IACAPAP President's Message Mar 2025

Since these have been quite holiday months and the IACAPAP bulletin editors have revised the bulletin publication schedule for 2025, moving the bulletin publication from the end of the month to mid-month,  shorterning the period since my last bulletin report, this presidential column will also be shorter.  

Here is the news that I would like to share with you: 

Professor Tobias Banaschewski and the local organizing committee continue working in preparation for our next World Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions in Hamburg, Germany from July 1st to 4th, 2026. We expect to have a preliminary line-up of keynote speakers in the first quarter of the year. In addition, IACAPAP received an impressive number of 124 applications for the Helmut Remschmidt Research Seminar 2025, a meeting that occurs in the year before our congress with the main goal of improving research skills of young mental health professionals. The seminar will be held from 7-12 September 2025, in the Monastery of Kloster Irsee, in Bavaria, near Munich. At the time you are reading this bulletin, the selection committee should have already announced the list of successful applicants. 

Regarding the collaboration between IACAPAP and the Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute:  

• The Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute Clinical Fellowship Program for Low- and Middle-Income Countries (LMICs): We will have a joint meeting in Porto Alegre in mid-March with our Mozambican fellows (including the first cohort, just finishing their training, and the second cohort, soon arriving to start the program), local mentors from Hospital de Clinicas de Porto Alegre, Brazil, mentors from Mozambique, and Peter Raucci, Program Director of Fellowships at the SNF Global Center. The goal is to strengthen the group identity, exchange experiences, and improve the program for both cohorts. In addition, to make the selection of pairs of countries for next rounds of the Clinical Fellowship Program for LMICs even more comprehensive and participatory, IACAPAP and the SNF Global Center for Child and Adolescent Mental Health at the CMI are working on a plan to expand partnerships for the program.
   
• SNF Global Center Item Bank - an Assessment Tool to Support Culturally Appropriate Global Data Collection: As announced in the previous bulletin, the psychometric evaluation phase is in progress. In addition, the SNF Global Center team is working on producing a set of items for measuring risk factors for mental health conditions and will be seeking feedback from IACAPAP members on priority ranking for these risk factors. This effort is led by Zeina Mneimneh, Program Director of Global Landscape Mapping/Epidemiology. More information will be shared with IACAPAP members in the coming few weeks. 

We were informed that the period where interested stakeholders can provide comments on the appeal document to include methylphenidate in the WHO Essential Medicines List, led by Professors Brooke Molina and Philip Shaw is already open. The announcement article can be found on the IACAPAP webpage and you can view the application file (A.19 Methylphenidate – attention deficit hyperactivity disorder) here. We strongly encourage all our national association members and individual members to enthusiastically support this appeal. The WHO Essential Medicines List guides which medications LMICs make available for their populations. Millions of children and adolescents with ADHD worldwide do not have access to generic methylphenidate just because it is not considered an essential medicine by WHO. The letters of support can be addressed to emlsecretariat@who.in.

As you might remember, our ante-penultimate paragraph is always dedicated to calling your attention to an impactful paper recently published on CAMH in the scientific literature. This time, I would like to highlight two papers addressing related areas.  One published in Lancet Psychiatry two months ago (Garcia-Argibay M, et al. Evaluating ADHD medication trial representativeness: a Swedish population-based study comparing hypothetically trial-eligible and trial-ineligible individuals. Lancet Psychiatry. 2025 Feb;12(2):131-139. doi: 10.1016/S2215-0366(24)00396-1), and the other in BMJ Mental Health that also appeared in 2025 (Stringaris A, et al. Comparing apples and oranges in youth depression treatments? A quantitative critique of the evidence base and guidelines. BMJ Ment Health. 2025 Jan 19;28(1):e301162. doi: 10.1136/bmjment-2024-301162). Why do they matter and how they are related? One of the pillars of care in child and adolescent mental health is to provide evidence-based interventions. To guide us on which are those interventions, well-designed randomized clinical trials (RCT) and meta-analyses (MA) are key tools. The two papers discuss challenges in this approach in different areas of CAMH. Garcia-Argibay et al. (2025) in a thoughtful exercise review all exclusion criteria normally used in RCT in ADHD. Then, authors used data from multiple Swedish National Registers to compare patterns of response to medication treatment for patients with ADHD divided in two groups: one not fulfilling exclusion criteria used in previous RCT trials in the area and a second one with patients fulfilling those criteria (i.e., eligible and ineligible individuals).  They found significant between-groups differences in some aspects of response to medication. This calls to our attention that evidence-based data emanating from well-designed RCT might not be always applicable to our individual patients. Even more-considering how strict are inclusion/exclusion criteria in RCT assessing interventions for mental health. Stringaris et al. (2025) showed that we also need to take care when reading data from innovative MA approaches like network-MA. Reviewing RCT assessing psychopharmacological and psychotherapeutic interventions for youths with depression, the authors found enormous between-groups differences in the treatment response of controls (i.e., much higher response in psychopharmacological trails). The data indicates that controls in psychotherapeutic trials receive less intensive interventions than those offered for active conditions, what is not seen at the same amount in psychopharmacological trials. This artificially biases our attempts to compare findings from psychopharmacological and psychotherapeutic interventions for youths with depression, making us rely on evidence data emanating from comparisons between “apples and oranges”. Obviously, this is not to say that we need to abandon evidence-based data in guiding our treatments, but that we need to refine even more our skills for critical reading and to detect how data translate to individual patients in our offices. 

Finally, regarding the auditable proposed goals in the previous bulletin, they are in progress since their time frame for implementation was longer than the period between the previous and this one. Thus, we will keep them up to our next bulletin. Just as a reminder, they are: 

1.         Have all the contracts in place between the African hosting country (South Africa) and the one who will send the fellows as part of the SNF Global Center Child and Adolescent Mental Health Clinical Fellowship Program, and a date defined for the launching of this program in the first semester of 2025.

2.          Have the host country and the one which will send fellows from Asia defined.  

3.         Have the first of a series of trials/surveys for psychometric assessment of the SNF Global Center Child and Adolescent Mental Health (CAMH) Item Bank launched in the first quarter of 2025.

I hope you all enjoy reading our Bulletin. 

IACAPAP Bulletin, Issue 77