Several years ago, I took my boys up to my dad’s house. Kevin (my autistic child) walked into the room where we were, stood in the middle of the room and suddenly started vomiting. Since he doesn’t vomit often, he was clearly upset and shaking his head.

Unfortunately, that meant the vomit was spraying everywhere. If that is not a classic case of interoception dysfunction, I don’t know what is.

At the time, no one was talking about interoception or suggesting interoception activities. Even though we knew Kevin had autism and sensory differences, no one explained how those challenges could affect his ability to recognize internal body signals.

Signs a Child May Have Interoception Difficulties

A child who struggles with interoception may:

• not notice hunger or thirst until they are very upset
• have frequent toileting accidents
• have a very high pain tolerance
• not recognize when they are tired or overheated
• struggle to describe how their body feels
• seem to go from calm to meltdown quickly

Quick Answers About Interoception

What is interoception?

Interoception is the body’s ability to notice and interpret internal signals such as hunger, thirst, pain, nausea, temperature, and the need to use the bathroom.

Why do autistic kids struggle with interoception?

Many autistic individuals have difficulty recognizing or interpreting internal body signals. This can make it harder to notice hunger, anxiety, pain, or the need to use the bathroom until the feeling becomes intense.

Is interoception a sensory system?

Yes. Interoception is considered one of the body’s sensory systems, along with vestibular and proprioception, which help regulate balance, body position, and internal body awareness.

Can interoception be improved?

Children can learn to recognize body signals with practice, language development, and supports such as occupational therapy or structured body-awareness activities.

What Interoception Is

Interoception is the body’s ability to notice and understand internal signals such as hunger, thirst, pain, nausea, temperature, and the need to use the bathroom. It’s often called the “body awareness sense,” and it helps us recognize what is happening inside our bodies so we can respond appropriately. For many autistic children, interoception can be harder to interpret, which can affect things like emotional regulation, toileting, hunger cues, and recognizing when their body is uncomfortable or overwhelmed.

Everyone has interoception; it’s a normal sensory system that helps us recognize what is happening inside our bodies. Most people notice signals like hunger, thirst, needing the bathroom, or feeling anxious without thinking much about it. For many autistic individuals, however, those internal signals can be harder to recognize or interpret, which can make things like emotional regulation, toileting, or recognizing discomfort more challenging.

If you grew up like I did, you probably learned that humans have five senses: sight, sound, taste, touch, and smell. But many professionals now teach that there are actually eight sensory systems.

In addition to the traditional five senses, there are three additional ones:

• 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.

Interoception is the ability to notice and understand internal body signals. These signals include things like hunger, thirst, nausea, needing to use the bathroom, pain, temperature, and even the physical sensations connected to emotions.

Our bodies have internal sensors called interoceptors that send information to the brain about what is happening inside the body. When this system works well, we notice body signals and respond appropriately. When it doesn’t, those signals may be missed, misunderstood, or delayed.

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.

Examples of Interoception Challenges

When interoception is difficult, kids may struggle to recognize what their bodies are telling them.

You may see things like:

• A child who doesn’t realize they are hungry until they suddenly become very irritable.
• A child who frequently has bathroom accidents because they don’t recognize the early signals that they need to go.
• A child who becomes overheated or too cold without noticing it.
• A child who doesn’t seem to react strongly to injuries or pain.

I’ve heard many stories of autistic kids breaking a bone and not even crying. Some parents don’t realize something serious has happened for days because the child simply didn’t show the typical pain response.

Interoception can also affect things like toilet training. Some kids truly don’t recognize the internal signals that tell them they need to use the bathroom. When teams are writing toileting IEP goals, interoceptive awareness may need to be addressed alongside those goals.

For my own son, interoception affects many everyday concerns. I often have to think about things other parents might take for granted–like whether he’s hungry, dehydrated, uncomfortable in his clothing, or experiencing medication side effects.

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. If you are setting toileting IEP goals for a child, you may have to consider interoceptive awareness skills to go along with it.

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.

Why Interoception Affects Emotional Regulation

Interoception is closely connected to emotional regulation because emotions also create physical sensations inside the body.

Think about how anxiety feels physically. Your heart might beat faster, your stomach might feel tight, or your breathing might change. Those physical signals help us recognize what emotion we’re experiencing.

When kids struggle with interoception, they may feel those sensations but not understand what they mean.

I saw this with my youngest son when he was eight. For several days, he kept telling me, “Mom, I think I’m going to throw up.”

It turned out he wasn’t nauseous at all. He was experiencing anxiety attacks.

Because he didn’t have the vocabulary or experience to recognize those body sensations as anxiety, he labeled them as nausea instead.

This happens to adults too. Many people go to the emergency room thinking they’re having a heart attack, only to learn they’re experiencing a panic attack. If you’ve never felt those sensations before, it can be hard to interpret what your body is telling you.

For kids, learning the language to describe body signals is often the first step in improving interoceptive awareness.

How It Shows Up at School

Interoception challenges can affect many parts of the school day.

A student might struggle to focus because they are hungry or uncomfortable but don’t recognize the sensation. Another student might become overwhelmed or anxious without noticing the early body signals that usually help people regulate themselves.

Some students may have a very high pain threshold, which can make injuries harder to detect. Others may be extremely sensitive to internal sensations.

Interoception can also affect behaviors that adults sometimes misinterpret. A child who suddenly becomes upset or dysregulated may actually be responding to internal discomfort that they cannot identify or communicate.

Because these signals are internal, teachers and parents often need to look for patterns and observable cues.

Parents often become very good at recognizing these signals. For example, my son Kevin recently started walking into the kitchen and standing near his Rifton chair. Since that’s where he eats, we quickly realized he was telling us—without words—that he was hungry.

Behaviors are communication. Sometimes we just have to figure out what the body is trying to say.

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.

Interoception and IEP Supports

A lack of interoception is not a formal medical diagnosis, and it is not listed in the DSM. However, the skills related to interoception are very real and can significantly affect daily functioning.

Occupational therapists often address interoception as part of sensory processing and body awareness work. Because these skills affect learning and independence, they can absolutely be addressed in an IEP.

For example, interoception-related supports might include:

• working with an occupational therapist
• teaching students to identify body signals
• using visuals or check-ins to help students recognize hunger, thirst, or fatigue
• practicing emotional awareness connected to body signals

If interoception affects toileting, emotional regulation, or self-care, those areas may also become part of measurable IEP goals.

The interoception system is complex, and the education and therapy fields are only recently beginning to focus more attention on it. But helping kids recognize and interpret their body signals can make a meaningful difference in their ability to regulate themselves and communicate their needs.

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 in our living room. 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 many 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.