In Reply Although unmeasured confounders are possible in any observational study, some confounders mentioned by Drs Sibley and Coxe (eg, sleep problems) could be mediators within a potential causal pathway—that is, media use disrupts sleep, which in turn increases ADHD symptoms. We adjusted for 8 plausible confounders, which did not substantively alter association estimates.1
Leventhal AM, Lee SS. Digital Media Use and ADHD Symptoms—Reply. JAMA. 2018;320(24):2599–2600. doi:10.1001/jama.2018.18103
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