As a child psychologist with a specialism in autism, I’ve seen first-hand the impact that interoception can have on a child’s overall well-being. But what exactly is interoception, and why is it so important? Don’t worry, I’ll break it down for you in simple terms and give you practical tips for supporting your child’s interoceptive awareness. So let’s dive in!
What is Interoception?
Interoception may sound like a complex word, but it’s actually quite simple! Interoception is the ability to understand what’s happening inside our bodies, like hunger, thirst, pain, heat and the need to use the toilet.
If children have weaker interoception they may have a harder time navigating daily life. Think of interoception like a GPS system for your body. So, let’s dive a little deeper into this fascinating topic!
Brain Differences in Autism: Interoception
As I’m sure you know, there are differences in the way the brain functions in autism spectrum disorder, compared with neurotypical people. Some areas of the brain are stronger and some are weaker.
Interoception is closely linked with a part of the brain called the insular cortex. The insular cortex receives information about the internal state of the body, including temperature, pain, hunger, thirst, and other visceral sensations.
The insular cortex is responsible for several tasks related to the internal state of the body. One of its main roles is detecting and integrating information about the state of the body.
The insular cortex also generates emotional responses to these bodily sensations. Another task of the insular cortex is to regulate the activity of the nervous system in response to changes in the internal state of the body. This is important for maintaining bodily homeostasis and responding to changes in the environment.
Interoception, Emotions and Emotion Regulation
The insular cortex also plays a role in the perception of emotions. It receives inputs from areas of the brain involved in emotional processing, such as the amygdala and prefrontal cortex. It integrates this information with interoceptive signals to produce subjective emotional experiences.
Autistic people who have difficulties with interoception may find it very difficult to recognise emotions in their own bodies. When you’re able to pick up on your body’s internal signals, you can better understand what emotions you’re feeling and respond to them in a healthy way. A condition called alexithymia is more common on autistic people than the general population. People with alexithymia have difficulty describing lor explaining how they feel, and may report feeling fewer or less intense emotions.
In other words, interoceptive awareness is closely related to emotion regulation and may be one of the underlying mechanisms explaining why autistic people often have emotion regulation difficulties. You can read more about this in a fascinating booked called How Do You Feel?
An Interoceptive Moment with Your Neurobiological Self by A. D. Craig.
Interoception and Anxiety
Here’s a common issue I have noticed. Many children and teens I work with are highly anxious because they know they are not picking up internal and external signals as efficiently as other people their age. They know that they often misread situations or don’t spot the signs to act until it’s too late.
It makes sense. You know there are probably things going on that you can’t spot, so you are anxious that you are going to miss something crucial. It’s so common in my clinic that I had to point it out. It’s common in autistic children or those with autistic traits who have high levels of insight. Have you noticed this in your child? If so, the first step is to improve the efficiency with which their interoceptive system works (see below).
Case Examples: Interoception Challenges
Alex is a 7-year-old boy who struggles with interoception. He has difficulty recognizing when he is hungry or full, often overeating or skipping meals altogether. Alex also struggles with regulating his body temperature, often becoming too hot without realizing he needs to adjust his clothing or cool down. He regularly overheats and can easily become dehydrated.
Maya is a 12-year-old autistic girl who has difficulty with interoception. She often experiences intense emotions without knowing why, and has trouble identifying when she is feeling overwhelmed or anxious. She doesn’t spot the tense muscles, racing heart or hot face. This leads to regular behavioral outbursts and difficulty with social interactions for Maya.
Liam is a 16-year-old boy with interoception challenges. He has difficulty recognizing when he needs to use the toilet, often waiting until it is an urgent need. In his school setting and when he is out and about, this makes Liam anxious that he will have an accident. Liam also struggles with understanding his own physical limitations and can push himself too hard during physical activities, resulting in regular injuries.
Interoception in Autistic Children vs Adults
As I’ve already mentioned, research suggests that interoception may be different in autistic people due to differences in brain structure and function. However, a recent study has found that interoception is affected much more in autistic children than adults. This is potentially good news for autistic people as it suggests that there may be significant improvements in interoceptive difficulties over time.
It is important to note that research on interoception in autism is still relatively new and ongoing, and there is much more to learn about the complexities of this topic.
While the exact mechanisms underlying these differences in interoception are still being studied, it is clear that this is an important area to consider in understanding and supporting individuals with autism. By better understanding how interoception works in autistic individuals, we can develop more targeted interventions and supports to help them navigate the challenges of daily life.
Why Might an Autistic Child have Quick or Extreme Swings in Emotion?
Interoception awareness plays a crucial role in emotional regulation. When an autistic child struggles with interoception, it can cause quick and extreme swings in emotion. This is because they may have difficulty interpreting the physical sensations that are associated with emotional states such as heart rate, breathing, and stomach sensations.
As a result, they may not be able to identify and label their emotional states accurately, leading to confusion and unpredictability in their emotional responses. They may not notice a signal such as racing heart rate until it is very strong, causing a seemingly sudden burst of anger or aggression. To an outsider it looks like the child’s emotions have “gone from 0-100” within a millisecond.
This can be challenging for both the child and those around them, but with the right support and interventions, the child can learn to better regulate their emotions and improve their overall well-being.
Why is it Important to Help Children Strengthen Interoception?
It is crucial to help children strengthen their interoception because it plays a significant role in many areas of their lives. For example, when children have a better understanding of their internal sensations and emotions, they can regulate their behaviour more effectively. This can lead to improved social interactions, increased self-esteem, and reduced anxiety.
Interoception activities (see below) help children to develop better physical and emotional self-awareness. This in turn helps them identify and communicate their needs to others. Ultimately, improving interoceptive awareness can help children to live more fulfilling and independent lives.
Strategies for Improving Interoception
Exercise, yoga, and other movement-based interventions have been shown to improve interoception in children with sensory processing disorder. These interventions help increase body awareness and improve sensory integration.
Biofeedback therapy involves using electronic sensors to monitor physiological processes such as heart rate variability. This information is then used to help children learn to regulate their physiological responses to stress and improve their interoceptive sense. Biofeedback therapy is typically administered by a trained healthcare professional and can be used in conjunction with other interventions. It has been found to be helpful in improving interoception.
Sensory Integration Therapy
Sensory integration therapy involves using specific sensory experiences to help children with poor interoceptive awareness. This therapy can include activities such as touching different textures, balancing on unstable surfaces, and using weighted vests. By improving overall sensory integration, interoceptive awareness can be enhanced.
Mindfulness and Body Scanning
Mindfulness and body scanning exercises involve paying close attention to the sensations in your body parts and your body as a whole. This can include focusing on the breath, noticing the body’s position, and becoming more aware of how the body feels. These exercises can help children become more in tune with their body’s internal sensations. They increase self-awareness.
Example of a Body Scanning Script to Improve Interoception
Find a comfortable place to sit or lie down. Take a deep breath in, and slowly let it out. Take a few more deep breaths, and imagine that with each breath you take, you are becoming more and more relaxed.
Now, let’s begin the body scan. Start by focusing on your feet. Wiggle your toes and notice how they feel. Are they warm or cold? Do they feel tingly or heavy? Notice whatever sensations you feel in your feet.
Now, move your focus up to your legs. Notice how they feel against the ground or the chair. Are they tense or relaxed? Do you feel any sensations, like a gentle breeze or the fabric of your clothes against your skin?
Next, move your attention up to your tummy. Take a deep breath in and notice how your tummy rises and falls. How does it feel inside your tummy? Do you feel hungry or full?
Now, move your attention up to your chest. Take another deep breath in, and notice how your chest rises and falls. Can you feel your heart beating? Can you sense any of the other internal organs in your chest area? Do you feel any tightness or tension in your chest?
Finally, move your attention up to your head. Notice any sensations you feel there. Is there any tension in your forehead or your jaw? Are you feeling relaxed or alert?
Take a few more deep breaths, and just notice any sensations you feel in your body. When you’re ready, slowly open your eyes.
Congratulations! You just completed a body scanning mindfulness meditation! This meditation can help you become more aware of how your body is feeling. That awareness can help you stay calm and focused, even when things get stressful.
Interoception and Toileting in Autistic Children
Interoception difficulties commonly lead to toileting problems in autistic children. They may not feel the urge to go to the toilet until it’s too late or very urgent, which can result in accidents. This obviously has implications for a child’s conficence and self-esteem as well as their peer relationships. Not being dry at night can also impact on sleep.
We can teach interoception skills over time, and we need to support the child with coping strategies in the meantime. Strategies like using a visual schedule, setting reminders with an alarm or timer, and practicing regular toileting routines can be effective.
These strategies can help a child develop a toilet routine and gradually become more aware of their body’s internal cues.
Interoception and Eating
Interoception often affects eating and drinking in autistic children. The importance of interoception in eating and drinking shouldn’t be underestimated and your child may need significant help with this. This can be provided by an occupational therapist, clinical psychologist or speech and language therapist.
If the body’s basic needs aren’t met, children will not have balanced moods, will not be able to learn effectively, and may experience physical health problems.
Children may struggle to identify the interoceptive sensation of hunger or thirst, or fullness. For example, a child may not make the connection that when their stomach growls and has a hollow sensation, they need to eat rather than continuing with their Lego.
Obviously this can contribute to significant problems such as:
- Low blood sugar leading to mood swings.
- Loss of weight.
- Gaining weight/ eating too much.
- Becoming dehydrated.
Interoception, Proprioception and the Vestibular System
We have the main five senses (sight, touch, taste, smell, hearing) and the lesser-known sense of interoception. However, there is another lesser-known sense which is closely related and vital for self-regulation. It’s called proprioception. Proprioception refers to the sense of body position and movement. It’s very common for autistic children to have poor proprioceptive awareness as well as lack of interoceptive awareness.
Interoception and proprioception are both sensory processes that play a crucial role in body awareness and self-regulation. Both senses rely on similar neural pathways in the brain and are closely interrelated.
The vestibular system, located in the inner ear, provides information about the body’s orientation in space and helps with balance and spatial awareness. It senses the movement of the head and provides feedback to the brain about the body’s position relative to gravity, so the body can make adjustments.
The vestibular system, proprioceptive system, and interoceptive system are all interconnected and work together to provide the brain with information about the body’s position and movements in space. Together with our “main” 5 senses, they make up the 8 senses in our sensory system.
All three systems work together to provide the brain with a comprehensive understanding of the body’s position, movement, and internal state. For example, when walking on an uneven surface, the vestibular system detects changes in balance, the proprioceptive system senses changes in joint and muscle position, and the interoceptive system monitors changes in the internal organs to help the brain maintain balance and adjust movements accordingly.
Occupational Therapy for Interoception Difficulties
If a child is struggling with interoception issues and experiencing significant difficulties with daily activities, it may be beneficial to consult an occupational therapist (OT) who specializes in sensory integration. An OT can work with your child to help them develop awareness and understanding of their internal sensations, as well as develop strategies to better regulate their sensory experiences.
I work closely with a team of OTs and the work they do can be life-changing for children. An OT will begin by conducting an assessment of the child’s sensory processing abilities, including interoception. Based on the results, they can then develop an individualized plan.
Interventions may include activities such as deep pressure massage, use of weighted blankets, and exercises to improve body awareness and motor planning. The OT may also work with the child on developing coping strategies, such as relaxation techniques and mindfulness practices, to help them better manage sensory overload and anxiety.
Interoception is an essential element of our sensory system. It allows us to sense and understand our internal bodily sensations and “know ourselves”.
Developing interoception in autistic children can have many positive effects on their emotional regulation, self-awareness, and social relationships.
As parents, we can support our children’s interoceptive development by creating opportunities for them to tune into their bodily sensations. By supporting our children’s interoceptive development, we can help them cultivate a deeper sense of connection and awareness of their own bodies, leading to better physical and emotional well-being.
Dr Lucy Russell is a UK clinical psychologist who works with children and families. Her work involves both therapeutic support and autism assessments. She is the Clinical Director of Everlief Child Psychology, and also worked in the National Health Service for many years. In 2019 Lucy launched They Are The Future, a support website for parents of school-aged children.
Through TATF Lucy is passionate about giving practical, manageable strategies to parents and children who may otherwise struggle to find the support they need.
Lucy is a mum to two teenage children. She lives in Buckinghamshire with her husband, children, rescue dog and three rescue cats. She enjoys caravanning and outdoor living, singing and musical theatre.
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