Interoception: The Eighth Sense and Autism

I jotted down on a piece of paper several odd behaviors I recently noticed in my autistic three-and-a-half-year-old son. At first glance, these behaviors didn’t seem related. He never seemed hungry, thirsty, or sleepy. He was often under-responsive to pain or physical touch and overly responsive to the temperature in food and beverages. He also appeared unable to recognize emotional changes in people, and the list goes on. But after looking at the list, I realized there must be a connection. I didn’t know what it was, but I’d soon find out.

What is Interoceptive Awareness?

Shortly after making that list, I attended a conference held by my local CARD (Center for Autism and Related Disorders). I went to a session called “Interoception: The Eighth Sensory System.” Kelly Mahler, occupational therapist, autism expert, researcher, and published author led the presentation. She started by defining interoception as a sensory system that provides information on how the body feels inside. In this short video clip, Kelly details this definition.

She then explained there are receptors everywhere in our body in places such as our mouth, ears, eyes, stomach, bowels, and skin. Those receptors send signals to a part of the brain called the insula. The insula interprets those signals and tells us we are experiencing fear, pain, thirst, or the urge to go to the bathroom, as well as other sensations or emotions.

For example, if you notice your mouth is dry, your brain may register thirst. If your stomach growls and you feel lightheaded, your brain may register hunger. Once you recognize the thirst or hunger, you act on it and get something to eat or drink, and the feeling of thirst or hunger goes away. That is interoceptive awareness.

Who can have poorly functioning Interoceptive Awareness?

People with conditions such as autism, anxiety, depression, trauma, eating disorders, obesity, toilet training difficulties, sensory processing disorder, and behavioral challenges often times have poorly functioning interoceptive systems.

Interoceptive Awareness and Body Sensations

Someone with good interoceptive awareness can recognize how their body is feeling on the inside and act accordingly. Such as feeling thirsty and getting a drink of water.

My son does not seem to recognize hunger. He’d go hours and hours without eating if I didn’t put food in front of him and coax him to eat. It makes sense. If you can’t recognize the symptoms of hunger and you are a busy child, how would you know it’s time to eat. And when your parent puts you at the table, and you lack the urge to eat, food isn’t really going to taste good.

Additionally, recognizing the sensation of feeling full is also impacted by interoceptive awareness. For my son, he probably feels full after one or two bites. Other individuals with interoceptive challenges may not recognize when they are full, leading to binge-eating and obesity.

Interoceptive Awareness and Emotions

Someone with good interoceptive awareness can read facial expressions and body language to interpret the emotions of others.

Kelly used the example of a parent feeling the pain and emotion of an injured child. The analogy made such sense because I remember taking my older children to get immunizations; it was almost as if I could feel the pain right along with them. For a person with poor interoceptive awareness, this type of empathy is challenging.

I see this in my son. He doesn’t seem to detect, for example, the emotion of anger in another person. Despite exaggerated body language, facial expression, or raising of the voice. It can be humorous because if I get angry, he looks at me and says, “Mommy, you’re happy.” He knows happy is good, and that is what he wants to see in me, but he’s clearly not grasping how I am feeling at that moment.

How can Interoceptive Awareness vary?

Kelly also mentioned that interoceptive awareness difficulties may vary from person to person.  They can be too big, too small or distorted.

For example, one child may overreact to a minor injury such as bumping their knee and writhe pain. Another child may go weeks with a broken arm and never complain. Another child may realize they aren’t feeling well but can’t identify if it’s nausea or a headache.

How to Improve Interoceptive Awareness

The good news, according to Kelly, is that interoceptive awareness can be improved. Kelly has worked with many children and adults and helped them enhance interoceptive awareness. Her new book The Interoceptive Curriculum: A Step-by-Step Guide to Developing Mindful Regulation is a systematic and guided process that professionals and parents can use to build interoceptive awareness in individuals who struggle.

One example she gave during the presentation was how to help a child realize when they are getting angry. She also said emotions, such as anger, can look and feel different from person to person. For one individual, anger may present as a flushed face and rising body temperature. Another person may clench their fists and grit their teeth. So helping a child identify which attributes happen in them when building interoceptive awareness is step one.

Kelly said often; this is the opposite of what we do. We see a person clinching their fists and assume they are angry. We may say to the child, “Why are you angry?” But maybe for that child, they clench their fists when they are nervous. Helping them identify the emotion and how it feels for them is key to improving interoceptive awareness.

The next step is acting. For one child, managing anger may work with a brisk walk. Another child may need to release anger by punching a pillow. Both the presentation of emotions and emotional regulation strategies are individualized.

Teaching children that emotions are temporary, and the faster you recognize them, the quicker you can take action, Kelly said, also helps emotional regulation.

How to Teach Interoceptive Awareness to a Young Child

I wondered how I could begin to teach interoceptive awareness to my young son. Most of what Kelly said was geared toward verbal and older children, teens, and adults.

After the session, I asked her. She told me the best way was to incorporate interoceptive awareness-building into our play and daily routines. For example, when I kiss his cheek, talk about how that feels. When he asks for a drink, talk about his mouth being dry and describe the term thirsty.

It really has begun to change the way I communicate with him. The other day I made him dinner, and when I told him it was time to eat, I talked about hunger and the feeling in our tummy.

I’ve been making more of an attempt to explain how it feels to get hurt. If he throws a toy, I talk about how he’s hurt the toy. “Buzz needs to sit down for a minute because when you threw him, he hurt his knee, and it doesn’t feel good. It feels bad.”

I know it will take time. But Kelly has given me hope that my son will be in tune with his body’s sensations one day. That type of independence for him will be life-changing. Also, that he will learn to recognize emotions in not only himself but those around him.

Before attending Kelly’s session, I had never heard the term interoceptive awareness. But by the end of her presentation, the connection between those random behaviors I’d written down was crystal clear. Understanding how interoceptive awareness impacts all of our daily lives has helped me understand my son better and has given me guidance in how to help.

I want my clients themselves (and people everywhere) to feel more understood. To feel more effectively supported, and to be more successful at identifying and managing the way that they feel. I want people to feel safer in their environments and within their bodies. I want them to be able to live a life full of purpose, meaning and joy. That is what sets my soul on fire! – Kelly Mahler