How to Help Kids With Autism Build Interoceptive Awareness

I had never heard the term, but I knew exactly what it was. My 3-and-a-half-year-old son has ADHD and autism.  I recently jotted down on a piece of paper several things I was noticing in him. Things that didn’t seem related, but at the same time seemed to have a connection.  Things like “never seems hungry, never seems thirsty, never seems sleepy, under responsive to painful stimuli, overly responsive to temperature of food, under responsive to physical touch, seems unable to recognize emotional changes in people,” and the list goes on.

Recently I attended a conference held by my local CARD (Center for Autism and Related Disorders) and went to a session called “Interoception: The Eighth Sensory System.” It was given by occupational therapist, autism expert, researcher and published author Kelly Mahler.

Mahler started off by defining interoception as a sensory system that provides information on how the body is feeling on the inside. She 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 which interprets those signals and tells us we are experiencing things such as fear, pain, thirst or the urge to go to the bathroom. 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.

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

My son does not seem recognize his body’s attempt to let him know it is time to eat. He can’t tell me this because he still struggles with communication, but I see it. 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? When your parent puts you at the table to eat and you aren’t hungry, food isn’t really going to taste good and you aren’t going to feel the urge to eat. Feeling full is another interoceptive feeling. My son probably feels full after one or two bites. Some people may not recognize the feeling of being full and may overeat.

Good interoceptive awareness also means having the ability to read facial expressions and body language to interpret the emotions of others. Mahler used an example of a parent feeling the pain and emotion of their child being injured. This made such sense because I remember when I used to take my children to get their shots it was almost as if I could feel the pain right along with them.

Someone with a poorly functioning interoceptive system has trouble with this. I also see this in my son. He doesn’t seem to be able to detect anger in someone.  No amount of body language, facial expression or raising of the voice works.  If I get upset with him he just looks at me and says, “Mommy, you’re happy,” when it should be clear that I am not. He knows happy is a good thing and that is what he is wanting to see in me, but he’s not really grasping how I am feeling in that moment.

Kelly Mahler also mentioned that interoceptive awareness difficulties are variable person to person.  They can be too big, too small or distorted.  For example, one child may overreact to a small injury such as bumping their knee and be writhing in 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 a feeling of being nauseous or having a headache.

The good news, according to Mahler, is that interoceptive awareness can be improved. Mahler has worked with many children and adults and helped them improve interoceptive awareness in many areas.  Her new book “The Interoceptive Curriculum: A Step-by-Step Guide to Developing Mindful Regulation” is a systematic and guided process 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 and to understand it’s different for everyone. When one person feels anger their face may flush and they may feel warm. Another person may clinch their fists and grit their teeth. So helping a child identify which attributes happen in them when they are angry is step one.

She 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 that child clinches their fists when they are nervous. You have to help them identify the emotion and how it is feels for them. The next step would be acting on it. For one child, overcoming anger may be helped by taking a walk. Another child may reduce the feeling of anger by punching a pillow or taking a rest. It is very individualized. She also said we need to teach our children that emotions are temporary and the faster you can recognize them, the quicker you can take action.

After the presentation, I thought a lot about how I could begin to teach interoceptive awareness to my 3-and-a-half-year-old. Most of what Mahler said seemed to be geared toward older children, teens and adults who were pretty verbal. I asked her and she told me the best way was to begin 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 how his mouth may be dry and try to 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.” It’s caused me to be more mindful of my son’s lagging interoceptive awareness and to look for ways to help teach him.

I know it will take time, but Mahler has given me hope that one day my son will be able to be in tune with his body and be able to self-regulate. That type of independence will be life-changing for 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 live a life full of purpose, meaning and joy. That is what sets my soul on fire!” – Kelly Mahler