Objectives: Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline. Methods: Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders. Results: Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed. Conclusions: Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.

Adolescent eating disorder symptoms, depression and anxiety, the impact of their symptoms on their parents, and parental self-efficacy were assessed before beginning family-based day hospital treatment, and at 3 and 6 months post-assessment. Parents' self-efficacy increased during the first 3 months of treatment, and their knowledge and confidence in their effectiveness against the eating disorder continued to increase between 3 and 6 months post-assessment. Adolescent eating disorder symptoms, depression and anxiety, and the impact of the symptoms on their parents decreased between 3 and 6 months post-assessment. The results suggest that family-based treatment can be adapted to day hospital programmes for adolescents. The results also provide preliminary support for a treatment duration of at least 6 months.Note: Means in the same row that do not share subscripts differ at P < 0.05. Clinical T-scores: elevated = 67-99; typical = 25-66, low = 1-24.Adapting family-based therapy 113

Family-based therapy is regarded as best practice for the treatment of eating disorders in adolescents. In family-based therapy, parents play a vital role in bringing their child or adolescent to health; however, little is known about the parent-related mechanisms of change throughout treatment. The present study examines parent and adolescent outcomes of family-based therapy as well as the role of parental self-efficacy in relation to adolescent eating disorder, depressed mood and anxiety symptoms. Forty-nine adolescents and their parents completed a series of measures at assessment, at 3-month post-assessment and at 6-month follow-up. Results indicate that, throughout treatment, parents experienced an increase in self-efficacy and adolescents experienced a reduction in symptoms. Maternal and paternal self-efficacy scores also predicted adolescent outcomes throughout treatment. These results are consistent with the philosophy of the family-based therapy model and add to the literature on possible mechanisms of change in the context of family-based therapy.