Close enough.

An 80-year-old woman bursts into the men's day-room at the retirement home. She holds her clenched fist in the air and announces, "Anyone who can guess what I have in my hand can have sex with me tonight!"

An old man in the back shouts, "An elephant?"

The woman thinks for a moment and says, "Close enough!"

While "close enough" in this instance might have made all the difference, for parents of children with special healthcare needs, "close enough" is not often close enough.

"Close enough" might be justification for payors and policy makers to alter windows of eligibility, reduce the number of days of active treatment, change the criteria of anything that is promising, and reconfigure the rates that allow Tab A to fit into Tab B, but in truth, it's truly not close enough.

"Close enough" is not a statistical term like the "intersection of events" or the "goodness-of-fit test" (two unlikely sounding statistical terms); nor is it a genuine epidemiological term like the "standard gamble" or "McNemar's test for dependent proportions" (try dropping either of those two at the next cocktail party). "Close enough" is one of those behind closed doors references that the "change artists" (not to be confused with the change agents) utter under their breaths when they've exhausted ways to make the "close enough" become closer.

If only human genetics would subscribe to the allowance of "close enough." The appearance of two X chromosomes and one Y chromosome would be considered "close enough," and folks with Klinefelter's syndrome would be put back into the totally normal gene pool. Take cystic fibrosis; there are over 700 different mutations on different genes that will cause the development of the disease to varying degrees. One would think that Mother Nature would declare "close enough" to normal on any one of these 700 culprits and just let the lungs do what they're supposed to do. With sickle cell anemia, the disorder is caused by having just one nucleotide misspelled, but it's enough to alter the red blood cells and play havoc with the cells trying to navigate their way through blood vessels. Heck, any English teacher grading a term paper would say "close enough" and give a passing grade if there was only "one" misspelled word. So "close enough" just doesn't cut it in the unforgiving, uncompromising world of gene coding.

For years pediatricians thought and exclaimed "close enough" when frantic parents questioned their children's confusing behavior. Parents heard the echo, "He's close enough to normal; bring him back in another six months." The myth of "close enough" delayed the fruits of early intervention for thousands of children with autism. Children who are now frantically playing "catch up" and who apparently are not quite "close enough" to go unnoticed.

For years, insurance companies denied continuation of needed physical therapy sessions for children with cerebral palsy, declaring that the allowable eight sessions were "close enough" to what was needed to show progress.

For years, state institutions flourished while state administrators declared that 12 guys with mental retardation living in a cottage was "close enough" (to real life in the community).

For years, there seemed to be complacency with the idea that people with Down syndrome living to the ripe old age of 19 was "close enough" to the longevity everyone else enjoyed.

"Close enough" is close enough to the slippery slope of words like "one standard deviation," "least restrictive," and "as deemed necessary." In many instances, "close enough" has blurred the lines of close enough.

"Close enough" has several relatives. It can be a derivative of "too close for comfort" or "too close to call," and both can haunt the exceptional parent. The idea that something or someone can be "close enough" to deprive, "close enough" to limit, or "close enough" to annoy is close enough to despair. The philosopher in me kicks in when we ponder when "close enough" becomes "far enough." "Far enough" can and has become the preferred distance between you and a group home. "Far enough" can and has become the response to the resources allotted to special education. "Far enough" can and has become the cry of the naysayers who dismiss the growing number of rights provided to people with disabilities.

And if anything I can hold in my hand can ever be considered "close enough" to an elephant, then perhaps we're not up close enough. To thrive as exceptional parents none of you can ever feel that what has been achieved is "close enough."

When it comes to advocating for your children, there is no room for "close" or the notion of "enough."

Rick Rader, MD, Editor-in-Chief

Director, Morton J. Kent

Habilitation Center

Orange Grove Center, Chattanooga, TN