I have a 2nd grader and IT DOES MATTER! the in class accom. plus the pull-out just aren't cutting it and she is frustrated with school. She will never act out at school, but we see all the signs at home from her words, to her grinding her teeth at night when she is frustrated, to just saying "School is dumb! Why do I have to go! Babies could do this!" Just stay on top of it, is all I can suggest. If you notice it's not working, advocate, advocate, advocate!