctor and school.
Some kids with ADHD and executive functioning challenges have difficulty setting reasonable goals, dealing with frustration, understanding when "good enough" is better than perfect. They can be taught strategies to help handle these situations and set up realistic expectations. That said, their innate drive for perfectionism may still come into play.
One side effect of stimulant medication for some kids is emotional difficulty. While this most often happens as the medication is wearing off, for some kids the medication increases emotional sensitivity. Perhaps you can explore a different medication (as well as dose) - for instance he is on Concerta, switch to Adderal.
As your Dr suggested, perhaps there is something other than ADHD going on. Are you sure the diagnosis is correct and or complete? Things like anxiety, OCD, Bi-Polar often look like ADHD or often present along side ADHD. Could this be a possibility? What about undetected learning disabilities? Sometimes very bright kids mask LD. But, as they are working so hard to overcome, they can get frustrated and overwhelmed. Sometimes they benefit from a structured, explicit teaching approach to help them cope.
How is his sleep, diet, exercise?
I'm glad to hear that you are working with a cognitive specialist and developmental pediatrician. He or she may be able to help you understand the triggers and teach your son to recognize when outbursts are coming on and find strategies to deal with them.
I think you are on the right track. I hope that you get answers and relief soon.
