I have been working through all of our sensory systems as part of my sensory processing series.  You can check out my previous posts here. Today we are going to explore the 8th (yes, 8th!) and the final sensory system, which is called interoception. This is a fairly new concept, that has been researched but is still relatively unknown by many.  Kelly Mahler is an OT who has done extensive work in this area, and I used her book exclusively for this post.  I did my best to summarize the basics in this post, but this is a fascinating sensory system with so much more to explore than what I could include in any blog post.

What is Interoception?

Thanks to a whole bunch of research, we can now more accurately describe this 8th sensory system.  Interoception allows us to ‘feel’ or sense the inside of our bodies. Receptors in our internal organs and tissues gather information from internal organs and send it to the brain. This sense helps us feel many important feelings such as hunger, fullness, pain, nausea, need for the bathroom, itch, tickle, body temperature, heart rate, muscle tension.  This sense also helps us feel our emotions.  

The Importance of Interoception

Interoception is key for a lot of important skills.  For example, it is closely connected to our emotions.  Think about it- each emotion evokes a certain feeling in your body.  If you about to enter a meeting that you know may be challenging, your stomach may flutter, your heart may beat quickly, you may start to sweat and your muscles may tense up.  These sensations indicate that you are feeling nervous.  Without solid interoceptive awareness, it would be hard to understand how we are feeling in certain situations.  

Additionally, interoception impacts skills such as decision making, intuition, social awareness, empathy, perspective taking, flexibility of thought, self awareness and problem solving.  

Interoception and Self Regulation

Self regulation is the ability to control the way we feel and act.  Self regulation can help in a variety of ways, including attending to tasks, persisting at challenging activities, controlling emotions, matching energy level to the task, and being able to engage in healthy behaviors, such as eating when hungry.  Interoception is so important for effective self regulation. Interoceptive signals send a message when the internal balance is off and prompts us to take action. This happens from birth. For example, if a baby is hungry, interoception system senses that and interoceptive signals send that message.  The baby takes action by crying. The caregiver then feeds the body. Awareness of internal sensations drives behavior as it relates to self regulation.   

 

Difficulties with Interoception

If people have difficulty with this system, we can describe it in similar ways that we have thought about the other 7 sensory systems: overresponsive and underresponsive.  We will add an additional descriptor for this system: discrimination.

If people overrespond as it relates to interoceptive signals, they feel their internal sensations more readily.  They may be distracted or highly anxious and may feel a lot of sensations at once, which may be overwhelming and stressful.  This child may take frequent bathroom breaks, or complain of pain with the slightest discomfort. This child may frequently request snacks or drinks

If people underrespond, they may not feel their internal sensations as readily, unless they are very intense.  This child may wait until the very last minute to use the bathroom, may be difficult to toilet train, may have a significant health concern but never complain of discomfort because it is more difficult for him to feel it.  

People may also have difficulty discriminating, or pinpointing exactly what internal sensation they are having.  This person may complain of feeling sick but can’t give specific symptoms, may insist he feels happy even though he is clearly outwardly mad.  It is hard in these situations for the person to correctly distinguish their internal sensations and make sense of them.

Building Awareness of Internal Sensations

The research shows that yes, interoceptive awareness can be improved.  The question is, how?  Improving awareness of internal sensation can take time.  We can make adaptations to help compensate for challenges with interoceptive awareness, and we can also engage students in activities to build awareness. 

When it comes to adaptations, think along like lines of setting alarms for bathroom and eating schedules, or using visuals to explain what clothing to wear based on the weather.  If kids have difficulty with interoceptive awareness, understanding their internal bathroom or hunger cues will be challenging, so they will need external help and reminders.  

When it comes to building awareness, think of activities designed to bring attention to internal signals.  Kelly explores a bunch of ideas in Chapter 4 of her book.  She explains that many interventions are based in the mindfulness research.  One simple activity is having kids do a body check.  You can use a visual of the body and work with the student to really think and identify how that specific body part is feeling.  Providing a visual of specific language that can be used to describe that body part can be helpful.  

The missing link?

Kelly Mahler cites a study in her book that indicates 90% of adults with autism are under or unemployed and have difficulty living independently due to poor social awareness, decision making, perspective taking, flexibility of thought, self awareness and problem solving.  She poses the question – could interoceptive awareness be the missing link? If you are remotely intrigued by this very basic overview, you will love reading more about this system! Below, I have linked to the book I used to write this post, which has a wealth of information including assessment and activity information.  Be sure to check out Kelly Mahler’s website, which has a bunch of research citations (also linked below) and some free downloads.  She also has some videos and podcasts on there that could be helpful to explore.  I can’t wait to continue to learn more about this system.  I plan to do at least one follow up post that explores a little more about interoception and autism specifically.  Drop any thoughts or questions you have below and I will do my best to incorporate into future posts!

References and Resources

Interoception: The Eighth Sensory System by Kelly Mahler

Interoception References by Topic complied by Kelly Mahler

Kelly Mahler’s website

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