The heat that afternoon was intense. Weather maps across Iowa were deep red, and warnings flashed across the screen. A high school football player on the other side of the state had died from heat exhaustion the week before. Cornfields wilted and shrank into hills of despondent brown.

I was running late as I parked and shuffled to a dilapidated satellite classroom building. I introduced myself to a teacher sitting at a desk and told him that I was there to meet a 21-year-old man named "Scooter" — a childhood nickname, I'd later learn, that had stuck. (I’ve changed all names and some details to protect him and to comply with privacy laws.) I needed a summer job after my first year of grad school, and he needed staff.

My experience with autism had been limited to movies and anecdotes from friends who worked in "the field" — care industry shorthand for post-institutional residential and community-living nonprofits supporting people with developmental disabilities. (“We’re always looking,” the agency had said, and hired me without any sort of drug screening and a cursory, astonishingly fast background check. The drug screening was my only concern while filling out applications.)

The teacher looked like he was close to retirement age and wore a hearing aid. He asked about my experience working with people diagnosed with autism. “None,” I said, and his face dropped.

“Don’t stand directly in front of him,” the teacher said, “and avoid making eye contact. He might perceive that as a threat. He’s very keyed in on body language. Introduce yourself, but let me take the lead.”

I was led to a corner of the room I hadn’t before seen. It was darker than the rest of the space and a few decibels quieter. In the nook, I saw Scooter. He had a stringy mustache and hair with great curling wings. One of his eyes wandered slightly. He sat behind a crescent-shaped table padlocked to the wall at both ends of the curved top. Scattered in front of him were piles of flashcards, jars of beads, toy cars, unfinished puzzles, crumbs from lunch, and a laminated piece of tagboard with a strip of Velcro down the center. As soon as he saw me, his face tightened into a sort of grimace, baring his teeth, but the rest of his face, his eyes, posture, and hands were unexpressive as he blankly leaned out into the dim classroom.

“Well, hi there,” I said, waving. I began to clam up in all of the pits of my body.

“Well, hi there,” Scooter said, and he let out a deep laugh.

The person I was going to meet that day had been a child in my mind. In front of me was a man. A man only two years younger than me.

The three of us sat at the table while Scooter and his teacher went through flash cards, and Scooter looked at me a few times with a penetrating glare. His expression settled into a sort of skeptical normalcy. I felt like I was being sized up, and I now realize that I was. Scooter has had dozens of staff come and go in his lifetime. He was right to wonder whether I would be sticking around.

As medical phenomena go, autism is a recently identified one, although perhaps not as recent as the current vaccination panic suggests. The term was coined in 1912, and the first person ever diagnosed with autism is now 81 years old. And yet the contemporary situation is an unprecedented one: Though the data we have is under constant scrutiny for its accuracy, methodology, and usefulness, the Centers for Disease Control reports that the current rate of autism diagnosis in the United States is 1 in 68. This is a continuation of a trend identified by the Environmental Protection Agency that started between 1988 and 1992, when the worldwide diagnosis of autism spiked from 6 in 10,000 kids to 24 in 10,000. Scooter, born in 1989, is part of a coming “tsunami” of autistic adults. Signed in August of last year, the Autism CARES Act has devoted $1.3 billion in federal spending to research, which is a drop in the bucket autism currently costs the United States annually. That number only stands to go up. Simply put, we have no plan for any of this.

People diagnosed with autism and other developmental disabilities used to be stuffed into institutions, and the horrors that took place within them are well-known. I've read about Achilles tendons being cut to prevent people from running away, teeth being pulled to prevent biting, cattle prods used to electrocute, endless streams of sedatives. While most of that has stopped, with the glaring exception of overmedication, the current system of care is hyperaware of this history.

Ideally, those who work with this part of the population now strive to empower them, to remove labels and barriers and work toward independence. And yet this is the ugly fact, a vestige of the institution era: The chief witnesses to Scooter’s life are not friends and family but scores of paid providers. People like me. We accommodate, teach, and encourage. We support. We never punish. And yet our interests are split between doing genuine good for another human being and getting a paycheck. So we're also probably looking around for something that pays better than $10 an hour and doesn't involve regular emotional, and sometimes physical, beatdowns. And that, in turn, affects people like Scooter.