IACAPAP President's Message Dec 2023

I would like to begin our last presidential column of 2023 wishing all IACAPAP friends and their families a very happy and healthy 2024! This was not an easy year with so many youths and families suffering the devasting impact of war in different parts of the world including Sudan, Ukraine and more recently in Middle East and the consequences of huge natural disasters like the earthquakes in Turkey and Morocco. IACAPAP has been monitoring and implementing actions to mitigate the suffering of youths and their families affected by war and natural disasters directly or indirectly through support to its national associations. We would be more than happy to hear from our members suggestions on how we can do more! 

At the same time, we finished our first year in the presidency of IACAPAP. I have been using this column as a vehicle to keep our friends informed on what is being done inside IACAPAP. The idea is not only keeping members transparently informed almost on time, but to allow for modifications on the course of action that can be made based on the feedback of our national member associations and individual members. Feel free to send us your suggestions, comments and critics about what IACAPAP has done.  

IACAPAP President - Prof Luis Rohde

As we approach the end of the year, I am proud to outline the progress on two major initiatives that showcase the fruitful collaboration between IACAPAP and the Stavros Niarchos Foundation Global Center for Child and Adolescent Mental Health at the Child Mind Institute. The SNF Global Center is one of the main mental health projects supported by the Stavros Niarchos Foundation Global Health Initiative. 

  • Child and Adolescent Mental Health (CAMH) Item bank: Building on our commitment to advancing CAMH, we are approaching the launch of a pivotal project: the creation of a universally accessible, culturally sensitive CAMH item bank. This initiative is crucial, as it addresses the stark absence of unified, evidence-based CAMH data, particularly in low- and middle-income countries (LMICs). The item-bank is designed to span a range of developmental stages, with specific versions for different age groups, including parents of preschoolers, school-aged children, adolescents, and self-report options for older youths. A rigorous process of expert reviews is on the near horizon, with our contract with the Child Mind Institute expected to be formalized before the new year. This sets the stage for IACAPAP’s affiliated national child psychiatry associations to begin cultural appropriateness evaluations in the first quarter of 2024. The significance of this tool was underscored by global CAMH leaders at the recent American Academy of Child and Adolescent Psychiatry symposium, emphasizing the necessity for consistent, comparative data to inform global CAMH services and policies.
  • Clinical Fellowship Program for LMICs: To directly address the shortage of CAMH professionals in LMICs, we are also working hard to launch a comprehensive Clinical Fellowship Program in Child and Adolescent Psychiatry. Mozambique, a nation with only one practicing Child and Adolescent Psychiatrist and a dearth of trained CAMH professionals, has been selected as the inaugural site. This program extends beyond psychiatrists to include psychologists and occupational therapists, embodying a holistic approach to CAMH care, consonant to the IACAPAP vision. The fellowship spans three years, with the first year dedicated to intensive training in Brazil, followed by two years of service in Mozambique's public health system, under continuous external supervision. This ambitious endeavor aims to build a sustainable model of CAMH training and care for LMICs.

Another piece of great news is related to our next World Congress of Child and Adolescent Psychiatry and Allied Professions in Rio in 2024 (see more details in this bulletin and at https://www.iacapap2024.com/ingles/index.php). The numbers are astonishing! In the very early registration deadline, we received an unprecedented number of 1490 registrations. The deadline for submissions of symposia, oral presentations and posters closed with 134 symposia, 266 oral presentations and 358 posters submitted. Be prepared for an unforgettable experience in Rio next year. If you have not registered yet, do it now! We might have to close registrations for the first time ever in the next early registration deadline at the end of February, since our venue has the capacity for only 2500 delegates.     

Based on the voting called in the last column, we defined early July as the date of the 2026 World Congress of Child and Adolescent Psychiatry and Allied Professions. Due to logistic reasons, the congress will be in Hamburg and not Berlin. I would like to thank our colleagues that voted and helped the Bureau in achieving the best decision on an issue that affects all of us!

As you might remember, I decided to include, as the last piece of the column, the discussion of an impactful paper in CAMH published in between the previous and this Bulleting in the scientific literature. This time, I selected a paper in my area of expertise, ADHD, published by a large group of researchers (Synergy for the Influence of the Month of Birth in ADHD -SIMBA- study group, a consortium 162 researchers) in The Lancet Psychiatry this month. The title is: “Association between relative age at school and persistence of ADHD in prospective studies: an individual participant data meta-analysis” (see at https://pubmed.ncbi.nlm.nih.gov/37898142/). The work was lead by Corentin J Gosling a psychologist from France and Professor Samuelle Cortese, a child and adolescent psychiatrist based on UK. There was robust previous data from population studies worldwide showing that younger children, especially in the first years of elementary school, receive more diagnosis of ADHD than older children in their classrooms. Two main competitive explanations were prominent in the literature. First, we are pushing our immature young children to demands that they cannot face and, as a result, stamping out an ADHD diagnosis. The second stated that young immature children with ADHD might have a more severe presentation making easier the initial recognition of the phenotype. The group tested the following research question: If young children with ADHD have a false positive diagnosis of ADHD, they should demonstrate a lower persistence of ADHD diagnosis in longitudinal studies than older children with ADHD. The investigation included 57 prospective studies following up 6504 children with ADHD. Results showed that the diagnosis of ADHD in younger children in a class is no more likely to be disconfirmed over time than that of older children in the class. Indeed, although not statistically significant, the direction of the association was in the other direction (i.e., younger children with ADHD tend to have more stable diagnosis across time - odds ratio 1·02, 95% CI 0·99-1·06; p=0·19). This finding has clear clinical and policy implications for CAMH.  

Finally, regarding the auditable goals proposed in the previous bulletin, they were partially achieved, since: a) the agreement with CMI on the collaborative work for the Child and Adolescent Psychiatry Clinical Fellowship Program was achieved; b) the preliminary program of the 2024 IACAPAP World Congress of Child and Adolescent Psychiatry and Allied Professions will be available online in the first weeks of January; c) we had almost two thirds of the expected registrations for the IACAPAP World Congress in Rio 2024 already done; d) we had the location and dates for the 2026 IACAPAP Congress finalized. The development of the Multidimensional, Culturally Sensitive, and Open-Access instrument to evaluate CAMHworldwide was slower than expected. The auditable goals up to the next bulletin will be: 

  1. Engage IACAPAP community for assessing the cultural adequacy of the Multidimensional, Culturally Sensitive, and Open-Access instrument to evaluate CAMH worldwide (goal pending from the last round);
  2. Have the first two teams from Mozambique selected for the Child and Adolescent Mental Health Clinical Fellowship Program and ready to begin training;
  3. Have the final program of the 2024 IACAPAP World Congress of Child and Adolescent Psychiatry and Allied Professions available online;
  4. Have more than 90% of the registrations for the Congress completed;

I hope you all enjoy reading our Bulletin.