It Was Never About the Toothbrush

For six months after we realized I was autistic, I still wasn't sure.

I argued with myself about it.

I kept wondering if I was just good at reading about things and seeing myself in them. If I was pattern-matching my way into an identity. If I was so desperate for understanding that I was convincing myself instead of discovering something true.

I could recognize patterns in my childhood, my relationships, my sensory experiences, and the way I communicated with people. I could look back at things I'd spent decades thinking were just weird little personality quirks and suddenly see how they might fit together.

But there was always that little voice in my head asking whether I was just seeing what I wanted to see.

Then I found out about the toothbrush test.

Well, that's what people sometimes call it online. The actual exercise is a demonstration task used in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), a standardized observational assessment used by clinicians evaluating autism.

It's not a personality quiz, and it's definitely not a magical trick that can diagnose somebody in thirty seconds.

But the idea behind it fascinated me.

The question seems ridiculously simple:

How do you brush your teeth?

In the clinical version, the person is asked to show and tell someone how to brush their teeth, as though they're teaching somebody who doesn't know how.

The examiner observes how the person communicates the task, including their gestures and how they explain a familiar sequence of actions.

And here's where it got interesting for me.

When I thought about how I'd answer that question, I didn't pantomime brushing my teeth.

I had questions.

Lots of questions.

Because what exactly are you asking me?

Are we talking about how I brush my teeth at home or when I'm traveling? Because I have different toothbrushes for those situations. Are we talking about my electric toothbrush? Because sometimes I don't like using that one, and I'll use a regular toothbrush instead.

Does the toothpaste matter? Because I don't like super minty toothpaste. I actually hate mouthwash for the same reason. That overwhelming mint sensation is not something I enjoy having in my mouth.

Are you asking about the physical movements? The order I do things in? How long I brush? How I know when I'm finished?

Do you want me to demonstrate it, or do you want me to explain it well enough that someone else could follow my instructions?

Because those are different questions.

And the answers might change depending on which one you're asking.

Meanwhile, someone else might hear "How do you brush your teeth?" and simply mime brushing their teeth.

Done. Question answered.

I haven't even started answering yet because I'm still trying to figure out which version of the question we're dealing with.

And that's the part that fascinated me.

It's not that neurotypical people can't have these questions, or that every autistic person would respond the way I do. There's no universal autistic response to brushing your teeth.

But for me, those questions happen automatically.

I'm not deliberately making the question more complicated. I'm not trying to be difficult or show off how much I know about dental hygiene.

My brain is immediately identifying variables that could change the answer.

Different toothbrushes. Different circumstances. Different sensory experiences. Different ways of interpreting what you're asking me to communicate.

And I want to account for those things before I answer because otherwise, how do I know I'm giving you the information you actually wanted?

I'm not struggling to understand how to brush my teeth. I'm trying to understand what you want to know about how I brush my teeth.

And suddenly, something clicked.

Because that wasn't just how I answered a question about dental hygiene.

That was how I'd been answering questions my entire life.

I've spent my entire life trying to make sure I understand the question before answering it. Trying to figure out exactly what someone means. Trying to anticipate which details they might need, which assumptions they're making, and whether the explanation I'm about to give them will actually communicate what I'm trying to say.

Sometimes that means turning a perfectly ordinary question into a TED Talk nobody asked for.

Sometimes it means getting stuck on a detail that somebody else doesn't even consider relevant.

Sometimes it means someone interrupts me halfway through an explanation and it feels like a bomb has gone off in my head because now I've lost the sequence I was building.

And sometimes it means I can't even begin answering until I've clarified what the hell we're talking about.

For years, I thought I was just being thorough.

Or annoying.

Or unnecessarily complicated.

Usually all three.

But that toothbrush question helped me recognize something I'd never really stopped to examine.

The amount of mental work I was doing just to answer an ordinary question.

And something else I hadn't really considered was how much of that process involved sensory information.

To someone else, the kind of toothpaste or toothbrush might be completely irrelevant to explaining how to brush your teeth.

To me, those details are part of the experience.

The way the toothbrush feels, whether I'm using the electric one or a regular one, whether the toothpaste is overwhelmingly minty, whether I'm following my usual routine or doing something different because I'm traveling. Those aren't necessarily separate considerations in my head.

They're all part of the information my brain is sorting through before I can answer.

Now, I want to be careful here, because this is where simplified explanations of autism can get misleading.

There's no universal rule that neurotypical people demonstrate brushing their teeth while autistic people explain it. Autistic people can use gestures, neurotypical people can give detailed explanations, and neither response tells us enough to diagnose anyone.

Research does show differences in how autistic and non-autistic people use certain kinds of gestures, but those differences vary between individuals and situations.

The actual ADOS-2 task is one small part of a much larger assessment. A clinician isn't simply watching to see whether someone mimes a toothbrush and then checking the autism box.

That's not how any of this works.

And my response to a question I encountered outside a clinical assessment certainly wasn't a formal diagnostic result.

But here's what I think gets lost when we focus entirely on whether a particular behavior is exclusive to autism.

It doesn't have to be exclusive to autism to be relevant to understanding an autistic person's experience.

This is why "everyone does that" misses the point.

Yes, everyone brushes their teeth.

Plenty of people explain things in detail. Plenty of people dislike interruptions, need clarification, have sensory preferences, or get frustrated when someone asks a vague question.

But when you're trying to understand your own brain, you're not just looking at whether you've ever done a particular thing.

You're looking at patterns.

How often does it happen? How automatic is it? How much effort does it take? How does it affect your life? Has it been happening since childhood? And how does it fit with everything else you've noticed about yourself?

For me, the toothbrush question wasn't an isolated revelation.

It was one more piece fitting into a picture I'd been trying to make sense of for decades.

It connected to the way I learned to navigate conversations, the way I need to understand the rules of a situation before entering it, and the way I can become completely overwhelmed when someone changes the expectations halfway through.

It connected to the countless times someone asked me what seemed like a simple question and I found myself needing more information before I could answer.

And it made me realize how many of the things I considered personal failings might actually be differences in how I process information and communicate.

That's a pretty significant realization to have while thinking about a fucking toothbrush.

But there we were.

I can't tell you that my response proved I was autistic. It didn't.

And I can't tell you that someone else's response would prove they weren't.

What I can tell you is that the experience changed something for me.

For six months, I'd been questioning every observation I made about myself. I'd been treating my own experiences like evidence that needed to survive a hostile cross-examination.

Every realization was followed by another round of doubt.

But this one made me stop arguing long enough to recognize something.

I wasn't inventing a new way of thinking because I'd read about autism.

I was finally noticing a way of thinking that had been there all along.

It wasn't proof. It was recognition.

And once I noticed it, I started seeing it everywhere.

That was when the question began to change.

Instead of constantly asking, "Am I really autistic?" I started asking something considerably more useful.

"Given that this is how my brain works, what do I need to function better?"

Because whether I had the perfect explanation for every trait wasn't nearly as important as understanding what those traits meant for my actual life.

I could give myself permission to ask clarifying questions instead of pretending I understood.

I could recognize why interruptions were so disruptive and start finding ways to manage them.

I could acknowledge that my sensory preferences weren't just me being picky or difficult.

I could stop treating my need for structure and accuracy as something inherently wrong with me.

And I could begin working with my brain instead of constantly demanding that it operate differently.

The toothbrush question didn't explain my entire life.

No single question could.

But it helped me recognize a pattern that had been there for as long as I could remember.

And sometimes that's how self-understanding happens.

Not through some enormous, dramatic revelation, but through an ordinary little moment when something you've always done suddenly makes sense in a way it never did before.

For me, that moment involved explaining how to brush my teeth.

Well, technically, it involved asking about six questions before I could even begin explaining how to brush my teeth.

Which is objectively ridiculous.

But apparently, that's how my brain works.

And I'm finally getting better at listening to it.

A Little Science Behind the Toothbrush

The toothbrush demonstration is part of the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). It provides clinicians an opportunity to observe nonverbal communication, gesture use, and how someone communicates a familiar activity. It isn't a standalone autism screening test.

A 2023 systematic review and meta-analysis in Psychological Bulletin examined 31 studies involving 701 autistic and 860 neurotypical participants. Researchers found group-level differences in certain types of gestures, while other gesture types showed less consistent differences. The findings don't establish a universal autistic or neurotypical response to any particular question.

Autism diagnosis considers a much broader pattern of developmental history, behavior, and communication. No single response can establish or rule out autism.

Sources:

• McKern, N., Dargue, N., & Sweller, N. (2023). Comparing gesture frequency between autistic and neurotypical individuals: A systematic review and meta-analysis. Psychological Bulletin. https://doi.org/10.1037/bul0000408

• Adapting and validating the Autism Diagnostic Observation Schedule Version 2 for use with deaf children and young people. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-021-04931-y

• CDC. Clinical Testing and Diagnosis for Autism Spectrum Disorder. https://www.cdc.gov/autism/hcp/diagnosis/index.html

If this resonates, you're not alone. I'm writing about these moments, the little observations that help us make sense of a lifetime of experiences we might never have thought to question.

I'm still figuring things out.

But I'm spending a lot less time arguing with myself about the kind of brain I have, and a lot more time figuring out how to live comfortably inside it.