This is only my experience and my thoughts, so take it for just that. No science to it. Behavioral management might work alone if you can so tightly control his world and his interactions as to make each situation work exactly as you have taught. The society expects more and more from a child and rightly so, this is our civilization and our standards. The disability of my child became more evident as the expectations increased. Having helped my difficult child over a behavioral hurdle was great but a new issue would evolve also. In my son's case, there would have been no behavioral management without the medications. He wasn't any day at the beach with medications but he was able to marginally function. I don't have a lot of personal faith in a kid like mine managing without the use of tools and supports. Medication is one of them.