Thanks for the replies.
Right now he's in 4th grade at a public school. The only accommodation is accelerated math (6th grade). He doesn't like school at all, though it's hard to sort out exactly what he doesn't like, since the answer is usually "everything". I imagine a gifted school would be a better fit, but there isn't one where we live. We don't really know what other sort of accommodations we should ask for.
We're going to have his vision tested. He did vision therapy when he was younger and it seemed to resolve those issues.
ADD has been suggested, but it doesn't seem conclusive at all so we're not sure how to pursue that/get more insight
-Elise