Dear Sir or Madam,

I write with regard to sharing my experience of last year’s attendance at the European Society for Child and Adolescent Psychiatry (ESCAP) 2025 Congress.

ESCAP, a not-for-profit association promoting the mental health and wellbeing of children, adolescents, and their families (European Society for Child and Adolescent Psychiatry website 2025), organizes a biennial congress, in different host cities (ESCAP Events Congress website 2025). Last summer, it was held in Strasbourg, France, with 185 symposia, 316 oral presentations, 36 workshops, and 293 posters (ESCAP 2025 Congress In Strasbourg 2025). The three-day event covered both updated guidelines and areas for future research and innovation in diagnostics and therapeutics for children and adolescents. Topics of interest discussed included complex cases, emerging conditions, the use of artificial intelligence and other modalities of information technology for the delivery of psychotherapy and management strategies implemented in developing countries. Participants were given the option of attending several parallel sessions, offering a wide range of topics. Several of particular relevance for clinicians were those covering new and revised treatment strategies of common pediatric conditions including ADHD and eating disorders, as well as physical comorbidities such as metabolic syndromes and the cardiac channelopathies, for example, Long QT interval syndromes and Catecholaminergic Polymorphic Ventricular Tachycardia.

Our esteemed colleague Prof Fiona McNicholas and members of her group shared details of ethical issues pertaining to the role of parents in the doctor–young person relationship, within the context of autonomy, involuntary treatment in approved in-patient CAMHS centers as well as court orders and legal involvement. The latter is of particular relevance for example, where there are disagreements between parents and healthcare professionals and in cases where children are in care of the State – key areas for addressing in the professional development of any trainee in Pediatric Psychiatry. Nonetheless, a salient takeaway point from this session was that parents have significant rights in making medical decisions for their children. However, when it comes to Irish Law, the family unit is central and the standard of practice focusing on the best interest of the child usually trumps respect for wishes (of child or parent).

Next, the impact of climate change on mental health in children was highlighted, particularly focusing on Climate Change Anxiety in kids. Though the presentation focused on managing the condition as a form of grief (which may not fall within the remit of many CAMHS services, but rather Primary Care), it may still be important for us to appreciate its features. However, what was interesting was learning how collective action and agency to prevent climate change may in itself, alleviate this form of anxiety (Schwartz et al. Reference Schwartz, Benoit, Clayton, Parnes, Swenson and Lowe2022). It was also suggested that effective coping strategies such as meaning-focused and problem-focused approaches that foster hope, can promote resilience in affected children.

The theme of occupational stress in child and adolescent mental health was well covered by our other esteemed colleague Prof Elizabeth Barrett. Here, she explained the importance of Balint and Reflective Groups (Kjeldmand and Holmström Reference Kjeldmand and Holmström2008) and Schwartz Rounds (Silke et al. Reference Silke, Rushe, Keating, Thurstan and Barrett2019), as well as training facilitators. Dr Ashley Liew from the Evelina London Children’s Hospital and South London and Maudsley NHS Foundation Trust, provided insight into “Corridor Care Conversations” which allows for therapeutic reflection on interactions and relationships. Such practices have potentially been useful in situations of moral distress during the Covid-19 pandemic (Rimmer Reference Rimmer2021).

Most of us are aware of the lack of resources and staff shortages in CAMHS in parts of Europe (Shamim et al. Reference Shamim, Sundhar and Panesar2024). Mr. Tom Osborn, CEO and co-founder of the Shamiri Institute in Kenya, addressed the audience on “task-shifting” practices. In a country where there are only 3 Consultant Child and Adolescent Psychiatrists, it has been necessary to implement a model whereby 18 to 24 year old youths are trained as lay providers, providing simple “low-touch” interventions in groups, under supervision. Though the situation in Ireland as well as the rest of Europe is different, we can learn from this model and consider analogous strategies in terms of providing more autonomy and empowering other allied mental healthcare staff.

Prof Edmund Sonuga-Barke discussed his team’s newly innovative research program “Regulating Emotions – Strengthening Adolescent Resilience (RE-STAR)” aimed at constructing a framework which enables youth with diagnoses such as ADHD and/or Autism to not just participate in, but rather become co-researchers themselves, where they may be able to impact the conduct and goals of research (Sonuga-Barke et al. Reference Sonuga-Barke, Chandler, Lukito, Kakoulidou, Moore, Cooper, Matejko, Jackson, Balwani, Boyens, Poulton, Harvey-Nguyen, Baker and Pavlopoulou2024, RE-STAR https://www.kcl.ac.uk/research/re-star). There is probably never a better time for such strategies especially of late, when there appears to be a paradigm “flip” from “cognitive dysfunction” to “motivational function,” and also from “disorder” to “diversity.”

In terms of the non-pharmacological management of ADHD, it is no secret that Parent Management Training (PMT) remains an effective tool. As many of us will be aware, PMT is an evidence-based intervention that has been proven effective in treating children with behavioral problems in general (Chanpen et al. Reference Chanpen, Chaiudomsom, Jeerasup, Inta, Thongseiratch, Thanaariyapaisan, Khongpiboonkit, Hataiyusuk, Ayudhya, Atsariyasing and Pornnoppadol2026) as well as more specifically, externalizing behavior disorders such as ADHD (Döpfner et al. Reference Döpfner, Görtz-Dorten, Häge, Handermann, Sulprizio, Hellmich, Vogel, Ruhmann, Althen, Karus and Banaschewski2025). However, a new form, digital PMT (d-PMT) is being investigated for efficacy in conjunction with pharmacological and psychological interventions, and this was highlighted in a symposium. d-PMT is a mode of PMT involving technology-assisted or internet-based parent training that was developed as a result of constraints such as accessibility, high cost, and scarcity of human resources associated with more traditional in-person PMT (Chanpen et al. Reference Chanpen, Chaiudomsom, Jeerasup, Inta, Thongseiratch, Thanaariyapaisan, Khongpiboonkit, Hataiyusuk, Ayudhya, Atsariyasing and Pornnoppadol2026). There are several proprietary d-PMT programs, for example, hiToco®. Results from a study by Döpfner and colleagues indicate that d-PMT (specifically the hiToco® version) may improve gaps in overall PMT techniques and may foster multimodal treatment of ADHD in children along with standard treatment (Döpfner et al. Reference Döpfner, Görtz-Dorten, Häge, Handermann, Sulprizio, Hellmich, Vogel, Ruhmann, Althen, Karus and Banaschewski2025). However, more research is required in order to investigate the efficacy of this and other forms of d-PMTs.

Our colleagues, Dr Sinead Murphy and Dr Hugh O’Marcaigh discussed the establishment of a pediatric liaison service for complex cardiology cases such as those with Long QT interval syndromes and Catecholaminergic Polymorphic Ventricular Tachycardia. It was highlighted that a significant proportion of these patients have an impacted quality of life, whereby they experience less than average expected play and activity levels, that is, “prescribed exclusion” of activities such as running, swimming, and others to name a few. This has a major impact on mental health. Their group is currently focusing on research into the prevalence of mental health disorders and neurodevelopmental disorders in channelopathies as well as the course of illness with and without treatment, psychoeducation and psychological interventions. The ultimate goal is to develop future treatment algorithms and protocols, for example, in patients with Long QT interval syndromes with very high QTc and a diagnosis of ADHD.

It may seem somewhat ironic to have to travel to France, in order to learn of details of our National Clinical Programme for Eating Disorders which were shared by McNicholas and colleagues. Details of the National Clinical Practice Guidance of the management of pediatric patients with Anorexia Nervosa (AN) were shared. The group also provided updates to therapeutic research regarding psychopharmacological and psychological treatments (Costandache et al. Reference Costandache, Munteanu, Salaru, Oroian and Cozmin2023; Fornaro et al. Reference Fornaro, Mondin, Billeci, Fusco, De Prisco, Caiazza, Micanti, Calati, Carvalho and de Bartolomeis2023). Interestingly, novel therapeutic agents being investigated in targeting core behaviors in AN include ketamine and psychedelics (Kirchberg et al. Reference Kirchberg, Pinson and Frank2024).

Physical health and diet was also a major theme, especially around obesity, diabetes, and other metabolic syndrome related disorders that are consequential to the long-term use of medications such as antipsychotics and other psychotropics. We were provided with draft guidelines on the commencement of metformin in young patients with obesity, high risk of diabetes and hyperlipidemia who are already taking or commencing clozapine or olanzapine and remaining on these in the long term (Carolan et al. Reference Carolan, Hynes-Ryan, Agarwal, Bourke, Cullen, Gaughran, Hahn, Krivoy, Lally, Leucht, Lyne, McCutcheon, Norton, O’Connor, Perry, Pillinger, Shiers, Siskind, Thompson, O’Shea, Keating and O’Donoghue2025). Likewise, draft guidelines on the choice of initial antipsychotics for treating females with First-Episode Psychosis were discussed – the focus being on agents that have the least potential for exacerbating hyperprolactinema and cardio-metabolic side effects. From a dietetic point of view, evidence and opinions about the role a Mediterranean Diet plays in the mental health and wellbeing of children were illustrated, as it is believed that this type of diet has a protective effect against ADHD in children (Camprodon-Boadas et al. Reference Camprodon-Boadas, Gil-Dominguez, De la Serna, Sugranyes, Lázaro and Baeza2025; Darabi et al. Reference Darabi, Vasmehjani, Darand, Sangouni and Hosseinzadeh2022) and depression in adolescents (Zielińska et al. Reference Zielińska, Łuszczki, Michońska and Dereń2022). Apart from diet, the role of physical activity (PA) in child and adolescent mental health was discussed, with prominent examples of studies conducted. One such included a scoping review of PA interventions which aimed to explore the extent of this form of intervention in CAMHS, as well as assess both mental and physical health outcomes (Haran et al. Reference Haran, Killeen, Smyth and McNicholas2024). Results as per Haran and colleagues suggested that PA interventions not only improve mental health in youth, but can also be effective and low risk adjunctive therapies in child and adolescent psychiatry. Furthermore, short term physical benefits have been observed.

Overall, the 2025 ESCAP Congress was very informative and offered an array of research and guideline updates, whilst providing a sense of direction in which the future of Pediatric Psychiatry practice is progressing. These developments would be considered essential knowledge for any trainee in Child and Adolescent Psychiatry, not just in terms of improving services and practices but also from a perspective of gaining appropriate skillsets to conduct research in this branch of mental health. The next congress will be held in Athens in 2027. See you there!

Yours sincerely,

D. Antoine Lachmansingh.