Planning for Every Possibility

Because Alex deals not only with autism but also anxiety, he relies heavily on schedules and carefully crafted plans to deal with a world that can easily overwhelm him. After months of not wanting to go places, recently he has finally overcome many of his fears about leaving the house. However, Ed and I must work together in tandem to make sure everything goes smoothly, which requires preparation on our part for every eventuality to make sure Alex’s outings are pleasant and stress-free. Failure to complete the necessary tasks could mean an anxiety attack for Alex, or even worse, a regression where he refuses to leave the house for weeks or even months.

Since last summer, with the guidance of Alex’s doctors, the dosages of four medications he takes have been reduced, and one has been completely eliminated. While this is a wonderful testimony to the progress he has made, the healing God has provided, and the benefits of behavioral and music therapies, one noticeable side effect has been increased sensory issues, which are common in autism. Most notably, his appetite, which has always been excellent, has decreased because he tells us that he doesn’t like the taste, smell, and texture of some foods. In addition, like many with autism, he is bothered by sound sensitivity now, something he had overcome many years ago. Besides covering his ears, he will often lower the television volume or complain that music is too loud. Consequently, we need to take these sensory issues into consideration when we take him places where sensory overload could be a problem.

Although we tease Alex that he is like the fairy tale character Goldilocks, who keeps looking until she finds what is “just right” for her, Alex isn’t intentionally picky. His heightened senses mean that bath water must be neither too hot nor too cold and volume must be neither too soft nor too loud. Going places this winter caused issues for him not only because he deemed the temperatures too cold, but also because the wind bothered him in how it felt and sounded to him. Trying to get Alex past his issues about leaving the house meant showing him that we understood his concerns and reassuring him that we would make outings as comfortable as possible for him.

One of the first issues we must consider in planning outings with Alex is time. He is especially conscious of time, relying on his watch and daily schedule to keep him calm. If we are going someplace, he needs to know when we are going, how long we will be gone, and what time we’ll be home. Whenever possible, we schedule appointments around the crucial times of his daily routine: mealtimes, bath time, and when his beloved game shows are on television. Thanks to DVR, we can tape any television broadcasts Alex might miss if he goes places, and making sure these shows are available for later viewing is one of Ed’s main responsibilities in this process of getting Alex to leave the house.

In addition, Ed acts as the enthusiastic game show host in convincing Alex to choose to go places. In our own version of Let’s Make a Deal, Ed has figured out all the tricks to get Alex to pick the unknown prize behind door number one. By reassuring Alex that altering his sacred daily routines will be worth the sacrifice, Ed makes him willing to venture out into the world. Because Alex trusts Ed, he usually buys into the persuasive techniques and agrees to the offer of an outing.

On the other hand, my main role is to gather any items Alex may decide he needs while we are gone. In case he gets thirsty or hungry, we bring along a drink in a sports bottle and a snack for him. In case he gets chilled in the summer, we take along a jacket. If his lips feel chapped, I carry lip balm in my purse for him. If mosquitoes are out, I have bug bands, wristbands that repel insects, for him to wear. If it’s too sunny, we have a ball cap for him to wear, and fortunately, the Transitions lenses in his glasses automatically darken like sunglasses. In case his hands get dirty, I carry wet wipes for him to clean them easily. When he was younger, I used to carry a change of clothes, too, in case he spilled something on them. Of course, mothers of young children also travel with all these items; however, one doesn't expect this need to continue when the child is twenty-six years old.

The newest addition to my list of things to bring is a pair of headphones to muffle sounds that bother Alex. While some children with autism always travel with headphones, we have not needed them until recently. Even purchasing those headphones required the “just right” mentality: not too loose and not too tight, not too big and not too small. And, in case he refused to wear them after all those considerations, they were not too expensive, either. After examining numerous pairs, we found the ones we thought were “just right” and were even able to find them in red, Alex’s favorite color, which was another good incentive for him to wear them.

After I have assembled everything Alex might need and Ed has sold him on going, we still have some reassuring to do. We have found that giving Alex too much time to think about things can give him opportunities to fret. Therefore, spontaneity often works better. Once we decide we’re going, we can’t wait too long, or he may change his mind. In addition, we’ve found that we can’t overwhelm him with too many choices: two is usually a good number of options to give him. Otherwise, he will respond with, “What would be good?” That translates to, “I don’t want to make a decision; please stop asking me questions!” After we get in the car, Alex also needs reassurance about the weather, especially if it’s too hot or too cold, or if it’s too windy, or if it might rain, or if there will be thunderstorms. Even though I will tell him that the weather is fine, apparently he doesn’t trust my meteorology knowledge and requires true confirmation from Ed that the weather is fine before we can go on our merry way.

Once we have arrived at our planned destination, we also know that we need an escape plan in case Alex becomes overwhelmed. Ed and I have often joked that we could work with people in the Witness Protection Plan because over the years we have become skilled in helping Alex get out of any public place unnoticed when he has suddenly wanted to leave. To make this easier, we always choose aisle seats in the back, know where exits are located, make sure we know where our car is parked, and look for signs that Alex has had enough. Knowing that anxiety can strike at any time, we always remind Alex that if he needs to leave at any time, we will take him home. (This also explains why we usually choose activities for him that are free or inexpensive.) If we need to make a hasty retreat, we are ready to do so at a moment’s notice.

Fortunately, our planning, experience, and cooperative efforts have paid off this summer. We have been able to take Alex walking on nature preserve trails, shopping at various stores, playing video games at the local family fun park, seeing exhibits at the county fair, and enjoying music at outdoor concerts. Certainly, the opportunity to experience various community outings is important for Alex, and we are pleased that he is willing to overcome his fears and sensory issues to try going different places. The rewards for our careful planning and preparation come when we see Alex smiling and having fun and even, as he did after a concert in the park last week, proclaiming that he liked it “one hundred percent!” Clearly, our efforts were a success, and we are thankful that Alex can enjoy life’s simple pleasures.

“Commit your actions to the Lord, and your plans will succeed.” Proverbs 16:3

Allergies and Autism

According to a recent study, food allergies are much more common in children with autism than in typical children. In the article “Kids with food allergies are twice as likely to have autism,” published online in Science News on June 8, 2018, Aimee Cunningham references a study published online in the June issue of JAMA Network Open. [To read this article, please click here.] This research used information from the U.S. National Health Interview Survey from 1997-2016 that included nearly 200,000 children from ages 3-17, 1868 of whom had autism. [To read the research article, “Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children,” please click here.]

Of those children with autism, 216 of them, or 11.25%, also had a food allergy, whereas only 4.25% of the typical children had food allergies. In addition, children with autism were found to also be more likely to have respiratory allergies or allergic skin conditions, such as eczema, than typical kids. Specifically, 18.73% of the children with autism had respiratory allergies, such as asthma, as compared to 12.08% of typical children. In addition, 16.81% of children with autism had skin allergies, while 9.84% of typical children had skin allergies.

In breaking down the groups of children with autism into age, gender, and ethnicity, the researchers noted some interesting trends. Skin allergies were less common in girls than in boys, and older children with autism (ages 12-17) were also less likely to have skin allergies. Respiratory allergies were also less common in girls than in boys, and white children with autism were less likely than other ethnicities to suffer from respiratory allergies. In addition, younger children (ages 3-11) were less likely to deal with respiratory allergies. However, statistics for food allergies in children with autism were significant for both genders, all ages, and all ethnicities.

While the research did not examine potential causes for the link between autism and allergies, the data suggests a connection between autism and autoimmune responses. One of the study’s co-authors, epidemiologist Wei Bao of the University of Iowa, states, “The causes of ASD remain unclear.” However, he suggests three possible scenarios: food allergies may contribute to autism, autism may contribute to food allergies, or some other factor may cause both food allergies and autism concurrently, such as immunologic dysfunction, notably autoimmune disorders and frequent infections, often seen in autism.

In discussing the immune function connection with autism, the authors suggest, “It is possible that the immunologic disruptions may have processes beginning early in life, which then influence brain development and social functioning, leading to the development of ASD.” Further, they note, “In addition, there may also be shared genetic and nongenetic risk factors influencing both allergy and ASD.”

Moreover, the researchers propose a link between autism and the gut-brain-behavior axis. Referencing the higher incidence of both gastrointestinal issues and food allergies found in autism, they hypothesize a potential chain reaction. As they explain, “Food allergy may involve alterations in the gut microbiome, allergic immune activation, and impaired brain function through neuroimmune interactions, which may finally affect the enteric nervous system and central nervous system leading to neurodevelopmental abnormalities.” Essentially, food allergies upset the gut, causing the immune system to overreact, and the autoimmune response impacts the brain negatively, causing symptoms of autism.

While I appreciate the efforts these researchers have made to connect allergies and autism, I found one statement in their article surprising: “Little is known about the association between food allergy and ASD.” For many years, parents of children with autism and many doctors know that allergies to gluten, milk products, and soy are quite common in autism. Moreover, removing these allergens from the diet often improves symptoms of autism, including digestive issues, such as diarrhea, constipation, and abdominal pain, which often leads to improved behaviors.

Furthermore, more research needs to be done regarding what might be the cause of the “immunological disruptions” found in autism. Clearly, some autoimmune issues exist, as indicated by the presence of food, respiratory, and skin allergies noted in this research article. Certainly, autoimmune tendencies could be inherited, but the increasing numbers of children with autism and allergies also correlates to the increasing numbers of vaccines given to children.

For example, when my mother was a child in the 1940’s, only four vaccines were recommended: smallpox, diphtheria, tetanus, and pertussis. When I was a small child in the 1960s, only eight vaccines (smallpox, diphtheria, tetanus, pertussis, polio, measles, mumps, and rubella) were recommended. When Alex was a child in the 1990’s, the following vaccines were recommended: diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, Hib, hepatitis B, and varicella. Today, small children are recommended to receive all of those vaccines plus hepatitis A, pneumococcal, influenza, and rotavirus. [Source: Children’s Hospital of Philadelphia: “Vaccine History: Developments by Year”]

While protecting children from disease is essential, the safety of the vaccine mechanism needs to be studied further to prevent the potential autoimmune issues found in autism. In addition to activating the immune system, which is what vaccines are supposed to do, vaccines also contain toxic substances, such as aluminum, formaldehyde, and thimerosal, as well as substances that can provoke allergic responses, such as egg protein, antibiotics, and monosodium glutamate (MSG). [Source: Centers for Disease Control and Prevention: “Ingredients of Vaccines–-Fact Sheet”]

Recognizing the connections between autism and allergies is a good first step. However, determining the source of both of these increasingly common conditions is necessary to prevent more children from suffering needlessly.

“And you will know the truth, and the truth will set you free.” John 8:32

Spiritual Gifts

A little over a week ago, I was having routine annual tests run at the lab where we also take Alex for his blood tests. While one lab technician was drawing my blood, another saw me from across the room and happily exclaimed, “It’s Alex’s mom!” Surprised that she recognized me with all the patients she sees and without Alex in tow, I was pleased that she remembered Alex and me. She went on to tell me that she missed him because she hadn’t seen him in a while, which I told her was a good thing because it meant he has been healthy. However, I explained that he would be coming in soon for his regular six-month blood tests, and she earnestly said that she hoped she would get to see him then. After asking if he was enjoying watching baseball on television this summer, remembering his devotion to the Chicago Cubs, she enthusiastically remarked, “He’s always so good! He’s my favorite patient!”

While her kind remarks about Alex made my day, filling me with motherly pride and endearing her to me for her sweetness, this wasn’t the first time she’s heartily praised him. Every time she has done his blood tests, she always shows her delight in seeing him, which is probably why he looks forward to having blood draws. Two of the other lab technicians have also proclaimed Alex as their favorite patient and seem to remember him fondly whenever they see him.  Of course, we are pleased that Alex cooperates fully with the tests and is pleasant and polite to the lab technicians. However, I think their warmth toward him goes beyond their kindness and his willingness to follow directions.

A few days later, I took Alex to Burger King, where two of the ladies who work there are especially friendly and call him by name. No matter what they are doing, they will rush over to greet him, ask him how he is doing, and make him feel welcome. Although I’m sure they recognize that he has autism, they never treat him condescendingly, and they patiently wait for him to give his order. As they say hello to him, take his hand, and tell him they’ve missed him, Alex smiles broadly, tells them, “Nice to see you,” and leans forward, putting his hands between his knees as his entire body shudders with joy. While they are friendly to all customers, these sweet ladies make Alex feel special, and I suspect he makes them feel just as special.

Sometimes I wonder what Alex’s vocation would be, had autism not affected his life so profoundly. While his cousins are pursuing college and careers and getting married and having children, Alex remains in a child-like existence. Beyond pondering what occupation Alex might have chosen, I wonder what calling he might have felt to serve others, had his language and social skills not been impaired. Perhaps those limitations are less important, however, than the spiritual gifts God provides. In Romans 12:6, the Apostle Paul notes, “In His grace, God has given us different gifts for doing certain things well.” He goes on to list various gifts, such as prophesy, teaching, encouraging and serving others, giving, and leadership. In re-reading this scripture, the last line made me recognize Alex’s gift: “And if you have a gift for showing kindness to others, do it gladly.”

Certainly, I believe that good people treat Alex kindly, perhaps because of or even in spite of how autism affects him. However, the more I watch people interact with him––whether it be his therapists who appreciate the smart, funny, and sweet young man he is and feel pleased to have witnessed the progress he’s made over the years, or those whose brief contact with him leaves a lasting positive impression––I see that Alex’s kind heart cannot be hidden by autism. Moreover, he doesn’t feel the need to conceal his joy when others are kind to him; his smile and happy shudder let people know how glad he is to see them, which has to make them feel pleased, too. If there were any doubt as to how much those people mean to Alex, their importance would be confirmed in knowing that he asks God to bless them every night in his bedtime prayers. I have to believe that God hears those earnest prayers from His child whom He graced with a gift for kindness.

Although I don’t know exactly what the future holds for Alex, I do know that God has good plans for him. More importantly, Alex trusts with unwavering faith that God has a plan for his life. Until those plans are revealed, we wait with hope and anticipation, and we are thankful for the people God places in Alex’s life who see the good in him and allow him to share his kindness and joy, giving his life a valuable purpose and meaning.

“The Lord is my strength and shield. I trust Him with all my heart. He helps me, and my heart is filled with joy. I burst out in songs of thanksgiving.” Psalm 28:7

A New Approach to Interpreting Autism Behaviors

Because impaired social skills are usually associated with autism, researchers have often concluded that most people with autism prefer not to interact with others. However, a fascinating research article recently published online in the journal Behavioral and Brain Sciences contradicts previous assertions that people with autism lack motivation to engage with others socially. In “Being vs. Appearing Socially Uninterested: Challenging Assumptions about Social Motivation in Autism,” psychology professors Vikram Jaswal, the father of a daughter with autism, and Nameera Akhtar provide a fresh and informed perspective as to why people with autism engage in behaviors that may appear anti-social.

In their 84-page article (which can be accessed by clicking here), these researchers examine four behaviors commonly seen in autism and previously attributed to a lack of social interest: limited eye contact, infrequent pointing, repetitive body movements, and repeating phrases, or echolalia. As they conducted their research, they used interviews of children and adults with autism and their families, considered alternative reasons for behaviors, and examined unique ways people with autism use to express their interest in socializing. Explaining their novel approach, they note, “These steps are crucial, we believe, for creating a more accurate, humane, and useful science of autism.”

Previous scientific studies asserted that people with autism preferred not to interact socially. To demonstrate this view, the authors cite earlier research in which people with autism are described as “confined in their own world,” possessing a “powerful desire for aloneness,” and having “little or no social interest.” In contrast, the authors point out that behavior does not always truly reflect thoughts and feelings, providing the examples of people who smile when they’re sad or people whose Parkinson’s disease affects their speech that could make them appear aloof. While some behaviors in autism may be deliberate, such as avoiding eye contact due to anxiety, others can’t be controlled, such as repetitive hand movements. The authors assert, “These unusual behaviors do not have any necessary relation to social motivation, and some may constitute adaptive responses to the unique circumstances of being autistic.”

The first behavior discussed in this article, eye contact, is often considered lacking in autism. As the authors note, eye contact varies even among typical people, depending upon their personalities and their cultures. Too much or too little eye contact can give the perception of being rude. In addition, “gaze aversion,” or looking away, proves helpful for typical people as well as those with autism to help them concentrate and solve difficult problems. In their interviews with people who have autism, the authors discovered that people with autism might avoid eye contact because they find it easier to focus on what the other person is saying. Also, some people with autism find eye contact overwhelming or uncomfortable. They want to engage with others, but looking them in the eyes may be stressful, so they avoid eye contact, which may help them better focus on what the person is actually saying.

Another behavior that may be lacking in children with autism is pointing to obtain things or to share experiences or to draw attention to something. While this lack of pointing has been thought to be an indicator that children with autism do not wish to engage in social behavior, the authors instead conclude that motor impairments are the true reason. In interviews with people who have autism, they revealed difficulties in being able to move the ways they wanted. One adult with autism commented, “I had very little sensation of my body.” Consequently, pointing may not be an issue with social motivation but instead caused by motor and sensorimotor deficits. In addition, people with autism may have different interests than others and have different opinions as to what is worth sharing. As one adult with autism noted, ‘I’m not entertained by the ordinary things that most people enjoy.”

Along with lack of eye contact and pointing, repetitive body movements in autism have been connected to a lack of interest in socialization. These stereotypical behaviors include hand flapping, spinning, rocking, and finger flicking. For people with autism, these self-regulatory behaviors often act as coping responses to anxiety. As the authors note, all people engage in these types of behaviors; typical people might twirl their hair, bite their nails, or drum their fingers when stressed or bored. In people with autism these behaviors may be involuntary or intentional, but the authors emphasize that none of them have anything to do with social connections.

The fourth category of behaviors commonly associated with autism, echolalia, deals with the verbal repetition of words and phrases. These utterances may be dialogue people with autism have heard on television or in movies, or they may repeat words and phrases they have heard others say. Typically, researchers have deemed echolalia as meaningless, and this type of language is discouraged in children with autism. However, the authors reject the notion that echolalia serves no purpose; rather, they compare it to early language development in small children. They state, “But just because a listener is unable to decipher the meaning of an utterance in a particular context does not mean that the speaker did not have one in mind.” For some people with autism, echolalia conveys anxiety and may help with stress, just as a typical person repeats a mantra. Some may use echolalia to get others’ attention by using phrases they can say easily, and what others perceive as “nonsense” may be a phrase misunderstood because of difficulty with pronunciation. Therefore, the authors emphasize the need to find meaning and make connections in echolalia because this behavior indicates the person with autism needs and wants to interact through communication.

By re-examining these four behaviors common in autism, the authors conclude that people with autism want to interact with others, but they have different ways of showing this interest in socialization. Moreover, they contradict previous views of autism behaviors as deficits in social motivation by offering valid alternate explanations, supported by interviews with people affected by autism. Finally, they point out that the previous perception of people with autism lacking social motivation negatively affects research and intervention. For example, therapists, teachers, and parents often encourage children with autism to make eye contact and discourage them from using repetitive motions and echolalia. These attempts to change behaviors may leave the child with autism frustrated and anxious, and the child’s “motivation to engage with someone might diminish.” Ironically, in trying to make the child more social, these methods may make them less social. In addition, some therapists, teachers, and parents may mistakenly believe that children with autism do not want to interact with others and leave them alone. Again, in misunderstanding the behaviors, they may not provide precisely what the child needs and wants––social interaction with others.

With Alex, we have witnessed how the common behaviors of autism have faded over time. His eye contact has improved as his anxiety has subsided, but if he is concentrating on something, he may need to look away. When he was little, he had trouble pointing to things, and would use his flat hand instead to point out something. Clearly, his fine motor delays hindered his ability to use his index finger as a pointer. Over time, he has gained a bit more control and can point to things, usually words (often on signs) he wants us to see or insects he wants us to remove from his vicinity. Although Alex doesn’t repeat lines from television or movies, he does have certain pat phrases he repeats throughout the day. Several times a day, he tells us about “young voices” he heard on television or dates that have special meaning for him or certain events he remembers. When he’s really upset, he’ll complain about gas prices or not wanting to use a typewriter. Though these comments may seem out of place, he has trouble expressing himself, especially when he’s anxious, and he knows these phrases will cue us he’s concerned. Speech has always been a struggle for him, and he relies upon phrases he’s perfected through many repetitions to get our attention, share experiences, and convey his thoughts and feelings. He obviously wants to interact with others, but delays in language and motor skills, along with sensory issues, make socialization difficult. Nonetheless, Alex shows perseverance and continually works to overcome these obstacles of autism.

While autism may remain a mystery to many, those of us who parent children with autism have learned many of the secrets they hold in their minds that process the world differently than the rest of us. That the father of a child with autism would pursue the real reasons for common behaviors, despite how they contradict the tenets held by most autism researchers, doesn’t surprise me a bit. When all the pieces of the so-called autism puzzle are finally found and assembled, the workers around the table are likely to be parents of children with autism, striving and seeking to find ways to make their children’s lives the best that they could be.

“There is no speech and there are no words, yet their voice is heard.” Psalm 19:3

U.S. States with Highest Autism Rates

Always seeking interesting and potentially helpful autism research, this week I found an online article listing the fifteen states in the U.S. with the highest rates of autism. Posted last December in the “Healthy Living” section of the findatopdoc.com website, this article cites a list the Los Angeles Times assembled of the states with the highest autism percentages. [To read this article, please click here.]

Those wanting to cut to the chase and learn which states have the highest autism rates will find themselves waiting for the pages to load and scrolling past ads since the states are listed separately in a slide show presentation format. Apparently, to build even more suspense, the states are listed in a countdown format, with the number one state not revealed until the end. Seemingly underscoring the seriousness of the autism epidemic, the website has chosen to use scenic photographs for each state that seem more appropriate for a website promoting tourism than describing a lifelong disability. The message comes across as, “Yes, these states have many people with autism, but they also have skyscrapers, mountains, lakes, and lighthouses!” Perhaps this website thought the lovely images would soften the harsh statistics. Somehow, these photographs suggest that the states listed and depicted are nice places to visit, but with the high rates of autism, one would not want to live there, to paraphrase the old adage.

According to this article, the states with the highest rates of autism are as follows:

1. Minnesota with 1.4% of the population having autism

2. Oregon with 1.2%

3. Maine with 1.1%

4. Rhode Island with 1.0%

5. Massachusetts with 0.9%

6. Pennsylvania also with 0.9%

7. Indiana also with 0.9%

8. Vermont with 0.8%

9. Connecticut also with 0.8%

10. Virginia also with 0.8%

11. Maryland also with 0.8%

12.  Michigan also with 0.8%

13.  Wisconsin also with 0.8%

14. California with 0.7%, and

15. Nevada also with 0.7% of the population.

Along with each state listed and the percentage of its population having autism––and, of course, its lovely tourism photograph––the article provides a brief commentary with a rather upbeat tone and offers resource information. For example, for my home state of Indiana, the article notes: “Indiana has one of the highest rates of autism in the country, but luckily also has many organizations that help autistic individuals. The Indiana Resource Center for Autism and Autism Society for Indiana are two of the biggest organizations in the state, providing tons of support resources for autistic individuals.” While I hate to sound ungracious to live in Indiana, which is apparently a great state to live if you have autism, “luckily” and “tons” seem to be poor word choices. However, I would agree that the Indiana Resource Center for Autism is, indeed, a terrific resource, especially its website and Facebook page. As a matter of fact, their Facebook page led me to this article.

Despite my usual optimistic outlook on life, even I found the overly upbeat tone of this article a bit much. For example, the article offers the following reassurance that may not be true: “Autism is not a death sentence, and many patients can lead healthy fruitful lives with the right support network.” Considering the high rates of unemployment among adults with autism along with the incidence of various mental and physical health conditions that often accompany autism, this assertion may overestimate the value of support networks. Nonetheless, the article continues touting these supports, stating, “Many different organizations have stepped up to provide support and awareness to autistic individuals, which poses a good sign for autism patients around the country.” Certainly, autism organizations prove helpful, but still many families struggle day to day in dealing with autism.

For those seeking reasons behind the high rates of autism in the fifteen states specifically listed, the article has nothing to offer, noting, “Researchers aren’t sure exactly what causes autism, and it is unlikely that geographical area directly affects the chance of a child being born with autism.” Unsatisfied with this casual attitude regarding the high rates of autism, I looked for trends and possible links. For instance, using the four regions of the country designated by the United States Census Bureau, I grouped these fifteen states geographically.

Three states, Oregon, California, and Nevada, are located in the West region that includes thirteen states. Four states, Minnesota, Wisconsin, Michigan, and Indiana, are part of the twelve states in the Midwest region. Only two states, Virginia and Maryland, both actually East Coast states, are part of the sixteen states found in the South region. Most notably, six of the nine Northeast region states have high autism rates: Maine, Rhode Island, Massachusetts, Pennsylvania, Connecticut, and Vermont. Surprisingly another Northeast state did not make this list; according to the U.S. Centers for Disease Control and Prevention, New Jersey has the highest autism rates in the country with 29.2 out of 1000 eight-year-old children diagnosed with autism. That would make seven out of the nine Northeast states with high autism rates; perhaps there may be a geographical connection, after all.

Using the World Atlas website, I looked for geographical trends that might affect autism rates. For example, on the list of U.S. states most affected by industrial air pollution, among the top twenty were six of the fifteen states with high autism rates: Indiana, Pennsylvania, Michigan, Virginia, Wisconsin, and Maryland. After considering environmental factors, I examined economic statistics. Of the twelve states with the highest poverty levels (over 17% under the poverty line), none of them are included in the list of states with high autism rates. In fact, the states with high autism rates tend to be among the wealthiest in the nation: Minnesota, Connecticut, Vermont, Maryland, and Virginia.

Since the high autism rates are often questionably attributed to better diagnosis, perhaps more educated parents are related to the higher rates in some states. Among the states with the highest percentage of holders of advanced degrees, four of the top states also have high autism rates: Massachusetts, Maryland, Connecticut, and Virginia, all of which are also in the Northeast region. Perhaps geography does make a difference, especially when other factors are considered.

What matters more than lists or regions or potential reasons is that too many families are dealing with autism. Even with touted support networks, autism involves medical and mental health issues and financial burdens. While small percentages may not seem daunting, calculating just how many people are actually affected may make the problem clearer. For example, in my home state of Indiana, whose current population is estimated at 6.7 million, with 0.9% having autism, that would mean 60,300 people, or approximately the population of Terre Haute, have autism. When the number of people in the state with autism is the same as the 12^th largest city in that state, clearly something must be done. No support networks, no matter how wonderful they may be, can keep up with that many people. Instead of making lists with pretty pictures and failing to ascertain real reasons, researchers must discover the underlying causes of autism in order to find the cures. As a nation, we must dedicate resources not only to help those affected with autism but also to seek ways to overcome this autism epidemic impacting millions of Americans.

“O Lord my God, You have performed many wonders for us. Your plans for us are too numerous to list. You have no equal. If I tried to recite all Your wonderful deeds, I would never come to the end of them.” Psalm 40:5