.... so, how can a teacher know what the right fit is? For e.g., running around and causing disruption in a classroom where the kid is expected to sit at his desk (in 4th grade, not K). What does the teacher do under those circumstances? My son was in such a situation and he just could not focus or concentrate when a boy used to noisily run around in circles and make funny noises, crack jokes etc. - especially during test taking. My son was not the only one in the class that got affected by that.
It's not OK for a kid to be disrupting the class, even if he can't seem to help himself.
Each year, I talk to DS's teachers to let them know what strategies have worked. Unfortunately, they always need to first work through their favorite one-size-fits-all strategy. Usually some sort of positive reinforcement check-off thing. I'll let them know that these generally fail, but it's their classroom, and they always want to try it first.
The better teachers - and he had a good one this year - pretty quickly see that the strategy has no impact. Then we talk about what to do. Here are some things that have worked. DS is not "all better." But he had a great year of growth and improvement. I'd say we had 3 types of strategies - prevention, mitigation and rehabilitation, if you will.
Prevention. DS struggles with being crowded, overwhelmed with noise/exciting behavior by another child, and impatient (which is a better way to say "bored" I think). For crowding and noise, DS - and others in the class who need it - have an escape hatch. The ability to remove to a quiet corner or a bench outside the classroom instead of working at a group table. To NOT sit on the carpet for the class meeting. He is also allowed to request to switch to a different small group, provided he can articulate a respectful reason ("Her voice is very high and loud and it hurts my ear" as opposed to "She's stupid and I hate her.") For the impatience - he can finish his work, even in a cursory fashion, and then move on to something he finds more engaging, provided it's at least tangentially related. So when the class had to write poetry, which he found to be awful, once he wrote a crappy 4-line poem, he was permitted to return to writing his novel about WW III. For pair work and seating assignments - he gets paired with other "quick" kids, and specifically NOT paired with kids that tend to spin up - even when those kids are also quick.
Mitigation. There are consequences for failure. But the consequence has to make sense. If he's blurting or disrupting, he is asked to take a break away from the class. Sit at the bench outside the classroom for a few minutes. Take some books back to the library. If he's having trouble on the playground - he is asked to go back in the classroom or into the library or office. He might lose part of recess if a problem was big enough. But not to stay to write punishment sentences, but rather to chat quietly with teacher about what happened, why it was not OK, and what alternatives would have been better. Sometimes, being given a chore can derail an escalating problem - like doing prep work for an upcoming project or sorting crayons or some such thing. This is delicate, because it's critical not to reinforce the behavior. But if the actions weren't within his control, it's not reward OR punishment to provide a re-direct. It's just a necessary means to address the problem and help him manage better in the future.
Rehabilitation. This is possibly the most important thing. Once DS is back on the rails, it helps so much for him to hear respect for his best efforts, and a reminder that he is still a worthwhile human being even though he failed this time. His teacher this year was a genius at this. He still cherishes the note she sent him while he was on the bench in the office: "DS, if you feel calm and ready to learn, you are welcome to return to our classroom. Love, Mrs. Teacher." And she really did welcome him and let him know he was loved. She also worked hard to remind him what he did well - "It was so great when you knew you were having trouble, and asked for a break in the quiet area." I was a tiny bit disappointed that she never did talk to him positively about his huge strength areas in academics, because I think this might have also helped. But that wasn't her style, and I can respect that.
This all requires a lot of effort and sincere care by the teacher, AND a super-humanly calm disposition to boot. I'm deeply grateful that 2 of his 3 teachers so far have been willing and able.
Hope this wasn't TL;DR!
Sue