Exploring Patterns of Self-Harm in Autistic Adults Using the Card Sort Task for Self-Harm.
Mirabel Pelton, Victoria Newell, Blandine French and 3 others
Autistic adults who self-harm most often described feeling agitated, exhausted, and in unbearable mental pain.
Not being able to talk to anyone preceded having access to means and acting on impulse. The task was safe and completed by all participants.
Key findings
1The most frequently chosen cards were 'I was very agitated and restless' (25), 'I felt exhausted' (23), and 'the mental pain was unbearable,' 'I felt depressed and sad,' and 'I hated myself' (22 each).
2A significant non-random sequential structure was found in the card transitions (chi-square 470.02, p < .01), meaning the order in which experiences were linked to self-harm was not random.
3The strongest sequential link was between self-harm and acting on impulse without planning, which also connected to having access to means to hurt oneself. 'Could not tell anyone how I was feeling' preceded both agitation and access to means.
Still to come
How it was doneWhat they found
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What it does not show
All 29 participants identified as White British, so the findings cannot be generalised to autistic adults of other ethnicities. Twenty-four of 29 were female, so the pattern may not reflect the self-harm experience of autistic men. Only 4 non-autistic participants remained after data cleaning, so the planned comparison between autistic and non-autistic groups could not be done. Nineteen participants were removed for unreliable or duplicated responses, and 2 were removed for scoring below the autism-trait cutoff, so the final sample is small and selected. This is a pilot: it describes what one group of adults selected from a card set, not a tested intervention or a causal pathway. Recruitment was online and paused for two years due to the pandemic, which may have skewed who participated.
Declared interests
Funded by the Alan B. Slifka Foundation, the NIHR Mental Health Research Groups Programme, the ESRC, the MindEd Trust, the Edinburgh Mental Health Network, and UKRI Digital Youth. The authors declared no conflicts of interest.
The easy way to misread this
Do not read the card sequence as a universal, causal pathway for every autistic adult who self-harms. This is a pilot with 29 people, all White British and mostly female, who selected cards from a fixed set to describe one recent episode. The sequential links are descriptive patterns in this small group, not proven mechanisms, and the tool has not yet been validated as a clinical assessment instrument.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →