Kelly is an occupational therapist, autism consultant, author, speaker and professor of occupational therapy

The 1 Big Thing that No One is Talking About: Interoception

It is commonly discussed that the human body has seven different sensory systems: smell, sound, sight, touch and taste, proprioception (body awareness) and vestibular (movement and balance). However, there is an additional sensory system, one that has been studied for decades in other fields, but is only just starting to make it’s way into the autism field. This one big thing, this extremely important sensory system is called interoception.

Interoception influences various aspects of health and well-being, therefore is a very important consideration. The following are the top 5 things you should know about interoception:
1. Interoception helps us to feel what is going on inside of our body. Have you ever noticed feelings coming from the inside of your body? For example, have you ever felt your stomach growl? Your mouth grow dry? Your heart race? Or your head hurt? The reason that many people can clearly feel these signals from the inside of the body is because of interoception. These signals often come from body areas that many times we can’t see, like the bladder, stomach or lungs, but we can still feel these body areas at certain times.

2. Interoception helps us to quickly and clearly identify our emotions. When we notice the signals from our body, they become clues as to what emotion we are experiencing. Think about this: How do you know when you are nervous? Perhaps you notice a fluttery stomach, shaky muscles, faster heart beat or shallow breathing. These internal body signals serve as clues that help you identify exactly what emotion you are experiencing at that moment: I Feel Nervous!!

A well working interoception system allows us to efficiently answer the question, “How do I feel?” For example, when you notice your muscles tighten, your fists clench and your voice grumble you know you are frustrated. Or when you feel your eyes grow heavy, your muscles become sluggish and your brain is foggy, you know you are tired. Or when you feel a dry mouth and dry throat, you know you are thirsty. Interoception helps us to detect a wide variety of emotions including: hunger, fullness, need for the bathroom, pain, illness, sexual arousal, anger, calmness, distraction or fear.

3. Interoception helps us control the way we feel. You have to know exactly how you feel in order to control it! When we clearly feel body signals, we are able to quickly detect our emotion and this urges us into action when necessary. Interoception serves as our motivation to seek out comfort in a timely manner.

For example:
· if you feel hungry—you are urged to eat
· if we feel full—we are urged to stop eating
· if we feel thirsty – we are urged to drink
· if we feel cold – we are urged to get a jacket
· if we feel the need to urinate – we are urged to seek a bathroom
· if we feel anxious – we are urged to seek comfort
· if we feel frustrated—we are urged to seek help

4. Many (but not all) people with autism experience differences with interoception. These interoception differences are commonly reported by people with autism. For example, Chloe, a 23-year old with autism shared, “Difficulties with interoception help to explain why I have such a hard time identifying my exact symptoms when I am sick, why sometimes I can eat snack after snack without feeling full and why I get upset so quickly, because I don’t feel it until I’m already far into the storm of the discomfort and frustration.”

Interoception experiences are different for all of us, including people with autism. For some, body signals can feel very, very intense:
“My son is incredibly sensitive to pain. The smallest cut or scrape can send him into a full meltdown.” –Shirley, mother of a 5-year old son with autism

“A lot of times the inside of my body feels like one of those glitter timers—the ones that you can shake and the glitter goes every which way. I feel so many different things at once and I’m not sure what is important. It is very overwhelming.”—Gracie, a 13-year-old with autism

On the other hand, for some people, body signals can be very dull or muted:
“My son walked around on a broken leg for 2 days without a single complaint or indication of pain. It wasn’t until I noticed the swelling and bruising, that I realized he had a serious injury.”—Nick, father of a 14-year old son with autism

“Even though my son is extremely verbal, when he is sick, he is usually not able to explain his specific symptoms to me or the doctor. He can tell me that he feels yucky, but being able to pinpoint exactly where he feels sick and describe exactly what it feels like is very difficult. That sure makes it hard to get him proper medical care.” —Sam, father of a 9-year-old boy with autism

“I do not realize that I am getting anxious until I am REALLY, REALLY anxious. By then it is too late. I can’t control it.”– Jolene, a 12-year-old girl with autism

Although interoception has been studied for decades in other fields, there is very little research investigating the interoception experiences of people with autism. In 2015 a study was published by researchers Fiene and Brownlow that found the participants with autism to have significantly lower levels of awareness of interoception signals. A second study was published in 2016 by a research team lead by Garfinkle that again found the participants with autism to have significant differences in with interoception. These studies were important first steps towards understanding interoception and autism, but we certainly have a lot more to learn. Given the major influence interoception has on emotional well-being, it becomes a vital focus area for research.

5. Interoception can be improved. The good news is that often times interoception can be improved. Techniques derived from mindfulness and other forms of meditation have been found to be evidence-based interventions to enhance interoception. Interestingly, the insula, or the interoceptive center in the brain, is strongly activated during meditation. Furthermore, individuals who participate in regular meditation have been found to have superior levels of interoception. Thus, a series of strategies that incorporate principals from mindfulness have been created for use with individuals with autism. These strategies, named IA Builders, are adapted versions of often times abstract mindfulness concepts and aim to improve interoception in a visual, engaging and concrete manner. Many children and adults with autism have experienced great outcomes through the use of IA Builders. Currently, several of these IA Builders are under formal study.

If you want to learn more about interoception, find many free resources at www.mahlerautism.com. Additionally, the brand-new book Interoception: The Eighth Sensory System (aapcpublishing.net) delivers an in-depth look at interoception including research, assessment and intervention tips. Join the Facebook group: Interoception: The Eighth Sensory System to share experiences, ask questions & get the most current information and research surrounding interoception.