“Let’s Fly.” Captain Burnham’s words on the USS Discovery were more than a command. They were a declaration of trust, of forward motion, of refusing paralysis.
That is the question before us now: What happens when children with disabilities grow up?
For decades, pediatrics treated disability as a childhood condition. The grant language, the fellowship training, the systems of care, all built on the assumption that disability ends at eighteen. But children with disabilities do not disappear. They grow into adults with complex needs. And medicine, blinded like Harold at Hastings, has refused to follow them.
The abandoned adult
The truth is stark. When children with disabilities grow up, the system collapses around them.
- Internal medicine and family practice: They do not know how to handle adults with disabilities. Training stops at childhood. Continuity evaporates. The adult patient is invisible.
- Psychiatry: Already overwhelmed. With waves of self-diagnosed ADHD and ASD, the default response is medication. No cognitive-behavioral therapy. No coping mechanisms. Just prescriptions thrown at the problem.
- Pediatrics: Will not touch it at all. The specialty that claimed ownership of disability care abandons its patients at the threshold of adulthood.
The result is abandonment disguised as specialization. Adults with disabilities are left to improvise, to self-diagnose, to turn to AI because the human system refuses to follow them.
The ethical reckoning
Is it ethical to leave adults with disabilities to self-diagnose with AI? The answer is no.
AI can provide information, but it cannot replace continuity of care, lived expertise, or human accountability. It cannot prescribe coping mechanisms, build therapeutic alliances, or stage the kind of trust that medicine once promised.
The reliance on AI is testimony to resilience, adults and families refusing silence, improvising with whatever tools they can find. But it is also indictment. It proves that medicine has failed to grow up with its patients. Internal medicine does not know how to handle them. Psychiatry is overwhelmed. Pediatrics refuses to follow.
The ethical failure is not in the use of AI. It is in the abdication that makes AI necessary. Systems collapse, and the Cassandra prophecy repeats: foresight ignored, harm endured.
The call to action
The question is not whether children with disabilities grow up. The question is whether medicine will grow up with them.
We need a new model: disability care across the lifespan.
Pediatric foresight must extend into adult medicine. Internal medicine and family practice must be trained to handle adults with disabilities, not treat them as invisible. Psychiatry must move beyond medication triage, embedding coping mechanisms, therapy, and continuity. Pediatricians must stop abandoning their patients at eighteen, and instead stage coordinated transitions into adult systems.
Training programs must embed transition planning. Fellowship curricula must include adult disability medicine. Interdisciplinary continuity must become the standard, not the exception. Otherwise, the Cassandra prophecy repeats: foresight ignored, harm endured, vindication delayed.
The HOPE Project: Never condemn without a solution
Critique without blueprint is just lament. Testimony must carry solutions. That is why the Madigan HOPE Project matters.
HOPE was not theory. It was practice. A nurse practitioner saw the adults with disabilities. I managed the psychotropic medications. Together, we built continuity where pediatrics refused to tread. The ethos of developmental pediatrics was carried into adulthood, proving that systems can adapt if they choose to.
HOPE showed that women with disabilities could be seen, treated, and respected. It demonstrated that psychotropic medication management could be staged responsibly, not abandoned to overwhelmed psychiatry. It proved that interdisciplinary care could cross the artificial boundary between pediatrics and adult medicine.
The irony was sharp: The American Pediatric Association passed on the project for the Health Care Delivery Award because it was “adult, not pediatric.” As if children with disabilities do not grow up. That refusal was pediatrics’ arrow-in-the-eye moment. But the project itself was vindication.
HOPE is the model:
- Continuity across the lifespan.
- Integration of medical and behavioral care.
- Recognition of women’s health needs.
- Partnership between clinicians and families.
Never condemn without a solution. HOPE was the solution. It remains the proof that foresight can become practice, that prophecy can become blueprint, that Cassandra can become Odysseus.
Closing cadence: Let’s fly
“Let’s Fly.” Captain Burnham’s words on the USS Discovery were more than a command. They were a declaration of trust, of forward motion, of refusing paralysis.
That is the call before us now. Children with disabilities grow up. They do not vanish at eighteen. They do not dissolve into categories medicine refuses to see. They become adults with complex needs, and the system must grow up with them.
We have condemned the failures: pediatrics blinded by its own definitions, internal medicine untrained, psychiatry overwhelmed. We have named the indictment: abandonment disguised as specialization. We have offered the solution: continuity across the lifespan, embedded in projects like HOPE.
Now the cadence must shift. Not lament, but propulsion. Not prophecy alone, but blueprint enacted. Cassandra foresaw. Odysseus endured. Homer recorded. Burnham commands: Let’s Fly.
It is time for medicine to take the helm, to trust its crew, to chart the uncharted. To stop abandoning adults with disabilities and instead stage continuity, compassion, and conscience across the lifespan.
The question is not whether they grow up. The question is whether we will fly with them.
Ronald L. Lindsay is a developmental-behavioral pediatrician.
