ADHD medication can work wonders, but supplementing that with behavior therapies is recommended.
I just gained custody of my 12-year-old nephew. He was taking Ritalin for many years and now takes Dexedrine. He has had a tough life with his Mom and stepfather. Now that he's been in our home for a while, we are seeing a big change in him. We taught him some anger-coping strategies, and now he only gets angry when things don't go his way. He's doing better in school, even though he still has social interaction problems. The Dexedrine dose was decreased and he's off of the sleeping pills. We attend a Trauma Treatment program. What can we do besides giving him Dexedrine? Without it, he goes berserk, but I think it is learned behavior.
It sounds like you are already doing quite a bit outside the medication. Although your nephew's medication can do wonders, supplementing them with behavior therapies can also help. Look at Harvey C. Parker's book, Problem Solver Guide for Students with ADHD and the website (http://www.chadd.org) for Children and Adults with Attention Deficit Disorders (CHADD) for more ideas that specifically target the behaviors you're noting.