The pregnancy analogy— why I don’t think the analogy is helping

I don't think autism should be compared to pregnancy, and I want to explain why.

For context, I've seen people use this analogy a lot as a way to explain that a person is either autistic or not.

They argue that just because a person has some of the traits, doesn't mean they're necessarily autistic. (Just like a person can be excessively tired, hungry, nauseous, etc. and not be pregnant.)

And though I understand the reason this analogy is being made, I don't think it accurately reflects the autistic experience. 

So I'm going to explain why.

But first... please understand that this is a highly nuanced topic and can't and shouldn't be flattened to make a point. So if you're interested in engaging, I ask that you engage with the nuance, not the headline. ❤️

So, the general idea with the pregnancy comparison is that a person can have nearly all of the signs of pregnancy, and not actually be pregnant. Because there can be other things causing each or all of those signs.

Example... men can have almost all pregnancy symptoms and not actually be pregnant.

So, the analogy is meant to explain that a person can have all the signs of autism but not actually be autistic because there could be other reasons those signs exist.

There are several reasons this analogy falls apart.

I'll start with the way a differential diagnosis is conducted. Aka, how a person is assessed for autism.

First, the practitioner assesses behavioral signs (things they or others can observe). They then consider all other reasons those signs might show up... and then determine the most likely reason those signs are there for this particular individual.

So, hypothetically, if a person showed all the signs of autism (aka met all the criteria)...

Even if other diagnoses could theoretically explain each and every sign...

If it would take 5 alternative diagnoses to explain them...

The diagnostician would likely diagnose autism... because it's the simplest and most likely explanation.

And if there were additional behavioral signs that could not be explained by autism, they would likely diagnose autism plus something else. 

Not exclude autism as a possibility and diagnose them with 5 alternative conditions. 

(I should add that this does, unfortunately happen... but not when a diagnostician is current and fully versed in how autism is diagnosed in 2025.)

But there's another way to look at the pregnancy analogy. 

And that has to do with the intensity of the signs.

So, let's say someone is a little fatigued all the time, is more hungry than normal all the time, has stomach issues all the time, etc etc... are those signs going to point to pregnancy? 

Maybe... but probably not.

And I think this is where the nuanced conversation really comes in.

Because autism has a lot to do with levels of challenges (how hard it makes life) and thresholds of tolerance (how quickly a person becomes distressed/incapacitated by those challenges).

So, at what point does a person go from just having some autism-like differences, to actually being autistic?

In my view, the answer is not as simple as... either a person is autistic, or they're not. 

Because I don't think that's actually what's going on in the brain.

In my view, every human brain is on a continuum of needs. And there are multiple continua (physical, mental, emotional, etc). But let's focus on physical for simplicity.

I believe that every human brain has a certain threshold of tolerance when it comes to physical needs.

We actually know this because it's well understood that different people have different pain tolerance levels and thresholds.

And no one would ever suggest that there are only two experiences when it comes to pain tolerance. The ability to tolerate pain, the INability to tolerate pain, and nothing in between.

There's even a sliding scale for describing pain that's used in ERs for this very reason.

So, in my view, this is actually true for every human challenge.

There's a sliding scale for all of it.

And what makes a person autistic has to do with the specific clustering of challenges they have... and how those challenges impact their ability to function in their daily life.

(A different set of clustered challenges would likely be due to a different diagnostic condition or conditions.)

It's not about whether or not they experience challenges... it's whether or not those challenges impair them. 

Which is literally how the diagnostic criteria are written. To identify a person's level of impairment, and therefore, their level of additional needs that goes beyond what is "typically" needed. 

So, it really comes down to whether or not the diagnostician considers the person's challenges to be sufficiently impairing for a diagnosis.

But I don't think that's the end of the story either.

Because I think a person can have all autistic challenges, and sometimes be impaired... but sometimes not.

And that can change based on their life circumstances, the support they get from their loved ones, and so many other factors.

So where do those people fall? Are they autistic, or are they not?

I don't think the answer is as simple as yes or no.

And that's where I think the pregnancy analogy falls apart.

Again, I don't think this is a simple conversation. But I do think it's an important one. 

So, if you have thoughts you'd like to share, please feel free to do so. 

But please don't dismiss the important nuances and complexity of the topic (some of which I couldn't get into in this post because it would have made it 3x as long). 

Because that's how we end up in closed loop and unproductive conversations.

Thank you. ❤️