BACKGROUND:Body mass index (BMI) at hospital admission in patients with anorexia nervosa (AN) represents a prognostic marker for mortality, chronicity and future body weight. The current study focused on the associations between BMI standard deviation score (BMI-SDS) at admission and reasons for seeking inpatient treatment. Further interest was given to the relationship between premorbid weight and weight at admission, as well as the effect of both weight at referral and reasons for admission on treatment outcome.METHODS:Data ascertained in the German Register of Children and Adolescents with AN were analysed to assess the parental and patient overlap for 23 predefined reasons for admission, using factor analyses and regressions models.RESULTS:Complete parent-patient data sets were available for 360 patients out of 769. The highest consensus rates between parents and patients were obtained for weight and eating behavior related reasons and hyperactivity. Based on factor analysis, four factors emerged. Premorbid BMI-SDS, age and 'low body weight' as stated by patients or parents explained almost 40% of the variance of the BMI-SDS at admission.CONCLUSIONS:Results underscore the relevance of age and premorbid BMI for BMI at admission. Only single reasons for admission explained further variance, with 'low body weight' having the largest effect. Approximately 40% of the variance of BMI-SDS was explained. For the first time, the effect of premorbid BMI for BMI at admission was robustly demonstrated in a multicenter study. Of the variance in BMI-SDS at discharge, our model could explain 37%, with reasons for admission having a small effect. Further investigation of the reasons for admission would be worthwhile to improve treatment and prognosis.

Both DSM-5 and ICD-11 have provided weight cut-offs and severity specifiers for the diagnosis of anorexia nervosa (AN) in childhood, adolescence and adulthood. The aims of the current study focusing on inpatients aged < 19 years were to assess (1) the relationship between age and body mass index (BMI; kg/m 2 ), BMI-centiles, BMI-standard deviation scores (BMI-SDS) and body height-SDS at referral, (2) the percentages of patients fulfilling the DSM-5 and ICD-11 weight criteria and severity categories for AN, and (3) the validity of the AN severity specifiers via analysis of both weight related data at discharge and inpatient treatment duration. The German Registry for Anorexia Nervosa encompassed complete data sets for 469 female patients (mean age = 15.2 years; range 8.9–18.9 years) with a diagnosis of AN ( n = 404) or atypical AN ( n = 65), who were ascertained at 16 German child and adolescent psychiatric hospitals. BMI at referral increased up to age 15 to subsequently plateau. Approximately one tenth of all patients with AN had a BMI above the fifth centile. The ICD-11 specifier based on a BMI-centile of 0.3 for childhood and adolescent AN entailed two equally sized groups of patients. Discharge data revealed limited validity of the specifiers. Height-SDS was not correlated with age thus stunting had no impact on our data. We corroborate the evidence to use the tenth instead of the fifth BMI-centile as the weight criterion in children and adolescents. Weight criteria should not entail major diagnostic shifts during the transition from adolescence to adulthood. The severity specifiers based on BMI or BMI-centiles do not seem to have substantial clinical validity.

Objective Nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are common disorders in childhood and are frequently accompanied by comorbid psychiatric disorders. Despite a high association between urinary and fecal incontinence with psychiatric and neurodevelopmental disorders, research on comorbidity between incontinence and anorexia nervosa (AN) remains scarce. Yet, it is well known that somatic consequences of AN include metabolic and gastrointestinal disorders. The study sought to assess the prevalence of incontinence and constipation in children and adolescents with AN and to examine associations of these two symptoms with body weight at admission and with BMI changes during inpatient treatment. Methods Data collected between 2015 and 2017 by a multicenter German web-based registry for AN were analyzed. Three hundred and forty-eight patients with AN (96.3% female, mean age = 15.1 +/- 1.8 years) were assessed regarding AN subtype, psychiatric comorbidity, body weight, incontinence, and constipation. Results Overall, 27.6% of patients had constipation, 1.8% had NE and 1.8% DUI. Prevalence of constipation did not significantly differ between AN subtypes. Constipation did not lead to any significant differences in weight/BMI changes during inpatient treatment. Discussion This is the largest study of incontinence and constipation in patients with AN, so far. Our results indicate that constipation is highly prevalent in adolescent patients with AN and reflects a clinically relevant condition. Despite, patients with AN do not have an increased prevalence of incontinence compared with the general population. Future studies should include medical examinations like ultrasound and physical examination of the lower abdomen to evaluate the severity of constipation.

Kenntnis der Terminologie und Klassifikation Kenntnis der Epidemiologie Kenntnis der Ätiologie Kenntnis der Differenzialdiagnostik, der diagnostischen Leitlinien und Komorbidität Kenntnis der therapeutischen Möglichkeiten Kenntnis der rechtlichen Bestimmungen

We aimed to compare the clinical data at first presentation to inpatient treatment of children (<14 years) vs. adolescents (≥14 years) with anorexia nervosa (AN), focusing on duration of illness before hospital admission and body mass index (BMI) at admission and discharge, proven predictors of the outcomes of adolescent AN. Clinical data at first admission and at discharge in 289 inpatients with AN (children: n = 72; adolescents: n = 217) from a German multicenter, web-based registry for consecutively enrolled patients with childhood and adolescent AN were analyzed. Inclusion criteria were a maximum age of 18 years, first inpatient treatment due to AN, and a BMI <10th BMI percentile at admission. Compared to adolescents, children with AN had a shorter duration of illness before admission (median: 6.0 months vs. 8.0 months, p = 0.004) and higher BMI percentiles at admission (median: 0.7 vs. 0.2, p = 0.004) as well as at discharge (median: 19.3 vs. 15.1, p = 0.011). Thus, in our study, children with AN exhibited clinical characteristics that have been associated with better outcomes, including higher admission and discharge BMI percentile. Future studies should examine whether these factors are actually associated with positive long-term outcomes in children.

Zusammenfassung. Hintergrund: Autismus-Spektrum-Störungen (ASS) umfassen die ICD-10-Diagnosen (International Statistical Classification of Diseases and Related Health Problems) frühkindlicher Autismus, Asperger-Syndrom und atypischer Autismus und zeigen eine Lebenszeitprävalenz von bis zu 1 %. Die S3-Leitlinie der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. hat zum Ziel, evidenzbasierte Diagnostik und Therapie für professionelle Akteure im Gesundheits- und Sozialsystem systematisch zusammenzufassen und klinische Empfehlungen zu konsentieren. Der vorliegende Artikel fasst die wesentlichen Ergebnisse zum Teil Diagnostik zusammen. Methodik: Die Leitliniengruppe besteht aus 14 klinischen und wissenschaftlichen Fachgesellschaften sowie Patienten-/Angehörigen-Vertretern. Die Empfehlungen basieren dabei auf den Ergebnissen systematischer Literatursuche, Datenextraktion, Studienqualitäts-Bewertung sowie metaanalytischer Datenaggregation in Kombination mit der klinischen Expertise der jeweiligen Vertreter. Die Empfehlungen wurden anhand eines nominalen Gruppenprozesses abgestimmt. Ergebnisse: Der aktuelle Forschungsstand zur Diagnostik wird zusammengefasst. Dabei liegt ein besonderer Schwerpunkt auf der Frage der Notwendigkeit und Entbehrlichkeit verschiedener Bestandteile des diagnostischen Prozesses. Nach einer allgemeinen Einführung zum Krankheitsbild werden insbesondere die wesentlichen Aspekte der Anamnese, die sinnvolle Verwendung von Screening- und Diagnostikinstrumenten, die internistisch-neurologische Untersuchung, apparative Diagnostik, testpsychologische Untersuchung, Aufklärung und Beratung sowie sinnvolle Verlaufsdiagnostik detailliert dargestellt. Schlussfolgerung: Die ASS-Leitlinie gibt evidenzbasierte, klinisch konsentierte Empfehlungen zum Prozess der Diagnostik von ASS im Kindes-, Jugend- und Erwachsenenalter. Sie bietet Anwendern zudem die Möglichkeit, sich in kurzer Zeit über die Hintergründe der Störung sowie verschiedene diagnostische Instrumente zu informieren.

Reduced social motivation is a hallmark of individuals with autism spectrum disorders (ASDs). Although the exact neural mechanisms are unclear, oxytocin has been shown to enhance motivation and attention to social stimuli, suggesting a potential to augment social reinforcement learning as the central mechanism of behavioral interventions in ASD. We tested how reinforcement learning in social contexts and associated reward prediction error (RPE) signals in the nucleus accumbens (NAcc) were modulated by intranasal oxytocin. Male adults with a childhood diagnosis of ASD (n = 15) and healthy controls (n = 24; aged 18–26 years) performed a probabilistic reinforcement learning task during functional magnetic resonance imaging in a single-center (research center in Germany), randomized double-blind, placebo-controlled cross-over trial. The interventions were intranasal oxytocin (Syntocinon®, Novartis; 10 puffs = 20 international units (IUs) per treatment) and placebo spray. Using computational modeling of behavioral data, trial-by-trial RPE signals were assessed and related to brain activation in NAcc during reinforcing feedback in social and non-social contexts. The order of oxytocin/placebo was randomized for 60 participants. Twenty-one participants were excluded from analyses, leaving 39 for the final analysis. Behaviorally, individuals with ASD showed enhanced learning under oxytocin when the learning target as well as feedback was social as compared to non-social (social vs. non-social target: 87.09% vs. 71.29%, 95% confidence interval (CI): 7.28–24.33, p = .003; social vs. non-social feedback: 81.00% vs. 71.29%, 95% CI: 2.81–16.61, p = .027). Correspondingly, oxytocin enhanced the correlation of the RPE signal with NAcc activation during social (vs. non-social) feedback in ASD (3.48 vs. −1.12, respectively, 95% CI: 2.98–6.22, p = .000), whereas in controls, this effect was found in the placebo condition (2.90 vs. −1.14, respectively, 95% CI: 1.07–7.01, p = .010). In ASD, a similar pattern emerged when the learning target was social (3.00 vs. −0.64, respectively, 95% CI: −0.13 to 7.41, p = .057), whereas controls showed a reduced correlation for social learning targets under oxytocin (−0.70 vs. 2.72, respectively, 95% CI: −5.86 to 0.98, p = .008). The current data suggest that intranasal oxytocin has the potential to enhance social reinforcement learning in ASD. Future studies are warranted that investigate whether oxytocin can potentiate social learning when combined with behavioral therapies, resulting in greater treatment benefits than traditional behavior-only approaches.

OBJECTIVE:Recent preliminary studies indicated a seasonal association of BMI at admission to inpatient treatment for anorexia nervosa (AN), indicating lower BMI in the cold season for restrictive AN. An impaired thermoregulation was proposed as the causal factor, based on findings in animal models of AN. However, findings regarding seasonality of BMI and physical activity levels in the general population indicate lower BMI and higher physical activity in summer than in winter. Therefore, we aimed to thoroughly replicate the findings regarding seasonality of BMI at admission in patients with AN in this study. METHOD:AN subtype, age- and gender-standardized BMI scores (BMI-SDS) at admission, mean daily sunshine duration and ambient temperature at the residency of 304 adolescent inpatients with AN of the multi-center German AN registry were analyzed. RESULTS:A main effect of DSM-5 AN subtype was found (F(2,298) = 6.630, p = .002), indicating differences in BMI-SDS at admission between restrictive, binge/purge and subclinical AN. No main effect of season on BMI-SDS at admission was found (F(1,298) = 4.723, p = .025), but an interaction effect of DSM-5 subtype and season was obtained (F(2,298) = 6.625, p = .001). Post-hoc group analyses revealed a lower BMI-SDS in the warm season for restrictive AN with a non-significant small effect size (t(203.16) = 2.140, p = .033; Hedges'g = 0.28). Small correlations of mean ambient temperature (r = -.16) and daily sunshine duration (r = -.22) with BMI-SDS in restrictive AN were found. However, the data were widely scattered. CONCLUSIONS:Our findings are contrary to previous studies and question the thermoregulatory hypothesis, indicating that seasonality in AN is more complex and might be subject to other biological or psychological factors, for example physical activity or body dissatisfaction. Our results indicate only a small clinical relevance of seasonal associations of BMI-SDS merely at admission. Longitudinal studies investigating within-subject seasonal changes might be more promising to assess seasonality in AN and of higher clinical relevance.

The diagnostics of autism spectrum disorder in children, adolescents and adults: Overview of the key questions and main results of the first part of the German AWMF-S3-clinical guideline Abstract.BACKGROUNDAutism spectrum disorders (ASD) include ICD-10 diagnoses of childhood autism, Asperger syndrome, and atypical autism; there is a lifetime prevalence of ~1 %. The aim of the evidence-based clinical guideline (AWMF-S3-Guideline) is to summarize the current evidence concerning diagnostic and therapeutic processes for professionals working in healthcare and social welfare and to provide consensus on clinical recommendations. The present study summarizes the most important results of the diagnostic part of this guideline.METHODThe guideline group comprised 14 clinical and scientific expert associations from the German healthcare system, in addition to representatives of relatives and patients. Recommendations were based on results of a systematic literature search, data extraction, the evaluation of study quality, and, if possible, meta-analytic aggregation of included data in combination with the clinical expertise of the respective representatives. Consensus-based recommendations were determined via nominal group technique.RESULTSThe AWMF-S3-Clinical Guideline, Diagnostic Part, summarizes current research on this topic. The main focus is put on the question of obligatory versus redundant diagnostic procedures. After a general introduction to the clinical picture of ASD, essential aspects like obtaining the medical history, the effective use of screening and diagnostic instruments, medical examination, the full diagnostic work-up as well as communicating the diagnostic results to relatives and patients are described in detail. We also conducted a meta-analysis on the stability of early diagnosis.CONCLUSIONThis first part of the ASD guideline offers users the opportunity to inform themselves about the background of ASD as well as evidence-based and broadly consented information on the correct diagnostic process of ASD from infancy to adulthood.

Zusammenfassung. Fragestellung: Die stationäre Behandlung von Patientinnen mit Anorexia nervosa (AN) wird in Bezug auf ihre mittel- und langfristigen Wirkungen und Nebenwirkungen kontrovers diskutiert. In der deutschen S3-Leitlinie zur Diagnostik und Behandlung der Essstörungen wird die Notwendigkeit eines auf Essstörungen spezialisierten Therapeutenteams betont. Die Versorgung von Kindern und Jugendlichen mit AN in deutschen Kliniken wurde im Hinblick auf aktuelle Diagnostik- und Behandlungskonzepte untersucht. Methodik: Ein Fragebogen wurde an 163 deutsche kinder- und jugendpsychiatrische/-psychosomatische Kliniken versandt, der die Versorgungsstrukturen im Hinblick auf allgemeine Charakteristika der Kliniken sowie Diagnostik und Therapie von Kindern und Jugendlichen mit AN erfasst. Ergebnisse: Alle Kliniken, die Patientinnen mit Essstörungen behandeln (N = 84), bieten Einzeltherapie, familienbasierte Interventionen und Psychoedukation an. Nahezu alle Kliniken definieren ein Zielgewicht. Die angestrebte vorgegebene Gewichtszunahme pro Woche beträgt im Mittel 486 g/Woche (von 200 g bis 700 g/Woche; SD = 117). Alle weiteren diagnostischen und therapeutischen Maßnahmen werden nicht von allen Kliniken durchgeführt. Schlussfolgerungen: In dieser ersten Untersuchung der Versorgungsstrukturen von Kindern und Jugendlichen mit der Diagnose AN in Deutschland konnte gezeigt werden, dass trotz einheitlich integrierter leitliniengerechter Basisbehandlung die Versorgung von Patientinnen mit der Diagnose AN in Bezug auf Diagnostik, Gewichtsrestitution und spezifischer einzel- und gruppentherapeutischer Interventionen deutlich unterschiedlich gehandhabt wird.

Zusammenfassung. Das Kompetenzanalyseverfahren (KANN) ist ein Fremdbeurteilungsverfahren für Eltern und pädagogische Fachkräfte zur Beurteilung beobachtbarer Kompetenzen von Kindern und Jugendlichen. In der Studie wird untersucht, ob, und wenn ja, inwiefern sich die Unterschiede zwischen den zwei Normstichproben (Schulnorm/Elternurteil vs. Kinder- und Jugendhilfe-Norm/Urteil pädagogischer Fachkräfte) durch (1) die Reliabilität des Messinstruments, (2) systematische Beurteilertendenzen und/oder (3) Kompetenzdefizite von Kindern und Jugendlichen in Erziehungshilfen erklären lassen. Hierzu wurden die Intra-/Interrater-Reliabilität und -Übereinstimmung an vier Stichproben aus dem Bereich der Erziehungshilfen analysiert: (A) Pädagoge/-in A – A (Test-Retest), n = 153; (B) Pädagoge/-in A – B, n = 169; (C) Mutter–Vater, n = 26 und (D) Pädagoge/-in – Elternteil, n = 136. Die Ergebnisse weisen auf eine gute Intra-/Interrater-Reliabilität und eine akzeptable Übereinstimmung im Urteil pädagogischer Fachkräfte hin. Zwischen unterschiedlichen Beurteilertypen (Pädagoge/-in – Elternteil), lässt sich eine deutlich niedrigere Interrater-Reliabilität und -Übereinstimmung feststellen. Der Vergleich des Elternurteils mit den beiden Normstichproben verdeutlicht die unterdurchschnittlichen KANN-Werte von Kindern und Jugendlichen in Erziehungshilfen. Eine Überschätzungstendenz der Eltern ist wahrscheinlich.

OBJECTIVEThe first web-based registry for childhood and adolescent anorexia nervosa (AN) in Germany was established to systematically collect demographic and clinical data. These data as well as information on how young individuals with AN can find access to healthcare services are presented.METHODPatients´ data from child and adolescent psychiatry departments of 12 university hospitals and two major nonuniversity hospitals in Germany were collected between January 2015 and December 2016. All patients met the ICD-10 diagnostic criteria for (atypical) AN. Sociodemographic data, type and amount of healthcare utilization before admission, and clinical data at admission and discharge were compiled.RESULTS258 patients with a mean age of 14.7 years and a mean BMI at admission of 15.3 kg/m2 were included. The parents and patients had a higher educational level than the general German population. More than 80 % of the patients reported having utilized healthcare before hospitalization. The mean duration of outpatient treatment before hospitalization was 7 months.CONCLUSIONSThere seem to be major barriers to specialist treatment for young patients with AN in Germany, which should be analyzed in future studies.

The German Competence Analysis Questionnaire (Kompetenzanalyseverfahren, KANN) is an external assessment tool used by parents and educators to determine observable competences of children and adolescents. The present study examined whether and how differences between the two norm samples (school norm/parental ratings vs. norm for child and youth welfare services/educator ratings) can be explained by (a) the reliability of the survey instrument, (b) systematic rating tendencies, and/or (c) competence deficits of children and adolescents in child and youth welfare. Thus, intra-/interrater reliability and agreement were analyzed in four sample sets of child and youth welfare services: (a) educator A A (test-retest), n = 153; (b) educator A - B, n = 169; (c) mother father, n = 26; and (d) educator-parent, n = 136. The results demonstrate good intra-/interrater reliability and a reasonable agreement for educators. Between different types of informants (educator-parent), the interrater reliability and agreement were considerably lower. A comparison of the parental rating with the two norm samples illustrates the below-average KANN results of children and adolescents in child and youth welfare. Furthermore, there is a probable parental tendency to overestimate their child's competences.

Objective: The medium-and long-term effects and side effects of inpatient treatment of patients with anorexia nervosa is still a matter of debate. The German S3-guidelines underline the importance of providing specialized and competent treatment. In this article we focus on the inpatient service structure in German child and adolescent psychiatric clinics with regard to their diagnostic and therapeutic concepts. Methods: A self-devised questionnaire was sent to 163 German child and adolescent psychiatric clinics. The questionnaire focused on the characteristics of the respective clinic as well as its diagnostic and therapeutic strategies. Results: All clinics with an inpatient service for patients with anorexia nervosa (N = 84) provide single-therapy, family-based interventions and psychoeducation. A target weight is defined in nearly all clinics, and the mean intended weight gain per week is 486 g (range: 200 g to 700 g/week; SD = 117). Certain diagnostic tests and therapeutic interventions are used heterogeneously. Conclusions: This is the first study investigating the inpatient service structure for patients with anorexia nervosa in German clinics. Despite the provision of guideline-based therapy in all clinics, heterogeneous approaches were apparent with respect to specific diagnostic and therapeutic concepts.

Little is known about use of early interventions for autism spectrum disorder in Europe. Parents of children with autism spectrum disorder aged 7 years or younger (N = 1680) were recruited through parent organisations in 18 European countries and completed an online survey about the interventions their child received. There was considerable variation in use of interventions, and in some countries more than 20% of children received no intervention at all. The most frequently reported interventions were speech and language therapy (64%) and behavioural, developmental and relationship-based interventions (55%). In some parts of Europe, use of behavioural, developmental and relationship-based interventions was associated with higher parental educational level and time passed since diagnosis, rather than with child characteristics. These findings highlight the need to monitor use of intervention for children with autism spectrum disorder in Europe in order to contrast inequalities.

Group-based psychotherapy in Autism Spectrum Disorder (ASD) has predominantly been studied in the United States by small studies in school-aged children without long-term follow-up. We report results of a large, confirmatory, multicentre randomized-controlled phase-III trial in children and adolescents studying the ASD specific, manualized group-based cognitive behavioural SOSTA-FRA approach. High-functioning ASD individuals aged 8–19 years old were randomized to 12 sessions SOSTA-FRA or treatment as usual. Primary outcomes were change in total raw score of the parent-rated Social Responsiveness Scale (pSRS) between baseline (T2) and end of intervention (T4), and between T2 and 3 months after end of intervention (T5). Trial registration: ISRCTN94863788. Between 20/5/2010 and 14/2/2013, n  = 320 ASD patients were screened, n  = 228 patients were randomized, and N  = 209 analysed. Mean pSRS difference between groups at T4 was −6.5 (95% CI −11.6 to – 1.4; p  = .013), and at T5 −6.4 (−11.5 to −1.3, p  = .015). Pre-treatment SRS and IQ were positively associated with stronger improvement at T4 and T5. Short-term ASD-specific add-on group-based psychotherapy has shown postintervention efficacy with regard to parent-rated social responsiveness predominantly in male high-functioning children and adolescents with ASD. Future studies should implement blinded standardized observational measures of peer-related social interaction.

BACKGROUND:Group-based psychotherapy in Autism Spectrum Disorder (ASD) has predominantly been studied in the United States by small studies in school-aged children without long-term follow-up. We report results of a large, confirmatory, multicentre randomized-controlled phase-III trial in children and adolescents studying the ASD specific, manualized group-based cognitive behavioural SOSTA-FRA approach.METHODS:High-functioning ASD individuals aged 8-19 years old were randomized to 12 sessions SOSTA-FRA or treatment as usual. Primary outcomes were change in total raw score of the parent-rated Social Responsiveness Scale (pSRS) between baseline (T2) and end of intervention (T4), and between T2 and 3 months after end of intervention (T5).TRIAL REGISTRATION:ISRCTN94863788.RESULTS:Between 20/5/2010 and 14/2/2013, n = 320 ASD patients were screened, n = 228 patients were randomized, and N = 209 analysed. Mean pSRS difference between groups at T4 was -6.5 (95% CI -11.6 to - 1.4; p = .013), and at T5 -6.4 (-11.5 to -1.3, p = .015). Pre-treatment SRS and IQ were positively associated with stronger improvement at T4 and T5.CONCLUSIONS:Short-term ASD-specific add-on group-based psychotherapy has shown postintervention efficacy with regard to parent-rated social responsiveness predominantly in male high-functioning children and adolescents with ASD. Future studies should implement blinded standardized observational measures of peer-related social interaction.

Die Diagnose Autismus-Spektrum-Störung (ASS) wird in den letzten Jahren häufiger gestellt. Dies ist v. a. durch die Standardisierung von Untersuchungsinstrumenten und den erhöhten Bekanntheitsgrad des Störungsbilds bedingt. In der 5. Auflage des Diagnostic and Statistical Manual of Mental Disorders (DSM-5) wird die ASS nicht mehr kategorial erfasst und den tiefgreifenden Entwicklungsstörungen zugeordnet, sondern findet sich u. a. zusammen mit dem Aufmerksamkeitsdefizit- und Hyperaktivitätssyndrom, den Tic-Störungen, den Intelligenzminderungen und den umschriebenen Entwicklungsstörungen im Kapitel der „entwicklungsneuroneurologischen Störungen“. Das Verständnis für die Ätiologie, für komorbide Störungen, aber auch für den Verlauf von ASS hat sich durch eine Zunahme von wissenschaftlichen Untersuchungen deutlich verbessert. All dies ermöglicht die frühere Diagnosestellung und die rechtzeitige Einleitung von Interventionen sowie gleichzeitig die verbesserte Entwicklung von Versorgungsstrukturen für Erwachsene mit ASS.

The German Competence Analysis Questionnaire (KANN): Autism-spectrum-disorders and/or ADHD Compared. Due to the frequent comorbidity of autism spectrum disorders (ASD) and attention-deficit hyperactivity disorders (ADHD) the investigation of similarities and differences between these two syndromes has been the focus of research in recent years. The main objective of the present paper is to compare the three clinical groups "ASD", "ADHD" and "ASD+ADHD" as well as a control group on the basis of competencies relevant to everyday and social life by using the German Competence Analysis Questionnaire (Kompetenzanalyseverfahren, KANN). The KANN is an external assessment tool used to determine observable personal resources (competencies) in children and adolescents. A total of n = 205 children and adolescents under the care of child and youth welfare services are analyzed. The results show that the clinical group "ADHD" is superior to the groups "ASD" (in this case statistically significant) and "ASD+ADHD" at the KANN-scale "Leisure Behavior & Peer Groups" and "Independence in Everyday Life". The similar KANN-profiles of the two autistic groups do not support - contrary to the additionally collected data of behavior disorders (CBCL/4-18) - the hypothesis of an additive symptom effect within the meaning of the loss of competencies for the combined diagnoses group "ASD+ADHD". Furthermore, the ability of the KANN scales to differentiate between a clinical and a non-clinical child and youth welfare group underlines the validity of the KANN.