Where would you go from here?
A real fucking doctor, that's where!
Generally speaking I think most parents of a young child would be very, very unhappy to find out that the medical professional charged with caring for their child was soliciting medical advice from random, unvetted people on Facebook and attempting to outsource their medical decision-making by asking questions wholesale like "Where would you go from here?" Because there's nothing that instills confidence in one's level of knowledge and competence like asking "Where would you go from here?"
I am by no means a psychiatrist, but even from my medical school days I remember that ADHD and tic disorders (such as Tourette syndrome) are often comorbid conditions, and that ADHD medications (particularly stimulants such as Adderall and Ritalin) may exacerbate or expose underlying tic disorders. In any case, when you've already switched between five (!) different drugs (Intuniv, Tenex, clonidine, Ritalin, Adderall) in an attempt to unsuccessfully manage a single condition, that's generally a good sign that you should throw in the towel and refer the patient to a psychiatrist - you know, like a real fucking doctor instead of turning your patient's treatment plan into a fucking crowdsourced Choose Your Own Adventure game. You would think a psychiatric-mental health nurse practitioner (PMHNP) would know better than that, right? Not so fast...
Yep! NP Kaitland Detwiler isn't even a PMHNP, but a FNP. Of course we've seen egregiously terrible questions from PMHNPs as well, but still, it's kind of a bad look to be fiddling with your pediatric patient's mental health, seemingly without any idea what to do next and having to resort to Facebook to solicit medical advice that may or may not be safe or correct. I'm also not sure how working in a level I trauma center or an online DNP with a focus on childhood obesity from Carlow University qualifies a person in any way to be managing pediatric ADHD. I count five physicians board-certified in pediatrics at the Pediatric Associates of Westmoreland...perhaps one of them might be a better resource for medical advice than Facebook?