I had Mike at 5 star create a custom down load for me - he's the one that told me the thing skips fourth when downshifting by design. It helped for programming issues. But it still needed to be able to breath to develop enough HP/torque to pull the load in fourth. It is really a pleasure to cruise up a grade in 5th-lock up, or 4th that previously caused it to go straight to third, but with out the SCT download, my other mods still probably wouldn't have completely corrected this. In 2011, Ford went to the six speed trans for the F series (6R140) and Ive heard its a big improvement.
On milage, I get a little better than pre-mods (almost 2 mpg) when driving conservatively which is to be expected anytime you allow your engine to develop power with less effort, and a lot worse when I tap into the previously unavailable power. Its a choice I like to have rather than being stuck with Ford's dictates, but that said, it appears to be an expensive option, as I tend to use what's available. For me its about performance and not economy - just my preference. Like the 640 hp small block chevy in my shop....