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[The author responds:]
In my study, I did distinguish between children whose parents were divorced and those whose parents remained married by assessing whether a divorce occurred at any point between 1994 and 2000, and I defined methylphenidate use as any methylphenidate use after the initial interview in my sample of children (who were aged 2–7 years, living in a household with their 2 biological parents and not using methylphenidate at the time of the initial interview).1 In the majority of cases, there was a clear pattern of methylphenidate use after the divorce occurred. However, because interviews for the National Longitudinal Survey of Children and Youth are conducted every 2 years, there are several instances in which divorce and the first instance of methylphenidate use occurred in the interval between observations, making it impossible to say which came first.
Having said that, divorce is a process and child mental health problems may surface in response to the heightened tensions and emotional disengagement that characterize disintegrating marital relationships that end in divorce. We need to study family dynamics as they unfold over time rather than a child's social address (household with married parents versus single- parent household) at a given point in time. My article shows that it is not simply residing in a single-parent household but, rather, experiencing the divorce of one's parents that predicts methylphenidate use. Determining why this association exists is an important area for future research.
An unanswered question is whether having children with attention-deficit hyperactivity disorder causes parents to divorce. Although I originally excluded children who were taking methylphenidate in 1994, I conducted subsequent analyses to evaluate whether these children were at greater risk for having their parents divorce. The results indicate they were not, a finding that corresponds with previous research.2,3
Footnotes
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Competing interests: None declared.