To the Editor: My prematurely born adult son is retarded and autistic. He has cerebral palsy, severe vision impairment, and hydrocephalus. He cannot eat, dress, use the toilet, or leave the house without assistance. He will need constant supervision for the rest of his life. Yet, according to the criteria of Dr Saigal and colleagues,1 he is making a “successful transition to adulthood.”
He became a high school graduate when he “aged out” of the relevant special education programs and is now pursuing his “postsecondary education” at a day school for the disabled. With the help of an attendant, he could enroll in community college classes and thus be counted as “in college.” A sheltered workshop job would put him among the ranks of the “permanently employed.” Group home placement would qualify as “living independently.”
Saigal et al suggest that their data on transition to adulthood “should provide hope to new parents” of extremely low-birth-weight (ELBW) infants. However, physicians should carefully consider, and share with parents, this study's criteria for adulthood transition. They should also take into account the many problems inherent in self-reports on which this study, and other studies involving this cohort, have been based.2 They should emphasize to parents that policies allowing near-automatic graduation for the disabled are beginning to change, at least in the United States. California, for example, will soon require passage of a high school exit examination as a prerequisite for a diploma.3 Nearly 80% of students receiving special education fail to pass this 8th-grade-level test.4
Unfortunately, we still do not have an answer to the important question of how many ELBW adults are living independently, free of parental and societal subsidies and supervision.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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