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We agree that the influence of prescribed medication on the long-term psychological outcomes associated with ADHD is an interesting and important area of research. However, we regret that our study is not best placed to address these issues.

Our study utilised a naturalistic design, identifying children recently diagnosed with ADHD through child and adolescent mental health services and paediatric clinics in the UK. As such, no restrictions or controls were placed on the prescription or continuation of stimulant medication in this group. To adequately test the questions posed by Dr Yang, specifically designed trials are required – well beyond the scope of our article.

Our findings indicated that prescription of medication at follow-up was associated with higher rates of ADHD symptoms, but not with the other psychological outcomes we assessed (including conduct disorder and substance use). Because our study does not provide sufficient data on stimulant use over time and because the majority (90%) were prescribed stimulant medication at some point, we did not expand further on the reasons for these findings, nor can we speculate on why those prescribed medication at follow-up had more ADHD symptoms.

We are therefore grateful to Dr Yang for highlighting this important area for research, but regret that we cannot address these queries using our data.

Edited by Kiriakos Xenitidis and Colin Campbell