This was my VERY first thought. When I would hear about my nephews acting up in school (or not knowing when to tell people they had to use the bathroom), it was ADHD. They also were asthmatic and had to be put on ventilators to help them breathe better. It's wild though because they're so easy breezy and quite the gentlemen as adults, but were loud and running wild as kids. They took meds though from a very young age. My brother and his wife were traditionally old school parents with the spankings but realized that just wasn't working.

I'd suggest seeing if they test. I did feel sad hearing that my nephews just felt groggy all the time when they didn't take meds, but it stopped the acting up in school immediately. At home, they were around their own belongings and more comfortable and knew their parents didn't play that. With that said, at home, they're also not sitting stock still behind a desk and chair for hours on end. Different environment.

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