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Danielle Rizzo’s son is screaming. He is planted in the middle of the lobby of his elementary school, clinging to rainbow-colored blocks as she gently explains that she is here — off schedule, in the middle of the day — to take him to a doctor’s appointment. But the first-grader is not listening.

"Happy Meal,” he repeats over and over again. “Happy Meal!”

His little brother, who is also going to the appointment, is nearby, not moving. Rizzo is relieved that the two of them are not melting down at the same time, which happens all too often, and firmly guides them out the door.

Rizzo’s children, ages 7 and 6, were at the center of one of the most ethically complex legal cases in the modern-day fertility industry. Three years ago, while researching treatment options for her sons, Rizzo says she made an extraordinary discovery: The boys are part of an autism cluster involving at least a dozen children scattered across the United States, Canada and Europe, all conceived with sperm from the same donor. Many of the children have secondary diagnoses of ADHD, dyslexia, mood disorders, epilepsy and other developmental and learning disabilities.

The phenomenon is believed to be unprecedented and has attracted the attention of some of the world’s foremost experts in the genetics of autism, who have been gathering blood and spit samples from the families.

Autism, which affects an estimated 1 of 59 children in the United States, is a “spectrum disorder” characterized by difficulties navigating social situations and restricted or repetitive behavior. Some people who have it never speak and need daily care, while others, like actress Daryl Hannah and Pokémon creator Satoshi Tajiri, are highly successful in their fields. In recent years a growing movement has been challenging the notion that autism is a disorder at all. Rather, advocates argue, it’s a difference that should be celebrated as adding diversity to human communities.

Rizzo hopes her children will cope better as they grow older, but for now, she knows they are suffering.

When she first found out about their many half-siblings, she consulted a genetic counselor, who she says told her the odds of so many blood-related children with autism occurring spontaneously was akin to all the mothers “opening up a dictionary and pointing to the same letter of the same word on the same page at the same time.”

“It was the donor,” Rizzo remembered thinking. “It had to be.”