How Practitioners Can Help With Poor Interoception

Researchers have known for some time that autism spectrum disorder (ASD) can disrupt the ability to sense body signals such as pain, hunger, and thirst—a skill known as interoception. Several recent studies shed new light on the ways autism, attention-deficit/hyperactivity disorder (ADHD), and ASD + ADHD can dysregulate interoception.  

If you’re working with a client with disrupted body awareness, researchers have some recommendations about how you can help. 

What is interoception and why does it matter? 

It’s the ability to understand the body’s messages. Interoception helps people know when they’re hungry or thirsty, when and where their body hurts, when they need to rest or use the bathroom, and any number of other physiological signals that help people stay healthy.  

Interoception also includes awareness of more subtle signals like heartbeat and breath—two signs that could help someone realize they’re becoming upset or anxious. For that reason, interoception is linked to the ability to manage or regulate emotions (Price & Hooven, 2018). Managing emotions can be challenging with autism and ADHD. 

Interoception is complex. It involves at least three separate abilities: 

• noticing body signals 
• perceiving or interpreting them accurately  
• knowing how good you are at understanding body signals  

Each of these elements can be affected by autism, ADHD, and ASD + ADHD (Kutscheidt et al., 2019; Yang et al., 2022). For some people, the ability to talk about their physical state can also be impaired. 

How can autism and ADHD change body awareness? 

In a recent study published in the Journal of Personalized Medicine, researchers describe several ways interoception can be disrupted by autism and ADHD (Edelson et al., 2022):  

1. Poor interoception can make people extra sensitive or extra attentive to signals from their bodies. 
2. It may make people less aware of bodily sensations. That, in turn, may lead to a higher pain tolerance that makes illness and injuries harder to diagnose. 
3. People with interoceptive differences may be aware that something is wrong but may have a hard time pinpointing what or where the problem is.  
4. Dysregulated interoception can create more anxiety. In some cases, anxiety can lead to extra stimming behaviors, aggression, self-injury, or violent behavior. 

What do researchers recommend? 

As a practitioner, you can help clients and their caregivers recognize when interoception isn’t working as it should. Researchers recommend these practical steps (Edelson, 2022). 

Find out more with focused assessments.  

Assessing functional, adaptive behavior and executive function can help you track how emotions change in different environments and under varying conditions. That information can help you determine how interoception might be affected. It can also yield valuable insights into physical symptoms. Sensory processing and integration assessments are another important tool for understanding interoceptive issues. And since anxiety is common with autism and ADHD, anxiety screeners and assessments can be particularly useful. 

Recommend medical and physical exams.  

Autism and ADHD often co-occur with medical conditions such as sleep loss and gastrointestinal problems. If a client isn’t accurately reading symptoms, it’s especially important to work with healthcare providers to identify any underlying health conditions that may need to be treated. 

Educate clients and caregivers.  

A growing body of evidence suggests that some people can learn better interoceptive skills. In a study published in Occupational Therapy International, researchers found that autistic children who practiced identifying body signals and linking them to their emotions were better able to regulate their emotions afterward (Mahler et al., 2022). Researchers used the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) and the Caregiver Questionnaire for Interoceptive Awareness, Second Edition (CQIA-2) to track changes before and after the program. 

You can also help educate caregivers about how to recognize signs that someone is experiencing pain, hunger, or another physical need. Caregivers can take steps to manage environmental features such as noise and temperature to prevent discomfort and anxiety.  

The Key Message 

Interoception—the ability to accurately sense what is happening in the body—can be disrupted with autism, ADHD, or ASD + ADHD. Though it isn’t a problem for everyone, it can cause physical and mental health problems for those with interoceptive differences.   

Focused assessments, regular medical care, and interoceptive education can help autistic people, those with ADHD or ASD + ADHD, and their caregivers adjust their environments and care for their overall well-being.  

Related Assessments: 

• (CAARS) Conners' Adult ADHD Rating Scales
• (ADHDT-2) Attention-Deficit/Hyperactivity Disorder Test, Second Edition
• (ADOS®-2) Autism Diagnostic Observation Schedule™, Second Edition
• (CARS™2) Childhood Autism Rating Scale™, Second Edition

Research and Resources:

Edelson S. M. (2022). Understanding challenging behaviors in autism spectrum disorder: A multi-component, interdisciplinary model. Journal of Personalized Medicine, 12(7), 1127. https://doi.org/10.3390/jpm12071127 

Kutscheidt, K., Dresler, T., Hudak, J., Barth, B., Blume, F., Ethofer, T., Fallgatter, A. J., & Ehlis, A. C. (2019). Interoceptive awareness in patients with attention-deficit/hyperactivity disorder (ADHD). Attention Deficit and Hyperactivity Disorders, 11(4), 395–401. https://doi.org/10.1007/s12402-019-00299-3 

Mahler, K., Hample, K., Jones, C., Sensenig, J., Thomasco, P., & Hilton, C. (2022). Impact of an interoception-based program on emotion regulation in autistic children. Occupational Therapy International, 2022, 9328967. https://doi.org/10.1155/2022/9328967 

Price, C. J., & Hooven, C. (2018). Interoceptive awareness skills for emotion regulation: Theory and approach of mindful awareness in body-oriented therapy (MABT). Frontiers in Psychology, 9, 798. https://doi.org/10.3389/fpsyg.2018.00798  

Yang, H. X., Zhou, H. Y., Li, Y., Cui, Y. H., Xiang, Y., Yuan, R. M., Lui, S., & Chan, R. (2022). Decreased interoceptive accuracy in children with autism spectrum disorder and with comorbid attention-deficit/hyperactivity disorder. Autism Research, 15(4), 729–739. https://doi.org/10.1002/aur.2679