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 (i) review the accessibility of a novel visual task - the Card Sort Task for Self-Harm (CaTS) – to explore self-harm with autistic adults; and (ii) to pilot the CaTS to identify proximal and distal contributing factors leading to self-harm, and 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), whilst 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 transition to self-harm. The CaTS offers a systematic approach to explore self-harm in autistic adults.