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Caring for a child with anorexia nervosa (AN) puts a strain on many parents. At the same time, actively involving the parents in treatment to increase their skills tomanage the disorder is important, as it seems to improve the child's prognosis. Home treatment requires the parents to be particularly involved. The aim of this study was to assess parental burden and caregiving skills and the association of these factors with the child's AN pathology in the course of a multidisciplinary home treatment (HoT). After 4 to 8 weeks of inpatient treatment, 22 adolescent patients with AN received home treatment with intensive involvement of their parents as co-therapists. Caregiving burden and caregiving behavior and the symptom severity of the child's AN were assessed using standardized questionnaires on admission to the hospital, at discharge from the HoT, and 1 year after admission (Eating Disorder Inventory-2 (EDI-II), Beck Depression Inventory-2 (BDI-II), Accommodation and Enabling Scale for Eating Disorders (AESED), Eating Disorders Symptom Impact Scale (EDSIS)). Parental burden was reduced and the parents' ability to manage their child's AN improved after the step-down treatment frominpatient treatment to home treatment and was also associated with lower eating disorder-specific psychopathology of the patients. HoT as a treatment setting does not seem to burden the parents as co-therapists and is associated with an improvement in skills in dealing with the child's AN.Zusammenfassung Die Betreuung eines Kindes, das an Anorexia nervosa (AN) erkrankt ist, stellt für viele Eltern eine hohe Belastung dar. Gleichzeitig ist die aktive Einbindung der Eltern in die Behandlung zur Verbesserung ihrer Fertigkeiten im Umgang mit der Erkrankung wichtig, da es die Prognose des Kindes zu verbessern scheint. Aufsuchende Behandlungsformen wie home treatment fordern besonders eine Beteiligung der Eltern. Das Ziel dieser Untersuchung war, die Belastung und Fertigkeiten der Eltern und den Zusammenhang dieser Faktoren mit der Essstörungspathologie des Kindes im Rahmen einer multidisziplinären home treatment Behandlung (HoT) zu untersuchen. 22 jugendliche Patientinnen mit AN erhielten nach einer 4- bis 8-wöchigen stationären Behandlung ein home treatment mit intensiver Einbeziehung der Eltern als Ko-Therapeuten. Die Belastung und die Fertigkeiten der Eltern und die Ausprägung der Essstörungssymptome wurden bei der stationären Aufnahme, bei Entlassung aus dem HoT und ein Jahr nach Aufnahme mit standardisierten Fragebögen (Essstörungsinventar 2 (EDI-II), Beck-Depressions-Inventar II (BDI-II), Accommodation and Enabling Scale for Eating Disorders (AESED) und Eating Disorders Symptom Impact Scale (EDSIS)) erfasst. Die elterliche Belastung reduzierte sich und die Fertigkeiten der Eltern im Umgang mit der AN ihres Kindes verbesserten sich nach der „Step-Down“-Behandlung von stationärer Therapie und HoT und waren mit einer geringeren Psychopathologie der Kinder assoziiert. HoT als Behandlungssetting scheint die Eltern als Ko-Therapeuten nicht zusätzlich zu belasten und mit einer Verbesserung der Fertigkeiten im Umgang mit der Erkrankung des Kindes assoziiert zu sein.

Attention-Deficit and Hyperactivity Disorder (ADHD) is a common child and adolescent psychiatric disorder with a prevalence rate of 3-7%. Formal genetic studies provided an estimated heritability of 0.6-0.8 and an approximately five-fold elevated risk for ADHD in first-degree relatives. Currently, four genome scans have led to the identification of chromosomal regions potentially relevant in ADHD; especially the evidence for linkage to chromosome 5p13 is convincing. Meta-analyses of a large number of candidate gene studies suggest association with gene variants of the dopaminergic receptors DRD4 and DRD5, the serotonergic receptor HTR1B, and the synaptosomal receptor protein (SNAP-25). Hyperactivity has been investigated particularly in animal models, focusing on knockout- and quantitative trait loci (QTL) designs, with promising results for the dopaminergic system. It is likely that several gene polymorphisms with moderate to small effect sizes contribute to the phenotype ADHD; different combinations of such predisposing variants presumably underlie ADHD in different individuals. Therefore, large samples for molecular genetic studies are mandatory to detect these polymorphisms. Accordingly, several of today's findings have to be regarded as preliminary. The understanding of ADHD's neurobiology may be advanced by new technologies, such as SNP-based genome scans performed with gene chips comprising 10,000-1,000,000 SNPs, as well as using more sophisticated animal model designs.