Reply

We thank those who have written commentaries on our paper.^{Reference O’Nions, El Baou, John, Lewer, Mandy and McKechnie1}

The aim of our study was to investigate life expectancy and years of life lost for adults diagnosed with attention-deficit hyperactivity disorder (ADHD) in the UK because average age at death in mortality studies of neurodivergent people has been widely misunderstood, leading to misleading conclusions and alarm.^{Reference Hand, Nikahd, Wolf, Hyer, Longo and Gilmore2,Reference O’Nions, Lewer, Petersen, Brown, Buckman and Charlton3}

Our aim was to provide an estimate of the overall difference in life expectancy experienced by people with diagnosed ADHD rather than to explore underlying mechanisms. We agree with the points raised that there are important mechanisms that could be examined in future work and that sex differences are important to explore further.

In response to Dr Ophir’s arguments pertaining to ADHD medication,^{Reference Ophir4} in our view, the best available evidence derived from registry data from Sweden for 148 578 individuals with ADHD aged 6–64 years, of whom 56.7% initiated ADHD medication, suggests that ADHD medication is associated with reduced all-cause mortality.^{Reference Li, Zhu, Zhang, Kuja-Halkola, D’Onofrio and Brikell5}