The first question is, what caused the outburst, seeing the doctor or the week off from the meds? That give you an idea of what he is thinking.
As far as his sister goes, maybe you can send her to a friends house for the first week and if your son stays calm, then have her come home.
Otherwise, I do not know what to tell you. Maybe ADHD medication is not what he needs but something for the anxiety.
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Louis J Bouchard
Rochester Minnesota
"Only when all those who surround you are different, do you truly belong."
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Fred Tate Little Man Tate