Interoception and Interoceptive Skills
Several years ago, I took my boys up to my Dad’s house. Kevin just walked into the room where we were, stood in the middle, and started vomiting. Since he doesn’t vomit often, he was upset by this and started shaking his head. It was like a vomit sprinkler. If that is not a classic case of interoception, I don’t know what is.
Ick. Won’t soon forget it. Despite his age, he lacked the skills to be able to identify his feelings and address them. He may have felt the interoceptive sensation of having to throw up, but not having felt that feeling many times before, he likely only knew that it was discomfort. Not that it was going to lead to vomiting.
When I think of that incident, I chuckle now. My stepmother had this dumb coffee table decoration. It was two squirrels sitting on a pile of decorative rocks, playing checkers. It was really hard to clean because a bunch of Kevin’s vomit got in there.
If you’re from my generation, we were brought up being taught that there are 5 senses: Sight, Sound, Taste, Touch, and Smell. Right?
Well, now many medical and educational professionals teach the 8 Senses.
Eight Senses, not Five Senses
- Proprioception is the perception or awareness of the position and movement of the body.
- Vestibular– The vestibular sense responds to a change in your head position or having your feet lifted off of the ground. It also contributes to balance and equilibrium.
- Interoception-The sense of knowing what is going on inside the body.
What is Interoception?
Interoception is the sense of knowing what is going on inside your body. This covers all parts of the body. Everything from headaches and dizziness to nausea, sexual feelings, and the sense of urgency that comes with having to use the toilet.
A person who struggles with sensory issues on the outside may also have sensory issues on the inside. We all have internal sensors called interoceptors that tell us what is going on inside our body, including hunger and thirst.
Interoceptive Skills and Communication
As parents, we do a fantastic job with this when our kids are babies. Babies don’t talk, so we look for other cues.
Somehow, when our kids are older, we often mistakenly assume that our kids will develop these skills. I mean–the skills to identify their internal issues, label them, and describe them to us adults, using words.
Ha! That doesn’t always happen!
If a child lacks interoceptive skills, they cannot identify and label the feelings. This often leads to a lack of self-regulation skills.
Interoception and Autism
But for some, either the interoceptors don’t function normally, the message doesn’t get sent, or doesn’t get perceived as normal. This may come from autism or another developmental disability, surgery, illness, or current medications.
Interoceptive Skills
I’ve heard several stories of autistic boys breaking a bone and not even crying. In fact, some (now feeling very guilty) moms said they didn’t know, and in some cases didn’t take the child to a doctor for several days. It happens!
You can see how not being able to feel and define a feeling could lead to much worse. Kids can get dehydrated, get frostbite or sunburn or have something going on internally that needs to be treated such as appendicitis.
Having interoception processing skills is also essential for toilet training. Some kids may truly be unaware that they have to go, or not know what that feeling is.
My son lacks interoception and in addition to my constant worrying about illness, I have to wonder about hunger, dehydration (which can increase seizures), how his seizure meds make him feel, and if he’s comfortable in his clothing or in his bedding.
If kids lack this skill, but inside they know they are uncomfortable or in pain, they may exhibit some undesirable behaviors.
Finding Interoceptive Cues
When my youngest son was 8, we were having some issues one summer. I’ve been very fortunate that for the most part, my kids do not throw up often.
Like, less than twice each, in their entire lifetime. (I likely just jinxed by typing that out)
Anyway, a few summers ago, all of a sudden, every other day he was telling me, “Mom, I think I’m going to throw up.”
Well, as it went on for a few days, we realized that it wasn’t nausea at all. It was anxiety, and he was having anxiety attacks. However, being only 8 and not familiar with anxiety or nausea, he didn’t know how to label his condition.
He’s not alone. Many adults go to the ER every year thinking they might be having a heart attack, only to learn it’s an anxiety attack. If you’re not familiar with the condition, you can’t name it.
So that’s your first step–deciding if your child has the language skills and the vocabulary to define these feelings.
Interoception and Occupational Therapy
A lack of interoception skills is not an official medical condition. As in, it is not in the DSM. And, even Sensory Processing Disorder is not in the DSM so you probably cannot get anyone to “diagnose” your child.
However, it is a needed skill set, so it should be documented. Generally, OTs work on this as they are often the professionals charged with helping kids with sensory issues. Being able to improve interoception skills can certainly be an IEP goal. (though it would need to be measurable!)
Your child’s pediatrician or OT is the place to start with this.
Interoception- OT Occupational Therapy
According to Wikipedia, there are several facets of enteroception. These include the features:
- attention
- detection
- magnitude
- discrimination
- accuracy
- sensibility
- self-report
You can see why our kids may struggle with any or all of these!
Incorrect interpretation of these senses can be too much or too little. They may feel too much. Interoception is also related to emotions, as having emotions results in body functions (such as a racing heart, etc.).
It also includes sexual feelings. Handing Sexual Relationships appropriately should be an IEP goal if necessary. Yes, you can have an IEP goal for sexual relationships. Inappropriate behavior in this arena is the quickest way to suspension and/or being ostracized by peers.
The interoception system is complex and is just recently starting to be addressed by the education and therapeutic world.
Some kids may over-regulate because they don’t know how to manage these feelings. In other words, making a big deal out of nothing. They feel anxious or nervous about something but cannot respond appropriately.
Other kids may not be able to focus on outward tasks because they are too focused on what is going on internally.
Observation and Knowing your Child
Most moms are incredibly tuned in to their kids. And some of it doesn’t require a special spidey sense to see.
Lately, Kevin has started walking into the kitchen and standing near his Rifton chair. Since that is where he sits to eat, it’s not hard to realize that in his own way, he is telling us that he is hungry.
Remember, when it comes to our kids and behaviors, all behavior is telling you something. We just have to figure out what it is. We have also been able to notice that when Kevin gets really super stimmy, he has to go to the bathroom.
My guess is that even as some of you are reading this article, you have lots of memories coming back to you indicating interoception issues. Since parents spend more time with their kids than anyone else, it’s up to us to identify antecedents and patterns.
The idea is to look for patterns so that we can help our kids identify these feelings and appropriate responses. And that’s before an emergency.
Dangers of a High Pain Threshold
When Kevin was a baby, still crawling around, I remember this one time he crawled right into this corner thing that sticks out. Within a few minutes, he had this huge purple golf ball on his forehead. Being a new mom, I called the pediatrician. I didn’t know what to look for or if I should run him to the ER.
I remember her saying, “Well, I don’t hear him crying and screaming in the background” and I was like, “Yeah, but you should see this thing, it’s huge!” He didn’t have any of his diagnoses yet, so I’m sure she thought I was just an over-worrying, new, first-time mom.
To this day, I’m astounded that he didn’t cry. Since that day, we’ve had several similar incidents. A high pain threshold is related to interoception. It often is the first example that parents are able to label, as pertains to their child’s sensory issues.
Interoception and your IEP
I’m leery of putting actual IEP goals in this article. However, if you see a need in your child, I would ask for an OT evaluation in this area.
From there, you and the OT can work together to develop a goal for interoception.
Yes, there is a curriculum developed for interoception and interoceptive skills.
It’s not cheap. However, it may be worth it for parents to buy it to work on at home.
- Kelly Mahler OTD, OTR/L (Author)
- 183 Pages - 05/31/2023 (Publication Date) - Kelly Mahler (Publisher)
How to Improve Interoception
Here are some things you can do to improve your child’s interoceptive skills and interoceptive awareness.
- Verbally Label Everything-As your child goes throughout his/her day, label everything. “Oh you’re drinking, that means you are thirsty” or “Wow it is really cold out today, we need a coat and a hat.”
- Sensory Diet-A Sensory Diet is something you can do at home and in the IEP. A good sensory diet designed and implemented to meet your child’s sensory needs will improve all 8 senses.
- Use Visuals-Books, pictures and visual schedules can all help with identifying some feelings such as hunger, thirst, and toileting.
- Talk about all your feelings, often. You may have to change adjectives until you can build up to the correct one. Instead of “Do you feel nauseated?” try using “Does your stomach feel good or bad?”
- Use Recall. “Remember that time you….” and go over how the child felt. Label it and also re-describe the solutions you used.
- Ask them to point. Can they point to the body part?
- Try Yoga and other Mindfulness Activities. Many adults have found yoga and other mindfulness activities to be helpful in increasing body awareness. Mindfulness Activities for Kids may yield successful results.
- Repetition: Moms, you know your kids and what teaching interventions work for them. Like anything else, this just takes practice.
This concept has only recently begun to be addressed for our kids. But, as a parent who worried about a “high pain threshold” for years, I am grateful to at least have a label for it. And some awareness.
You cannot solve a problem if you cannot define the problem. Good luck!
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