Interoception refers to the internal sense that helps individuals perceive and interpret bodily signals, such as hunger, pain, or emotional states. For many autistic individuals, it can be difficult to recognize and respond to these internal signals.
Increased awareness of interoception in autism can lead to better management of this essential sensory system, improving overall well-being.
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What is interoception?
Most of us who support and love an autistic person know about the seven senses, which help everyone better understand the world. Why do we know this information?
Almost all autistics find parts of the sensory world problematic, overwhelming, unsettling, and sometimes downright painful because of their neurology or the way their brain is wired.
Briefly, the seven senses are:
- Tactile: Provides information through touch (e.g., pressure, texture, hard, soft, sharp, dull, hot, cold).
- Vestibular: Tells us where our body is in space, speed, direction of movement (e.g., walking on a rope bridge, bending over to tie shoes, swinging on a swing)
- Proprioception: Provides information about where a certain body part is and how it is moving (e.g., putting your arm through the sleeve hole without seeing it, knowing that your feet are on concrete or grass without looking)
- Visual: Uses sight to understand objects, people, and boundaries as we move through space (e.g., size, color, shape, height, in the crosswalk, standing near someone).
- Auditory: Provides information about sound (e.g., loud, soft, high, low, near, far).
- Gustatory: Gives information about types of taste (e.g., sweet, sour, bitter, salty, spicy).
- Olfactory: Provides information about types of smell (e.g., musty, acrid, putrid, flowery, pungent).
Because of recent work, we have become aware of an eighth sense that can make life more challenging for autistics: interoception. Interoception helps us understand the inside of our body, known as feelings/signals/states.
Thanks to our interoception system, we understand the following:
- Hunger/thirst
- Pain/body temperature
- Need to use the bathroom
- Emotional regulation
Autism and interoception
Interoception is a 24-hour per day experience. It happens all day, every day. The neuromajority’s interoception system works nonstop to keep our body and emotions in harmony.
Autistics, however, do not automatically have this experience. Their harmony is often “off.” When the harmony is off, life can feel confusing, impacting social skills, relationships, problem-solving, and self-care.
Approximately 98% of autistics have these experiences. Most “over feel,” “under feel,” or “confuse” what their sensory system is trying to tell them.
Hyper-interoception in autism
“Overfeeling” occurs when autistics may “overfeel” some of the signals inside their bodies, causing them to be distracted by or highly anxious about certain sensations.
For example, “over feeling” may be so great that a scratchy throat feels like a major health issue, or a hangnail might require an anesthetic.
The autistic individual may repeatedly ask to go to the bathroom because the slightest urge feels like an emergency.
The impact of interoception challenges
Challenges with interoception can significantly impact an autistic person’s life. Difficulty in recognizing and interpreting body signals can lead to confusion and affect social skills, relationships, problem-solving, and self-care.
Misinterpreting signals, such as confusing hunger with a stomachache, can add to this confusion and distress. Others may not easily recognize their internal body signals. They may “underfeel” or not even detect certain body states.
For example, those who “underfeel” may not recognize the urge to eliminate waste until the last minute, when the feeling becomes very intense. In addition, the individual may not realize that they are becoming overheated while playing outside.
Still, others may confuse one signal for another. They may feel overwhelmed and interpret it as a headache. A slight touch can be interpreted as a punch. Constipation may be mistaken for feelings of irritability.
Many autistic individuals have anxiety and meltdowns, and interoception problems often lead to these issues. Some don’t know that interoception is supposed to automatically help them to:
- recognize how they are feeling, and
- change that feeling if it doesn’t create harmony between the body and emotions.
How to improve interoceptive awareness in autism
Because of their neurology, most autistics require direct instruction to understand their interoception system, as they do not recognize their feelings/states/signals.
In addition, they may need to be taught other skills related to the eighth sensory system, such as the names of specific feelings/states/signals that provide harmony between the body and emotions. They may also have to learn strategies to change their state as needed.
Activities for improving interoceptive awareness
One of the most effective ways to help autistic individuals with interoception challenges is to visually teach them about their eighth sense and how their interoception system impacts home, school, community, and work.
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In addition to visual information, the individual may need multiple practice opportunities and coaching to develop the skills to identify and use interoception strategies when challenges happen.
An occupational therapist (OT) or someone with a comprehensive knowledge of the sensory systems can create and teach activities, such as:
- Yoga
- Mindfulness
- Breathing exercises
- Physical activities
Evidence-based studies and information help the individual notice body signals, connect them to emotions, and determine what action to take to promote comfort within the body.
Addressing the challenges with understanding
Interoception allows us to understand the feelings/signals/states inside our body. Most autistics need visual instruction, multiple practice opportunities, and coaching to use their interoception system to create harmony between their body and their emotions.
Understanding the interoception system provides a firm foundation for instruction in other critical areas, such as:
- recognizing disharmony between the body, emotions, and the environment;
- using strategies to create harmony between self and multiple environments.
Many online resources are available to help address these challenges, from articles to videos and assessments created to ease your worries.
FAQs
Q: What are the signs of bad interoception in autism?
A: Signs of poor interoception in autism include difficulty recognizing internal body signals such as hunger, thirst, pain, or needing to use the bathroom. Individuals may also confuse internal sensations, like mistaking hunger for a stomachache or feeling overwhelmed for a headache. They may either overreact to minor sensations or underreact and fail to notice important bodily signals.
Q: How do you teach interoception in autism?
A: Teaching interoception in autism involves direct instruction and visual aids to help individuals recognize and interpret their internal body signals. Techniques include using visual charts, engaging in mindfulness exercises, practicing yoga, and doing breathing exercises.
Q: What is proprioception in autism?
A: Proprioception is a sense that provides information about the position and movement of body parts. In autism, proprioceptive challenges can manifest as difficulty coordinating movements, judging distances, or knowing where one’s body is in space without looking. For example, an autistic individual might struggle to catch a ball, write, or navigate a crowded space.
Q: What is an example of hypersensitive interoception in autism?
A: An example of hypersensitive interoception (hyper-interoception) in autism is when an individual feels intense discomfort from minor internal sensations. For instance, a slight itch or minor discomfort may be perceived as highly painful or distressing.
References
Mahler, Kelly. The interoception curriculum: a step-by-step guide to developing mindful self-regulation. Hershey, PA: Kelly Mahler (2019).
Mahler, Kelly, Kerri Hample, Claudia Jones, Joseph Sensenig, Phoebe Thomasco, and Claudia Hilton. “Impact of an interoception-based program on emotion regulation in autistic children.” Occupational Therapy International (2022): 1–7.
