When my now six 1/2-year-old autistic son was three, I jotted down several recent behaviors. He never seemed hungry, thirsty, or sleepy. He was often under-responsive to pain or physical touch and overly responsive to temperature in food and beverages. He struggled to interpret emotional shifts in others, and the list just went on. At first glance, these behaviors didn’t appear related. But my gut instinct pushed me to dig further.

What is Interoceptive Awareness?

Shortly after making the list, I attended a conference at 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 on the inside.

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

 

For example, if you notice your mouth is dry, your brain interprets thirst. If your stomach growls, your brain interprets hunger. Once you recognize the thirst or hunger, you act on it by eating or drinking, and the feeling goes away. That is interoceptive awareness.

 

Who can have poorly functioning Interoceptive Awareness?

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

Interoceptive Awareness and Body Sensations

Someone with good interoceptive awareness can recognize how their body feels on the inside and act accordingly. But autistic children, like my son, may not.

My son does not behave as if he recognizes hunger. He’d go hours without eating if I didn’t coax him with his preferred foods at the preferred temperature. It makes sense. If you don’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 places you at the table, and you don’t feel hungry, food isn’t going to taste appealing and can led to maladaptive behaviors.

 

Additionally, recognizing the sensation of feeling full can also be impacted by interoceptive awareness. For my son, he probably feels full after one or two bites. Other individuals 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 correctly interpret both their emotions and the emotions of others.

Kelly used the example of a parent experiencing the pain and emotion of an injured child. Think about when you take your child for immunizations. You almost feel the pain with them. This type of empathy can be challenging for an individual with poor interoceptive awareness.

 

I notice this in my son. Despite exaggerated body language, facial expressions, or voice raising, he doesn’t detect anger. It can be humorous because if I get angry, he looks at me and says, “Mommy, you happy!” He knows happy is good, but at that moment, he’s not grasping my actual emotional state.

How can Interoceptive Awareness vary?

Kelly also mentioned that interoceptive difficulties can vary from person to person; being too big, too small, or distorted.

For example, one child may overreact to a minor injury and writhe in pain after a simple knee bump. Another child may go weeks with a broken arm and never complain. Another child may notice a sensation in their tummy but can’t infer whether it’s hunger, pain, or the urge to have a bowel movement.

The good news is interoceptive awareness can be improved. Kelly has worked with many children and adults and helped them enhance interoceptive awareness. Her books, courses, and other resources can help professionals and parents build interoceptive awareness in individuals of all ages who struggle.

One example she used was how to help a child realize they are angry. She said emotions, such as anger, can look and feel different. Anger may present as a flushed face and rising body temperature for one individual. Another may clench their fists and grit their teeth.

She went on to say we often make assumptions based on how we experience those emotions. We see a child with a clenched fist and assume they are angry. But, maybe for that child, they clench their fists when they are nervous.

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

Additionally, teach children that emotions are temporary. The faster you recognize them and the quicker you can take action, helps emotional regulation.

 

Our Family’s Experience

Before attending Kelly’s session, I had never heard the term interoceptive awareness. But since, I’ve learned as much as I can from Kelly. My son was recently fortunate enough to take one of her courses through the same CARD center where I first heard the term. Kelly’s work has truly provided our family with how to not only understand my son but how to help him.

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 liv a life full of purpose, meaning, and joy. That is what sets my soul on fire. – Kelly Mahler