Autistic people are at a high risk for suicide, and self-harm is one of the strongest predictors of death by suicide among autistic adults. Despite these data, there are still no validated measurement tools specifically for autistic people to assess self-harm - with or without suicidal intent. This points to a significant gap in our ability to optimally understand and support this community.

A study published in the journal Autism, 2026 Jul, sought to describe the challenges reported by autistic people when completing the "SITBI" (Self-Injurious Thoughts and Behaviours Interview). Additionally, the study examined researchers' experiences in providing support to participants. The study was conducted as part of a pilot of a controlled clinical trial investigating autism-adapted safety plans in the UK, and included a thematic analysis of feasibility interview transcripts.

The Path to an Authentic Answer

The study findings point to one central challenge, termed "reaching an authentic answer," which included three sub-themes:

  • Understanding suicidal plans: Difficulty in matching autistic people's personal perception of suicidal plans to the available response options in the measurement tool.
  • Defining parameters for suicidal thoughts: Challenges in presenting the nature of their suicidal thoughts using the given options.
  • Describing self-harm: Difficulty in describing and quantifying the nature of their self-harm with the available response options in the questionnaire.

The researchers report that they were able to bridge these gaps by validating the autistic experience and developing a trusting partnership with participants. They did this by clarifying ambiguous language and by working together to find an answer that accurately matched participants' experiences. In many cases, intervention and adaptation were required to ensure that the answers given truly reflected the internal reality of the person being asked.

These preliminary findings indicate that the way self-harm and suicidal thoughts are reported may differ for autistic people compared to non-autistic people. The implication for autistic adults in Israel is the need for greater awareness on the part of professionals - therapists, psychologists, and medical personnel - of these difficulties. A deeper understanding can help in adapting assessment tools and building more effective support plans that recognize the unique experience of the autistic person.

It is important to note that the study data were collected randomly, and not for the purpose of a comprehensive review of this topic, which may be a limitation in generalizing the findings.

The study emphasizes the importance of validating suicidal and self-harm experiences among autistic people, and how appropriate support can enable them to report their condition more accurately and authentically.