We've tried every possible ADHD strategy and behavior mod intervention. They are certainly helpful, but not enough to prevent significant difficulties at schools. I personally do not think they use of ADHD interventions/strategies alone are very realistic except with mild ADHD. I think in my son's case, the probable ADHD is not severe, but it's certainly more than a mild case. My son does not have severe hyperactivity, but he is in constant motion, and most of all, he does have pretty severe inattention/lack of focus. It seems to be getting worse, in fact, as the demands of school increase. I think we are probably at the point of trying medication, so we will be asking about that. I don't want to jump into that if there could be something else going on, however I no longer believe it's just a matter of being underchallenged. DS is affected in most aspects of life to some degree, but it seems that school work is affected even more significantly now. We went ahead and made the appt with the developmental/behavioral pediatrician for next week.