Thank you for the added information. It helps a lot. I believe I can now be of help with this issue.
First, let me say I can imagine how overwhelming this situation must be for you. We've ruled out autism spectrum and attachment disorders. We're left with severe ADHD. That's both good and bad news.
And this is actually the key to my answer to you that you need to consider and think about. The good part is that those other two possibilities are very difficult lifelong problems. But then, so is ADHD though it often is more manageable as the child ages. That's the good part. The bad part?
You are going to have to be very proactive. Because most schools expect you to medicate the kid and that's it. But you need more, much more. Because your son is exhibiting extremely severe symptoms.
I have had one case that this reminds me of almost exactly. That boy came to my office at 13 as well. You are going to need to be in charge of this and it is going to be time consuming. You have four parts to manage:
1. The school: you need to get an IEP (Individualized Education Plan or Program) created by the school district. They don't want to do this because it's expensive. However, they are mandated to do this. But you will have to force them. And if they can't provide the services your child needs, they have to pay for a private school that can. Expensive. So you have to fight for it.
2. Psychiatrist. Most psychiatrists don't want to stick with a kid this severe because it's work on their part. So you have to keep on them, being friendly, flattering, etc. And also getting them to keep trying different dosages, combinations of meds, etc. But he needs medication. So go back to the psychiatrist.
3. Psychologist. He needs to work with a child psychologist who is expert in ADHD. That means you have to push for a good referral. And check out who the top people are in your area. He needs therapy to help in managing this as he ages.
4. Your son. You need skills to work with him. Support groups are IMPORTANT. Finding them is not so easy so you have to ask the school people if they know of any, look online for your city, ask the psychologist, etc. This is not a step to skip! You need the support. And you need to read and become an expert in ADHD. Russell Barkley (he's a pessimist), XXXXX XXXXXowell (mid-ground), and Thom Hartmann (optimist) are the leading authors.
What can you expect for your child? A lot will be determined by how much effort you can put into this. Remember the case I mentioned above? After we got the steps above in place, I referred them to another psychologist who specializes only in ADHD. One of the two parents had to make this almost a full time job at first and then it eased up. But there's always staying on top of his symptoms and being proactive.
Okay, I've given you a lot here. But you're already experiencing a lot. Why did you have to have this challenge? I don't know. But somewhere within you is the ability to help your son if you take charge of this disorder.
I wish you the very best!
Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX