Exploring Patterns of Self-Harm in Autistic Adults Using the Card Sort Task for Self-Harm

Autistic adults self-harm more often than non-autistic adults, but there are no tools to assess patterns of self-harm in autistic people. This study aimed to (1) review the accessibility of a novel visual task - the Card Sort Task for Self-Harm (CaTS) - to explore self-harm with autistic adults and (2) to pilot the CaTS to identify proximal and distal contributing factors leading to self-harm and experiences following self-harm. First, autistic adults (n = 5) with lived experience of self-harm reviewed the CaTS for clarity and accessibility. Second, we undertook a pilot administration of the CaTS and used sequence analysis to explore significant transitions between factors before and after self-harm. Participants (n = 29, autistic or possibly autistic, female = 82%, mean age = 41.62) selected, on average, 42 cards to describe self-harm. Most frequently selected cards described agitation (n = 25), mental pain (n = 22) and depression (n = 22), while most infrequently collected cards included being in a gang and talking to a teacher (n = 0). Agitation and acting on impulse preceded self-harm. Feeling better, worse, exhausted and hopeless followed self-harm. Improving emotion regulation and meeting autistic communication needs could reduce the transition to self-harm. The CaTS offers a systematic approach to explore self-harm in autistic adults.Lay AbstractWhy did we do this study?Autistic adults self-harm more often than people who are not autistic. This is particularly worrying because self-harm is something that can contribute to suicide. We know that autistic people feel that their experience of self-harm is not well understood by other people, such as doctors.What did we want to know?We wanted to know if the card sort task for self-harm (called the CaTS for short) is a useful way to explore self-harm with autistic adults.What did we do?First, we worked with five autistic adults to make sure the CaTS is clear and works for autistic people. Second, we invited autistic and non-autistic adults to do the CaTS. To do the CATS, someone chooses the cards that are relevant to their experience and puts them on a timeline to explain what self-harm is like for them.What did we find?We found that (1) the CaTS is helpful and accessible to explore self-harm with autistic adults and (2) the CaTS uncovered patterns of self-harm. Twenty-nine U.K.-based autistic adults did the CaTS: most were female (82%, average age was around 42). Participants picked, on average, 42 cards to describe self-harm. The cards that were chosen most often described agitation, mental pain and depression. The cards that were chosen least described being in a gang and talking to a teacher. The order of the cards suggested that people felt agitated and acted impulsively before self-harm. After self-harm, they felt better, worse and hopeless. We found that it is safe and feasible to do the CaTS with autistic people. Support could consider how best to support people who are impulsive and how to prevent people accessing the means to hurt themselves.