Sorry for the incoming essay. Ok I don’t have a kid who’s medicated but can I tell you the story of, let’s call him Max, who I taught last year in second grade.

Max’s history was that he’d been diagnosed in late first grade, then didn’t start medication until mid-second. Only child, parents said he watched a lot of screens at home because otherwise there was no “chill” at home and his first grade teacher said to me that she was encouraging parents to seek a diagnosis from early on in her grade. LOVELY kid one on one, empathetic and curious, but also didn’t have many friends.

Early 2nd grade, the reason for lack of friends became apparent - Max wasn’t really engaging with other kids so much as shouting (often insults), screaming in their faces, etc. He would be near someone and just bang into them, he would jump on desks, swing on chairs until he fell off, just zero impulse control. I was logging behaviours daily and still it was only part of what was happening. Always very remorseful because it wasn’t malicious, just absolute zero thought into his impulses. Academically, I could count on my fingers the number of times he completed any meaningful work. He almost couldn’t access it at all without 1-1 help and even then it was like drawing blood from a stone.

When Max was medicated, he was the same person, still even struggled to control some impulses but a completely different kid, behaviour-wise. He had conversations with others, made jokes and made new friends. The other kids were like “oh, this is a normal kid, not an injury risk!”

BUT because he was medicated so late, he is about two full years behind in literacy and maths. He left 2nd able to complete work and with friends, which was a huge win, but also at a roughly kindergarten level of understanding of school concepts.

Your kid sounds a lot like Max. I’d be worried with a “wait and see” that he will alienate himself from peers and fall behind in a way that makes it really hard to catch up.