Grandmaternal Diethylstilbestrol and Attention-Deficit/Hyperactivity Disorder in Children —Reply

In Reply We appreciate the interest that Drs Ryan and Smith and Dr Costas have expressed in our article. Drs Ryan and Smith raise the issue of exposure misclassification and the potential problem of overreporting of grandmaternal diethylstilbestrol (DES) exposure by mothers whose children have attention-deficit/hyperactivity disorder (ADHD). First, we were not clear in the article, but the κ of 0.74 for nurse and grandmother reporting was specific for DES. We also found that the DES-specific κ value did not vary by ADHD status. Concern for biased recall does need to be considered, and our results should indeed be interpreted cautiously, while hopefully spurring more work in this are a. That said, some aspects of our study differ from the military study Drs Ryan and Smith reference. When the nurses reported their mothers’ DES exposure (1993), there had been no human studies of any third-generation effects and possibly only 1 mouse study of tumors. Thus, the level of attention to potential anthrax effects on those directly exposed was not there for third-generation DES effects in 1993. In addition, the nurses were not queried about ADHD in their children until, at earliest, 12 years after the question about their mothers’ DES exposure (2005). So the possibility of primi ng the nurse to think about a possible DES-ADHD association by asking about exposure and outcome at the same time was avoided. Additionally, the specificity of elevated effects in the first trimester would...
Source: JAMA Pediatrics - Category: Pediatrics Source Type: research