**Developmental-Behavioral Pediatrics: The Consequences of Inbreeding on a Previously Esteemed Specialty**
Developmental-behavioral pediatrics (DBP) was formerly led by trailblazers who shaped the discipline with authoritative texts, established benchmarks, and created a unique character for the specialty. However, DBP today is disjointed, frequently misapprehended, and, sadly, at times resistant to inventive concepts. As an experienced practitioner in the field, my own career path illuminates the harmful impacts of inbreeding and seclusion within DBP, resulting in the deterioration of the specialty and a deficiency in advocacy for children.
In expansive military medical facilities, I have witnessed how retired military DBPs, all trained in that same setup, have taken my place. This cycle of training and hiring is akin to the notorious inbreeding methods of the Habsburg dynasty, where generations of closed unions caused genetic illnesses and eventual downfall. Similarly, the DBP culture at these establishments has turned inward, shunning fresh ideas and clinging to its entrenched legacy. Consequently, innovation has faltered, leaving the specialty delicate and averse to newcomers.
A fitting metaphor springs to mind—a saguaro cactus under a hundred years old, standing tall but devoid of arms, symbolizing survival without progress. This mirrors the present condition of DBP.
The trend of insularity extends beyond military institutions. My tenure at a major state university exhibited a parallel path; my successor only remained for two years before moving on, reflecting occurrences at a southwestern university where temporary budget cuts proved inadequate. Expertise in DBP was irreplaceable by generalists, and every replacement resulted in failure. The myths of cost savings unraveled, elucidating that retaining expertise is priceless and cannot be substituted. Savings are illusory when institutions disregard specialists; dysfunction merely deepens.
The essence of the issue lies in leadership. Founding DBP leaders recognized the necessity for diverse perspectives and consciously avoided hiring their proteges. The present leadership seems lacking in this wisdom, permitting the specialty to decline. Efforts to publish significant research, such as on autism—which increasingly affects children—were turned down not for scientific deficiency but because of a reluctance to confront the realities of autism care.
Without strong leadership, DBP stays in the shadows, with institutions negligent and ineffective. Mismanagement of cases and dismissing expertise are common, ensuring a field that survives yet fails to flourish.
From my encounters in the midwestern city, as well as in Ohio and Florida, the replacements for NDD instead of actual DBP professionals lacked essential dedication to intricate developmental issues like autism. Their presence symbolized institutional desperation and miscalculation.
My professional background includes seventeen peer-reviewed publications and eleven book chapters. When contrasted with the leadership credentials in certain current organizations, the disparity is striking. My knowledge and commitment were disregarded for incompetence, reminiscent of Habsburg decline—the same insular mindset cultivating frailty.
DBP is suffering as a result, much like a cactus without arms, enduring yet hindered. In the absence of innovative leadership, the field cannot advance; it remains detached, resisting new ideas, facing potential collapse.
The conclusion is unmistakable: in medicine or military, the absence of leadership leads to institutional decay. Without leaders to reclaim DBP’s essence, the specialty will continue to be fragile and obscure. Just as the Habsburgs demonstrated the perils of closed dynasties and the saguaro illustrated stunted growth, today’s DBP underscores the high cost of neglecting innovative cultivation. Only with vigorous leadership can DBP reclaim its rightful role in advocating for children’s welfare. The caution is unmistakable, and responsibility cannot be deferred.
*Ronald L. Lindsay is a retired developmental-behavioral pediatrician whose career encompassed military service, academic leadership, and public health transformation. His professional journey, detailed on LinkedIn, highlights his lifelong dedication to advancing neurodevelopmental science and fostering equitable care systems.*