Wow! This is a very trying time for you.  It sounds like you work, help manage the home and finances, plus keep a five year old and twin sisters clean, feed and loved.  That is three two plates full and just one.

What really sticks out to me if what he told his teacher.  Of course, you love him more than words can say; however, he is needing some individual time with you and some praise as well when you see him doing something that you can praise.  Suggestion:  If he washed his hands before eating.  You might say to him.  "Good Job with those clean hands."  My suggestion is to find the time to give him. Could you find a family member or babysitter to sit with the twins the same day and time every week and  spend it with him.  No cell phone, No T.V. Just him and you. You playing together. Something he likes to do.  You also might need some time for yourself.  

I love to watch SuperNanny even tho I am 73 because she has so many good ideas for families that are having very difficult times. You and your husband, if you can't afford family counseling,might make it a necessity to watch SuperNanny.  Check out and see if she has a website for you to look out.  I wish you well, I feel your frustration.

If you're noticing a lot of behaviors that all of a sudden started happening around the same time, it may be helpful to focus more on what might have changed around the same time as the behaviors started to occur.

On the other hand, maybe you experienced a more gradual change, starting with certain behaviors? If that's the case, it may be helpful to trace that chain of behaviors back to the initial behaviors that occurred, and think about what might have started those behaviors. For example, it's possible that the day care started introducing learning activities as he grew older, that those activities frustrated him, that that frustration made school less desirable, which made morning routines more difficult because they inevitably led to him having to go to school, and so on.

It would also be helpful if you found someone with experience working with behavioral issues to help you learn more about why things are happening, and what you might be able to do about it. The behaviors you're describing don't necessarily suggest a particular cause (e.g., such as bipolar disorder), but could be caused by a number of things. Getting to the bottom of the cause(s) is the necessary first step, which can be hard to do without someone with a lot of training/experience dealing with that sort of thing.

If there isn't a counselor at school, you may want to visit your city/county's mental health center and make an appointment, or visit a private counselor if you'd prefer that.

One great piece of news is that you are actively trying to help your son, which is a huge part of the process. Unfortunately, responses on the internet are going to be limited because we just don't have all of the information and can't give you very specific suggestions on what to do without more information. Keep being persistent, though - it will pay off!