IACAPAP President's Message Mar 2024

By Professor Luis Augusto Rohde, Professor, Department of Psychiatry,Federal University of Rio Grande do Sul, Director, ADHD Program , Hospital deClínicas de Porto Alegre, Brazil

As we are approaching our World Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions, briefly known as the IACAPAP World Congress (see more details in this bulletin and at https://www.iacapap2024.com/ingles/index.php), I will concentrate this presidential column on highlighting some of the innumerous activities that we will have there. The challenge is enormous since there are so many highly interesting and informative activities scheduled!

Firstly, it is important to note that regarding the auditable goals related to this Congress, proposed in the previous bulletin, we are in good shape! The program is online, and we have 2700 registrationsfrom 93 nationalities up to now, more than our capacity (our venue has the capacity for only 2500 delegates). We are moving to have the most well attended IACAPAP congress ever. A note: not all registered people have paid yet! They will have up to April to finish their registration. As we know that some might not finish their registration with payment, we will allow the last 300 registrations. So, if you want to be in the most prestigious event on CAMH in 2024, this is the time for you to finish your registration with payment or apply for a new one! We are expecting to close registrations in Mid-April since the congress should be sold out at this time. Just recapitulating 120 symposia, 251 oral presentations and 490 posters. So, this is the place to share experiences, learn and show your work on CAMH! 

The first activity that I would like to highlight is our opening ceremony. Besides an entertaining cultural activity, a surprising challenge proposed by one of the dearest and most influential IACAPAP members, we will have a talk by Tom Osborn. Tom is the co-founder & CEO of the Shamiri Institute. His trajectory is astonishing! Tom is a community mobilizer, entrepreneur and research scientist. Born and raised in poverty in rural Kenya, he has started and worked for organizations that aim to disrupt the status quo and lift communities out of poverty. At 18, he co-founded GreenChar, a social enterprise that provided homes and institutions in rural Kenya and urban slums with clean energy. For his work and leadership at GreenChar, he was the youngest recipient of Echoing Green Fellowship – an award for the world’s best social entrepreneurs. At 19, he was named on the Forbes’ 30 under 30 list in Social Entrepreneurship, the second youngest person to receive the honor. Besides his entrepreneurial experience, Tom graduated from Harvard College with a degree in Psychology (High Honors). If you remember a paper in Lancet that I highlighted two bulletins ago (Transforming Mental Health Systems Globally: principles and policy recommendations), you will quickly understand why Tom should be our guest speaker in this opening ceremony. I will avoid any spoiler, but he will be talking about scalable approaches that his team is developing in Kenya to address mental disorders in young people relying on principles as evidence-based interventions and task-shifting. 

We will also have two wonderful debates at the congress. One addressing a very contemporaneous issue, our understanding of the broadness and limits of the conceptualization of neurodiversity and questions on the overlap and blurring of its conceptualization and psychopathology. In simple words, where does neurodiversity end and where does psychopathology begin? We will be in the hands of great experts in the field – Emily Simonoff from Kings College in London and David Coghill from the University of Melbourne, to approach this question. Another very pressing issue in different countries is related to the misuse of stimulants by adolescents and young adults. There are several hidden nuances and outspreads in this area. Nobody is better than Jef Newcorn (Mount Sinai) and Tim Wilens (Harvard University) to guide us in this discussion. 

My last highlight goes to our first Grand-Round at the IACAPAP World Congresses. We all know that research is extremely important to the field, but the great majority of our delegates are clinicians experiencing difficult challenges in their day-by-day clinical activities. Irritability is present in several mental health conditions, transposing dichotomous diagnostic barriers and when highly severe causing huge impairment for individuals, their families and society. We will have a case presented by Luisa Sygaya, a young and experienced clinician and researcher on irritability and discussed by two experts in the area – Boris Birmaher from the University of Pittsburgh and Toni Ramos Quiroga from the Universitari Vall d ’Hebron.  

Moving to a different topic: I would like to highlight the progress made these last three months in the collaboration between IACAPAP and the Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute:    

  • Child and Adolescent Mental Health (CAMH) Item bank (for more information on the initiative please see the previous bulletin): The first version of the item bank has been assessed by a committee of 10 experts on CAMH from different parts of the globe. Their valuable suggestions have been incorporated. Now, we are initiating the process of sending the latest version of the item bank of mental health questions for different age groups (parents of preschoolers, school-aged children, adolescents, and self-report options for older youths) to hundreds of clinicians and researchers worldwide - including IACAPAP’s affiliated national child psychiatry associations - to assess cultural appropriateness.  
  • Clinical Fellowship Program for LMICs (for more information on the initiative please see the previous bulletin): The SNF Global Center Clinical Fellowship Program is progressing quickly! The first three candidates from Mozambique (one psychiatrist, one psychologist, and one occupational therapist) were selected with support from the Mozambique Ministry of Health and will begin their training in Brazil on April 1st, 2024. We, alongside the SNF Global Center leadership and our collaborators in Mozambique, decided to have one interdisciplinary team come to Brazil, since this is the debut cohort and we plan to learn with our fellows before expanding.  

Having already decided the location for the 27th World Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP 2026 Congress Hamburg) with the help of our members, I am very happy to announce that you also defined the location of the 2028 Congress. We will be going back to Oceania after so many years. The congress will be in New Zealand. I would like to give a special thanks to our colleagues in New Zealand that prepared a wonderful and very detailed application.

On April 23rd, we will have the World Infant, Child and Adolescent Mental Health Day (WICAMHD). As usual, our past president, Daniel Fung, is working hard with the World Psychiatric Association Child and Adolescent Psychiatry Section (WAP-CAP), the World Association for Infant Mental Health (WAIMH), and the International Society for Adolescent Psychiatry and Psychology (ISAPP) to have, as usual, a series of activities commemorating the day and our traditional webinar. This year, the theme selected was: In their own words: Bridges to Understanding Mental Health, reflecting an issue that gained enormous force inside the MH community, the participation of people with lived experience in decisions in the field. In other words, “nothing about me, without me”. We hope that you join us in the exciting activities being prepared and that our national associations could embrace this campaign by doing activities in their countries (see more about the WICAMH day in this bulletin).    

As you might remember, our ante-penultimate paragraph is always dedicated to the discussion of an impactful paper in CAMH published between the previous and this Bulletin in the scientific literature. Unfortunately, I will have to repeat the area on CAMH, since a very relevant paper on ADHD was just published in JAMA, two weeks ago. The title is: ADHD Pharmacotherapy and Mortality in Individuals With ADHD. The leading author is Lin Li from the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (see at: https://pubmed.ncbi.nlm.nih.gov/38470385/). There is strong debate in the field right now if methylphenidate should be incorporated or not in the WHO List of Essential Medicines, an issue that I will address in the next bulletin. This paper is one more piece of compelling evidence for the clinical relevance of pharmacological treatment of the disorder. In an observational cohort study in Sweden authors identified individuals from school age to old age with an incident diagnosis of ADHD from 2007 through 2018 and no ADHD medication dispensation prior to diagnosis. Follow-up started from ADHD diagnosis until death, emigration, 2 years after ADHD diagnosis, or December 31, 2020, whichever came first. Findings are clear: In individuals with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly, as expected, for death due to unnatural causes.  There is no more relevant outcome to be assessed than mortality.     

Finally, regarding the auditable goals proposed in the previous bulletin, they were completely achieved, since: 1) we just began the engagement of the IACAPAP community for assessing the cultural adequacy of the Multidimensional, Culturally Sensitive, and Open-Access instrument to evaluate CAMH worldwide; 2) the first team from Mozambique was already selected for the Child and Adolescent Mental Health Clinical Fellowship Program and the will begin training in April 2024; 3) the program of the 26th World Congress of International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP 2024 Congress Rio) is already available online; 4)  registrations for our IACAPAP World Congress were much more than targeted.   

The auditable goals up to the next bulletin will be:  

  1. Have the cultural assessment of the Multidimensional, Culturally Sensitive, and Open-Access instrument to evaluate CAMH worldwide either completed or close to completion.
  2. Have the first team from Mozambique already in training as part of the Child and Adolescent Mental Health Clinical Fellowship Program and have the next locations (country of trainees and host country).
  3. Have a wonderful congress in Rio with lots of opportunities for learning, sharing knowledge and enjoying the companion of colleagues from all around the globe.
  4. Have the IACAPAP committee, to appeal the WHO to include methylphenidate in their Essential list of medications, formed and working.   

I hope you all enjoy reading our Bulletin.