He cried and pinched and scratched at me after being presented with a birthday cupcake for our last visit together.

Tuesday of this week was a chaotic day, starting with an irate child who was definitely not a fan of the Chantilly cake​ from Whole Foods. He has no idea what he’s missing, it’s delicious. 15/10 stars.

This is what autism looks like for so many of the families we work with. Unpredictable, inexplicable, sometimes combative. No words to help bridge the gap between what we’re seeing and what he’s experiencing.

It was the morning after the wild announcement from the White House that pregnant mothers should – at nearly all costs – avoid taking Tylenol (acetaminophen is the ingredient in question, but Tylenol is the brand everyone – including our president – knows).

And the internet went wild. Cue the flags to sprint to polar ends. Depending on whether you’re a member of the MAGA movement or not will dictate what you now think of Tylenol and pregnancy.

I don’t talk much about politics. Which means, I’m hoping, I have people from all persuasions in my little community.

But I’m going to wade in, just a tiny bit, today – because these days the things we care so much about (children, families, science) have been sucked into the political vortex with everything else.

As with everything, my views are not mainstream.

We have a crisis.

Our science is a whole lot ​shoddier​ than many people account for. We have methodological flaws, incomplete results, ​tiny sample sizes​ from which we extrapolate absurd conclusions, ​skewed population samples​, and an inability to replicate an astonishing number of studies.

You can literally find any scientific study to back up what you believe. Science can be bent to the will and agenda of the person pointing to it to back up their claims.

I had always been taught to believe in Science. That it was objective, and clean and a process by which we come closer to the truth.

But Science – as it is practiced today – is more like religion. Find the sect that makes the most sense to you, and then follow its creed faithfully. And you’ll need faith, because if you dig too far in you’ll find holes in what you’ve been told is Truth.

This is what happened to me. I began to dig into the Truth that is at the core of all we practice, and began to discover a whole lot of holes. And it really disturbed me, contributing significantly to my professional unraveling.

Nuance appears to be a lost art – for everyone.

Trumpers point to a ​study​ that shows a “moderate increased relative risk” of neurological disorder when pregnant mothers used acetaminophen, without adding the nuance that the relative risk went from 1.33% to 1.53%, and the study authors believed that the correlation was a result of fevers and headaches (which get treated by acetaminophen) – issues already known to be correlated with adverse neurodevelopment outcomes. These authors did not conclude the medicine contributed to later autism, ADHD or intellectual disability.

BUT – non-Trumpers are also ignoring that in the study’s limitations, the authors note “…one cannot definitively exclude the possibility that the use of acetaminophen beyond a certain dose at a critical point might pose some risk.”

They cannot – without a shadow of doubt – tell you Tylenol does not increase the risk of autism. Why? Because actual science does not work that way. There is always a shadow – by design.

The way science is meant to be practiced is an ongoing iteration that discovers new things and makes our focus more clear. Certainty is its antithesis, because there’s always new angles and new questions.

But for so many of us – we practice Science. And Science is Certain.

We are Experts that have the Truth backed up by Science. A Science with no room for nuance that veers even slightly off the well-beaten path of “accepted evidence.” Despite the fact that science is designed to always present new ideas – those who believe in Science cling to it religiously, and fight just as vehemently to protect its known pillars.

Frankly, I think we are largely responsible for the dumpster fire we currently find ourselves in.

To be abundantly clear – and to jump all the way into this political sewage I prefer to avoid at all costs – I think it incredibly irresponsible for the President of the United States to give medical advice – based on incredibly limited and contradictory studies – to pregnant women who have been told by the medical establishment something entirely different.

How f****ing confusing for them. How incredibly unfair. How much stress and uncertainty this presents to women doing everything they can already to keep their unborn child safe. Now – they get to decide if they should hold out on a fever (that is strongly believed to cause fetal problems), or risk taking medicine and question forever the integrity of that decision – especially if their child ends up having autism (which some of them certainly will).

But I’m also infuriated with the other side. These posts that like to point out that autism has existed long before Tylenol. That autism isn’t something to prevent – it’s just difference. That there’s no epidemic because diagnostic criteria has changed.

Bullshit. Ask anybody working with children and families for longer than a decade, and you’ll hear us all say – autism is more prevalent. We are seeing it way more often. We don’t know why.

Again, as with everything – you can find Science that points to whichever view you want here. I find this ​view​ to be trustworthy, but I’m sure if you think differently you can look to this ​one​ and it’ll say something totally different. And you get to decide what you want to believe.

And therein lies the problem.  Both of these links will take you to “experts.” Experts who are pretty certain they’re right about what they’re saying. Who are very persuasive.

Also persuasive are the Expert influencers everywhere – including in the therapy community – who embrace neurodivergence as something only to celebrate, without any nuance at all.

Autism is a lifelong disability for many, many, many people. That doesn’t take away from the dignity of these people, the love their families have for them, or make them lesser in any way. But it’s foolish to pretend people don’t want to prevent profound disability – and that they are somehow “ableist” in saying so.

I’m seeing more kids like my Tuesday morning friend, not fewer. And I can promise his mother wishes things weren’t so difficult for him. He’s made lots of progress, is in the best therapy available to him – and still. Life is really challenging for them all.

Nuance is a lost art, and experts have a lot to account for in this department. We can be so damn certain of something, insist we know best – and then when science ultimately ends up saying something else enough times – it becomes Science and we begin saying something totally different.

And yet – we are aghast at people who don’t trust us, who are skeptical. They are so stupid. We know best.

People are desperate for answers about all kinds of things – and when experts can’t be trusted, and Science can back up any claim – we should expect them to use it against us.

We can improve our science, let go of our Science, and practice nuance – or we can expect more of the same.

I don’t have the answers. But I got asked enough times this week what I thought about this whole thing that I thought I’d write about it today. Thanks for sticking with me.

As I’ll note in each post: 

These are not my original ideas, but rather a synthesis of what scholars in a variety of fields have learned and written. I often do not have answers to the tensions I see – my aim is not to be another expert in a field already over-run with them. Instead, I want to shine a light on knowledge we take for granted but shouldn’t.

In each essay I write, I’ll link the relevant sources when possible as well as cite them at the end. I hope you’ll join this conversation.

REFERENCES

Ahlqvist, V. H., Sjöqvist, H., Dalman, C., Karlsson, H., Stephansson, O., Johansson, S., Magnusson, C., Gardner, R. M., & Lee, B. K. (2024). Acetaminophen use during pregnancy and children’s risk of autism, ADHD, and intellectual disability. JAMA, 331(14), 1205-1214. https://doi.org/10.1001/jama.2024.3172

Apicella, C., Norenzayan, A., & Henrich, J. (2020). Beyond WEIRD: A review of the last decade and a look ahead to the global laboratory of the future. Evolution and Human Behavior, 41(5), 319–329. https://doi.org/10.1016/j.evolhumbehav.2020.07.015

Levitt, S. D. (2025, August 1). The data sleuth taking on shoddy science (Ep. 163) [Audio podcast episode]. In Freakonomics Radio. https://freakonomics.com/podcast/the-data-sleuth-taking-on-shoddy-science/

Public Health On Call. (2025, June 6). Is there an autism epidemic? Johns Hopkins Bloomberg School of Public Health. https://publichealth.jhu.edu/2025/is-there-an-autism-epidemic?ref=readtangle.com

Smith, A. (2023, May 9). First large study of “profound” autism finds rising problem with disparate impacts. Rutgers Health. https://rutgershealth.org/news/first-large-study-profound-autism-finds-rising-problem-disparate-impacts?ref=readtangle.com

Udesky, L. (2025, January 20). ‘Publish or perish’ culture blamed for reproducibility crisis. Nature. https://doi.org/10.1038/d41586-024-04253-w