Interview with Heidi M Feldman
How has Developmental-Behavioral Pediatrics evolved since the previous edition? How has it evolved since the first edition?
The first edition of this text was truly revolutionary. It helped to define the field of Developmental-Behavioral Pediatrics. Importantly, it pulled together two strands of clinical practice and research, as reflected in the hyphenated name: developmental pediatrics, which focused on developmental disabilities, such as cerebral palsy, intellectual disability, and autism, and biological influences, such as genetics and neurobiology and behavioral pediatrics, which emphasized normal development, temperamental differences among children, parent-child interactions, and social or environmental influences on children’s development. The second through fourth editions expanded on the first edition, adding new information based on emerging evidence to improve clinical practice.
We are publishing the fifth edition almost 14 years after its predecessor. In the hiatus, developmental-behavioral pediatrics, as a subspecialty, has moved to a central position, at the heart of pediatrics. General pediatrics, which has seen a dramatic reduction in the prevalence of infectious diseases through vaccination and widespread use of antibiotics, are now on the front line for identifying children whose development is delayed or behavior is different from that of most children, and who benefit from family education and appropriate early intervention. Subspecialty pediatrics, which has witnessed a reduction in child mortality of once lethal conditions through advances in science, medicine, and technology, now considers developmental and behavioral outcomes as important indicators of treatment effectiveness and quality of care. In addition, the field continues to evolve as our understanding of both biological and environmental influences expands.
The fifth edition of the text has a new table of contents, which reflects the full integration of developmental and behavioral medicine. The material in many chapters is expanded to reflect our burgeoning knowledge. There are many new chapters. It is designed to meet the needs of a wide range of professionals across different fields of inquiry and practice.
What is the most exciting aspect of the new edition? What chapter or topic covered are you most excited about?
The interdisciplinary nature of developmental-behavioral pediatrics is well reflected in this edition. The editors are an interdisciplinary team with a broad range of training and experience. Terry Stancin PhD, is an internationally recognized pediatric psychologist. She stimulated an expansion of the section on Assessment and Management of conditions typically seen in developmental-behavioral pediatrics and pediatric psychology practice. Two other new editors with distinctive perspectives joined the team. Manuel E Jimenez MD MPH is a developmental-behavioral pediatrician with additional training in public health who conducts research on public policy and service delivery systems for children with disabilities. He brought fresh perspectives to chapters on environmental, social, and political influences on children and families. Nathan J Blum MD is an experienced developmental-behavioral pediatrician, a national leader in fellowship and interdisciplinary training, and the Project Director of DBPNet, a research consortium of developmental-behavioral pediatrics programs from 16 academic medical center. He edited many chapters on developmental-behavioral conditions, including their assessment and treatment. These three new editors joined Heidi M Feldman MD PhD, a developmental-behavioral pediatrician and developmental psychologist, and Ellen R Elias MD, a developmental-behavioral peditrician and geneticist, who served as editors of the previous edition.
The authors of the chapters similarly reflect the interdisciplinary nature of the field. Among the physician contributors are developmental-behavioral pediatricians, general pediatricians, child and adolescent psychiatrists, neurologists, and geneticists. Among the other contributors are psychologists, rehabilitation therapists, including occupational therapists, physical therapists, and speech-language pathologists, art and music therapists, social workers, and lawyers. Many chapters are authored by an experienced writer, an acknowledged national or international leader in the field, paired with an emerging leader, who would benefit from the mentorship. This deliberate strategy supports the careers of the younger authors and contributes to securing the future of the field.
Many new topics are found in this edition. The text provides expanded information on the theoretical foundations of human development and behavior; it discusses trauma, adverse childhood events and resilience across the life span. It includes updated information on mechanisms of genetic and epigenetic etiology of developmental-behavioral conditions. It covers racism and bias within medical practice. It articulates principles of psychological assessment and includes a broad array of evaluation approaches. It expands on treatment options, from attention to common factors, psychological therapy, rehabilitation, and psychopharmacology.
Each chapter of the book begins with a colorful vignette relevant to the topic, often an illustrative clinical case. These vignettes contribute to the book’s highly practical focus, emphasizing approaches to evaluation, counseling, treatment, and ongoing care. The vignettes also serve as reminders of the human dimensions of developmental, behavioral, and emotional conditions and are written to stimulate understanding and compassion.
Who will find the greatest value from Developmental-Behavioral Pediatrics? Has the audience changed since the book first published?
Developmental-behavioral pediatricians, from trainees to seasoned clinicians, will find value in this updated text. The appeal of the text extends far beyond the subspecialty. General pediatricians who share management of children with disabilities with subspecialists may find the textbook particularly relevant to their care of children with special health care needs and disabilities. Other subspecialists in pediatrics, child and adolescent psychiatrists, child neurologists, and physiatrists are likely to find the material relevant to their clinical practices.
We designed the book to have broad appeal to the non-medical professionals who are part of the interprofessional teams caring for children with disabilities and special health care needs. This group includes pediatric, developmental, and clinical psychologists; related therapists, such as clinical social workers or marriage and family counselors; and rehabilitation specialists, including occupational therapists, physical therapists, and speech-language pathologists. This book may prove useful to educators, especially educators who specialize in special education or general educators who teach children with a wide range of abilities and experiences in inclusive settings.
The book is likely to prove valuable to public health professionals, including the maternal-child health workforce, particularly because children with disabilities and special health care needs comprise about 15-20% of the population of children. Finally, the text is designed to help policy makers in government, insurance, or industry to understand children with disabilities and their families in order to make wise and compassionate policy.
What problem do you hope the future generation of your specialty will be able to solve?
Our distinctive individuality arises from a complex interaction of biological, social, environmental, and ecological forces, acting over time on an evolving organism. My greatest hope is that future generations in this specialty, armed with knowledge about the factors and with deeply held moral values, support the full participation of all individuals in a diverse and compassionate society.
Is there anything else about the book you’d like to say?
This text rests solidly on a set of values that includes humanism and inclusion. As the editors have articulated in the final post-script, we affirm the right of children, adolescents, and, for that matter, adults with disabilities and special health care needs to be included within our society and all its institutions, including family, school, workplace, and community. Simply, society benefits from diversity, and inclusion is the fair and just approach. At the same time, we honor individual differences among people. The focus of management and treatment is enhancing functioning, rather than correcting a difference. Thus, we simultaneously acknowledge that all have the right to belong and the right to be different.
About the Editor
My name is Heidi M Feldman. I am the Ballinger-Swindells Endowed Professor of Developmental and Behavioral Pediatrics at Stanford University School of Medicine.
As an undergraduate student at the University of Pennsylvania in the late 1960s, I first anticipated going into education and, specifically, special education, an avenue that seemed appropriate for young women of my generation. In my junior year, I took advanced seminars in psychology that so excited me, that I decided to switch majors, write a senior thesis, enter graduate school, and ultimately get a PhD in developmental psychology. Yet, as I was approached the end of my PhD program, I could no longer resist the strong urge to go into medicine, just at the time when medical schools began to accept increasing proportions of qualified women. I enrolled in medical school at University of CA San Diego. I naturally gravitated to Pediatrics. I was fortunate to have several professors in Pediatrics, especially Martin T Stein and Suzanne Dixon, who emphasized child development as the foundational science of Pediatrics. After residency, also at University of California San Diego, I went on to do fellowship training at Children’s Hospital of Boston in what was then called Ambulatory Pediatrics and Child and Family Development and would now be labelled as Developmental-Behavioral Pediatrics. In this emerging subspecialty, my interests in education, special education, psychology, and pediatrics integrated seamlessly. I had somehow stumbled into the path I sought all along.
After my training, I joined the faculty at the University of Pittsburgh School of Medicine and the Children’s Hospital of Pittsburgh. During my 22 years there, I built clinical program in developmental-behavioral pediatrics, launched a fellowship in developmental-behavioral pediatrics, obtained federal funding to create an interdisciplinary training program, and developed a research career that focused on the development of language, thinking and reading skills in children with a variety of conditions that put these critical skills at risk. I joined the faculty at Stanford in 2006. My focus at Stanford has been building clinical and training programs, developing a research focus on developmental neuroscience, and mentoring the next generation of leaders in developmental-behavioral pediatrics. I have been proud to serve in several national leadership roles, including President of the Society of Developmental and Behavioral Pediatrics, Chair of the Sub-board for Developmental-Behavioral Pediatrics of the American Board of Pediatrics, and inaugural treasurer of the National Academy of Distinguished Educators in Pediatrics.
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