Hi Jmcbk, I can’t give medical advice, but if I were in your shoes, I’d do lots of reading about ADHD meds and potential side effects, specifically on developing brains. If you’re in a position to do so, you may want to visit one or more health care provider who are open to non-pharmaceutical perspectives on ADHD, or are at least willing to have a fruitful conversation about the risks vs. potential benefits so that your decision is as informed as it can be. You know him best, I’m sure, so if you don’t think the labels he’s been given are interfering with anything important, you may just choose to ignore them altogether and just let him be him. If his reported attention challenges are really interfering with learning or other important things, maybe a different evaluation or approach would help to make sure a problem with his learning environment not meshing with his learning style isn’t really the problem, rather than an attention issue on his part. Other things I’d look into, or try to find a provider with knowledge in, would be the effect of diet on attention and behavior. Some small dietary tweaks work wonders for some people. Regarding education, one child’s ‘least restrictive environment’ is sometimes another child’s greatest obstacle. Whether a child will do better in a smaller class or in a mainstreamed class depends a lot on the child, the teachers, and as you’re aware, the other students. Trust your gut and keep paying attention to the communication you get from your son. If he starts in a small class this fall and seems to be doing okay, keep going from there. But if you see problems, you may want to keep pushing for other options. Good luck to you and your son.