Kerim Munir

John Edward Fogarty (1913–1967), known across Washington as “Mr. Public Health,” was the bricklayer-congressman who, with Senator Lister Hill, helped build the modern National Institutes of Health (NIH); he died on the morning of his fourteenth swearing-in. The Fogarty International Center (FIC), established in his memory in 1968, became a principal instrument for developing global health research capacity, training some 6,000 scientists from more than 100 nations. Born in the infectious-disease emergencies of its first era—HIV/AIDS above all—FIC deliberately widened its scope at the turn of the century to the noncommunicable diseases of low- and middle-income countries—cardiovascular disease, tobacco-related illness, and chronic conditions across the lifespan, together with mental health and neurodevelopmental disorders; within that paradigm shift, FIC’s collaboration with the National Institute of Mental Health made possible the program described here. Drawing on a principal investigator’s twenty-five-year account of FIC’s first award in Türkiye—where, in the aftermath of the 1999 earthquakes, FIC-supported research training developed alongside the country’s first National Mental Health Policy—this Perspective revisits Fogarty’s legacy as the Center again faces proposed elimination, and argues that where public trust has been strained, the remedy is accountability and reform, not the elimination of the nation’s critical global scientific arm.

The Autism Diagnostic Observation Schedule (ADOS) and its second edition (ADOS-2) have acquired a de facto “gold standard” status for reliably diagnosing autism in the United States, even though the developers themselves emphasize that the instrument should be used as part of a holistic, clinically driven developmental assessment. This narrative review is informed by diagnostic accuracy studies and the global mental health relevance of ADOS/ADOS-2 to lowand middle-income countries (LMICs) using Türkiye and the United States as point of contrast. We consider the benefits of ADOS/ADOS-2 —its contribution to standardized observation, cross-site comparability, and detailed phenotyping in research and complex clinical cases—as well as its limitations, including extensive training requirements, time-intensive administration, high kit costs, proprietary licensing, and tightly regulated translation policies. These factors substantially limit the practicality of routine ADOS/ADOS-2 use in LMICs and other resource-constrained settings, where most autistic children live. In the United States, ADOS/ ADOS-2 based assessments have become deeply integrated into specialty services and, in some regions, even informally mandated by insurers or school systems, with consequences for wait times, access, and equity. In Türkiye, autism is primarily diagnosed through clinical assessment by child and adolescent psychiatrists without formal requirements for ADOS/ADOS-2, which expands clinical autonomy but results in less standardization and weaker cross-site consistency. We argue that treating the ADOS/ ADOS-2 as a universal diagnostic “gold standard” is unachievable given the global public health resource constraints in LMICs. Autism diagnosis, service eligibility, and research, especially in such a poor resource setting will require scalable, open-access, and cost-effective tools for both routine care and population-level studies.

The legacy of the Soviet childcare system has contributed to persistently high rates of child institutionalization across many countries in Eastern Europe, the Caucasus and Central Asia. Although countries throughout the region have adopted deinstitutionalization and family reunification policies, most programs provide limited support to address children's mental health needs or family functioning during the critical transition from institutional care to family and community reintegration. This study compares and optimizes 3 prevention and early intervention approaches to improve mental health outcomes for children with a history of institutional care. Using the multiphase optimization strategy, the study experimentally evaluates which interventions-family strengthening, trauma-focused child mental health services, or economic empowerment-yield meaningful improvements in child mental health. This randomized clinical trial used a full 2³ (2×2×2) factorial design. A total of 439 children aged 7 to 12 years with a history of institutional placement and subsequent family reunification, along with 305 primary caregivers (parents or kin caregivers), were recruited from the 3 largest cities in Azerbaijan. Participants were randomly assigned to 1 of 8 experimental conditions, each receiving different combinations of the 3 interventions plus usual care. The family strengthening intervention consisted of a 12-session multifamily group program designed to improve parent-child relationships and supportive parenting. The asset-based economic empowerment intervention included opening a Matched Child Development Account with a US $50 seed deposit, 2:1 matched savings up to US $20 per month, and an 8-week financial education program for caregivers and children. Data on child mental health outcomes (self-esteem, depression, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, internalizing and externalizing problems), cognitive and social processes (executive functioning, working memory), social and academic functioning (eg, grades), family functioning, and economic well-being were collected at baseline, 1-year, and 2-year follow-ups using multi-informant surveys (child, caregiver, and teacher reports), digital cognitive tasks (Wechsler Intelligence Scale for Children, Fifth Edition and Cambridge Neuropsychological Test Automated Battery), and clinical assessments. Recruitment occurred between 2022 and 2023, with 2-year follow-up data collection completed in 2025. Intervention effects analyses are ongoing and are expected to be completed in 2026. This study will identify the most effective and efficient combination of interventions to support the mental health of children reintegrating from institutional care. The findings are expected to provide important evidence to support deinstitutionalization and family reunification initiatives in the region and strengthen the global evidence base on effective, scalable community-based interventions addressing multilevel determinants of mental health among at-risk children in low- and middle-income countries.

BACKGROUND The legacy of the former Soviet system of childcare has made post-Soviet countries report some of the highest rates of children living in institutions to this day. Often referred to as “social orphans”, many of these children have at least one living parent but are placed in institutions voluntarily by their parents, primarily for socio-economic reasons, including poverty. Given the challenges associated with institutional care on children, including its impact on long-term developmental and mental health outcomes, many countries in the region are implementing deinstitutionalization policies with a strong focus on family reunification. To further support children and families during this transition, these efforts could be strengthened by providing comprehensive support for children's mental health and improving family functioning. OBJECTIVE This protocol outlines the National Institute of Child Health and Human Development-funded Optimizing Prevention Approaches for Children Reintegrating from Orphanages in Azerbaijan study. METHODS This randomized controlled trial employs the Multiphase Optimization Strategy (MOST) to test the effectiveness of three community-based intervention components—family strengthening, child mental health services, and economic empowerment in the form of Child Development Accounts (or Matched Child Saving Accounts)—on improving the mental health outcomes of children with a history of institutional care in the country. RESULTS Recruitment and data collection for this study was complete as of June 2025. The study enrolled 436 children and 305 of their caregiver participants from the three largest cities in Azerbaijan. The majority of caregivers are female (92.46%), predominantly mothers and grandmothers, and families exhibit significant economic instability. Over half of children (52%) exhibit depressive symptoms, nearly 40% exhibit symptoms of PTSD, and over one-third exhibit symptoms of ADHD. Analysis of baseline data suggest that economic instability, parental stress, and family environment appear to play important roles in child outcomes among this population. Specifically, economic deprivation is positively associated with parental distress (β = 0.38, p < .001) which, in turn, was negatively associated with a supportive family environment (β = -0.69, p< .001). A more supportive family environment was linked to fewer child internalizing problems (β = -0.54, p < .001). CONCLUSIONS These findings provide important evidence to support deinstitutionalization and family reunification initiatives in the region and strengthen the global evidence base on effective community-based interventions addressing multilevel determinants of mental health among at-risk children in low- and middle-income countries. These efforts are important because most of the mental health challenges that show up in older age could be prevented if children are intervened on early in their life. CLINICALTRIAL The study is registered with [ClinicalTrials.gov] [NCT05396625]; [https://clinicaltrials.gov/study/NCT05396625]

Catatonia is a transdiagnostic syndrome observed across psychiatric, medical, and developmental disorders. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), it is not classified as a stand-alone disorder but as a specifier or syndrome that accompanies other conditions. This review examines the current state of knowledge on catatonia in children, adolescents, and individuals with neurodevelopmental disorders, particularly autism spectrum disorder and intellectual developmental disorders. Several DSM-5-TR criteria overlap with baseline behaviors in these populations, creating a risk of false-positive diagnoses. To improve specificity, a refined framework that requires at least 2 of 5 core signs—stupor/immobility, new-onset mutism, posturing or catalepsy with waxy flexibility, severe negativism or withdrawal, and stimulusindependent excitement/agitation—each demonstrably new or worsened from baseline is proposed. The Bush–Francis Catatonia Rating Scale and its Pediatric Catatonia Rating Scale adaptation is reviewed, highlighting their limitations in developmental contexts. Catatonia typologies relevant to neurodevelopmental conditions are also outlined, the cautious use of the lorazepam challenge test is discussed, and converging neurobiological evidence implicating gamma-aminobutyric acid, glutamate, dopamine, cortico-striato-thalamo-cortical circuitry, and immune mechanisms is summarized. Future directions include psychometric validation of pediatric tools, empirical item reduction, integration of biomarkers, and treatment prediction studies to refine developmental assessment and clinical care. Cite this article as: Munir KM. Rethinking catatonia in neurodevelopmental conditions: Toward a refined typology and research framework. Psychiatry Clin Psychopharmacol. 2025;35(4):315-321.

Advancing doctoral and postdoctoral international bioethics training in low-and-middle income countries (LMICs) is essential to address the emerging and reemerging healthcare needs of local populations. The COVID-19 pandemic underscored the need for sustenance of global collaboration and rapid adaptability in the future to further prioritize research frameworks to benefit LMICs. Thus, the purpose of the manuscript is to share the successes, challenges, and future considerations of building bioethics research capacity in seven federally funded training programs supported by the Fogarty International Center of the National Institutes of Health D43 mechanism. We advocate for continued investment in training programs recognizing that it requires committed time and effort, specialized funding opportunities, cultural sensitivity, and interdisciplinary faculty support both domestically and internationally. This investment supports cross-disciplinary collaboration, enhances the ethical conduct of research and recognizes the importance of context-sensitive research that generates evidence-based data for global solutions.

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition influenced by a myriad of developmental, biological, psychological, and socio-demographic factors. The ELENA cohort seeks to delineate the intricate interplay of these factors, facilitating the identification of risk factors and the development of targeted interventions. This paper emphasizes the clinical profiles of children and outlines key findings from a biopsychosocial perspective. The ELENA cohort, a multicenter initiative across French regional centers, conducted a systematic prospective analysis on children newly diagnosed with DSM-5 ASD between 2012 and 2019. This encompassed direct assessments and parent-reported questionnaires covering a broad spectrum of developmental, biological, psychological and socio-demographic measures. Embedded case–control studies further examined risk and protective factors, alongside specific environmental and psychosocial influences during pregnancy and early childhood. A subset of participants also contributed biospecimens, with data enhancement via linkage to French National Administrative Healthcare Databases. The study unveils baseline clinical characteristics for 876 children, average age 6 (SD ± 3.3) previously unreported in protocol descriptions. It highlights the study’s developmental biopsychosocial approach and its novel findings on children’s socio-adaptive functioning, ASD severity, comorbidities, quality of life and interventions. Employing developmental biopsychosocial insights offers a promising pathway to integrating health, social care, and experiential insights, ultimately aiming to enhance the future well-being and outcomes for children with ASD. This approach underscores the need of a holistic, interdisciplinary strategy in encouraging and supporting the ASD community.

The global burden of psychiatric care of intellectual disabilities/intellectual developmental disorders (IDD) remains unaddressed in general. The aim of this study was to explore the knowledge and attitudes of general adult psychiatry practitioners in Turkiye. A self-administered cross-sectional survey was conducted to gather information regarding the medical and postgraduate training experiences, views, and attitudes towards IDD (n = 265). Among the respondents, 47.9% reported receiving some training on IDD in medical school, and 75.4% during residency training. Almost all respondents felt strongly that further specialty training would be beneficial. Majority of respondents indicated that they would be willing to see patients with IDD despite finding it difficult to diagnose/manage their co-occurring mental disorders. The most common mental health problem endorsed was ‘challenging behaviour’. The most prescribed psychotropic medication class was antipsychotics. The results of the study highlight need for training, normalization, and enhancement of community inclusion in IDD.