Tuesday 5 December 2017

The Hidden Sense of Interoception

One of the things that I have learnt on our Autism journey thus far is that you never stop learning. Never!

Since O started her therapy sessions we have begun yet another learning journey.

But before I get onto the topic of this post, there is some background information that you need to know about first, otherwise you may become slightly confused.

Ever since O started Kindy, we have always struggled to get her to drink water regularly, eat her recess and lunch at school and go to the bathroom on a more regular basis.

I am sure that she has a hidden camel hump somewhere, as on some days she will rarely drink water during the day but then she loads up in the afternoon and evening. I also wonder if she has a bladder of steel as this little superhero can hold on for a very, very long time!

We've always put these struggles that we have down to O just simply being too busy at school or simply forgetting. Now the issue with not drinking enough water or eating enough food throughout the day leads to other more serious complications. On more occasions than I would like, we have ended up in the emergency department of our local hospital with a very dehydrated child.

It was only in talking to O's key therapist and the school age services coordinator that we realised that perhaps, just perhaps, O's sense of interoception hasn't fully developed.

I can now hear you asking, what on earth is interoception?

I have talked briefly about interoception in a previous post, but let's go into a little more detail.

First we need to go back to basics. We all know about the five senses - hearing, sight, smell, touch and taste. But there are three others that are considered our hidden senses. Senses that we don't consciously think about or are aware of on a daily basis.

The sixth sense is our vestibular sense - this sense provides our bodies with information as to where our head and body are in space. It helps us to keep our balance as we move about.

Then we have the seventh sense which is proprioception. This is our body sense that tells us where our body is in relation to the rest of us. It also tells us how much force to exert when performing different activities like hugging someone, shaking hands, cracking an egg open and so on.

Then we have an eighth sense - our interoception sense. This is a relatively unheard of internal part of the sensory system and consists of all of the internal sensations that we may feel on a daily basis when we're hungry, thirsty, anxious, nervous or when we need to go to the bathroom. Any sensations that originate from within our bodies all stem from the sense of interoception. Receptors in our body organs and skin, are constantly sending information about the inside of our bodies to our brain.

Our sense of interoception is always there in the background and it isn't something that we are generally consciously aware of.

In some individuals, particularly those who have sensory processing difficulties, this hidden sense may still be developing. And as with sensory processing difficulties, individuals may be under-responsive, over-responsive or a combination of both.

Some specialists consider that individuals with sensory processing difficulties may not know how to verbally label the data that their brains receive from the interoceptive sense. If they are not receiving enough data, the sensations that they receive may be confusing. And likewise if their brains are receiving too much data from the interoceptive sense, the sensations may become very overwhelming.

In O not feeling the need to drink water regularly in essence means that this part of her interoception sense is under-responsive - she simply isn't receiving enough data to register that she is thirsty.

In O being in a constant state of anxiety at times in essence means that this part of her interoception sense is over-responsive. Her brain is receiving too much information and the data becomes a distraction so she is unable to focus on anything else and enters into an anxious state.

The tricky thing about our sense of interoception is that the data that it sends to our brain, is required for a range of basic and advanced functions. These functions range from breathing, being hungry or bring full, needing to go to the bathroom, being aware of our own emotions, being able to manage our own emotions and everything else in between.

So it makes sense then that if a child's sense of interoception is still developing, then they may struggle with recognising and responding appropriately to their own emotions and to those of others.

If an individuals brain has difficulties in making sense of the information that it receives, then the individual may not be tuned into their internal body cues that assist others to interpret emotions. They may have difficulty "feeling" the different emotions that they experience. If an individual is not able to interpret their own different body sensations, then they may have difficulty in identifying their own and others emotions.

So how can we help children whose sense of interoception may still be developing?

One of the activities that O's key therapist has been working on with O is labelling different emotions and talking about what some of the external AND internal feelings that she may feel that are associated with these emotions. We have quite a number of body outlines with different sensations written around them - anger, nervous, happy, sad, you get the picture. This has been incredibly beneficial and very effective as O is now starting to recognise the early warning signs of her different emotions and can now verbally tell us how she is starting to feel.

Earlier this year, I developed a social story called "My Book About My Feelings" to assist O in labelling her own emotions. The story started to assist O to identify how she felt inside when she was sad or anxious.

We regularly read books and talk about how the characters might be feeling in particular situations.

When we see the little superheroes experiencing different emotions, we will verbally assist them to label their emotions - "Oh you look very excited....." or "I can see that you are becoming angry/frustrated by ..............." This not only assists them to label their own emotions but it also provides them with the appropriate language so that the next time, they may be able to verbally express themselves.

We also verbally label our own emotions and our internal sensations to the little superheroes. If they recognise that they too experience these internal sensations then they will begin to connect the dots!

Interoception issues are not as well known as other sensory processing difficulties and as such, medical professionals are still developing strategies to further develop this sense in those who need it.

The great thing about being on a learning journey with the little superheroes is that as we have an awareness of and basic understanding of the possible causes behind the little superheroes behaviour and/or functional limitations, means that we are helping the little superheroes. Just having an awareness of the sense of interoception and implications of this sense still developing means that we are able to trial different strategies to see what works best for them. It means that we are more understanding when we see them struggle with skills that everyone seems to take for granted.

So the next time you see a child who can't seem to get the hang of toilet training, or they never seem hungry or thirsty, or they fly off the handle at the drop of a hat, keep in mind that perhaps their sense of interoception is still developing.


  1. I've never heard of this before, but it sounds fascinating. I try to be very in tune with my emotions, which helps a lot with my relationships with other people because I can communicate them better. I can only imagine how helpful this must be for someone with Autism. That's amazing that you've been able to work your creativity into helping O express themselves. How awesome!

    1. It is something that I wasn't aware of either, but it makes a lot of sense!

  2. I love that you are doing everything you can to help O cope with her autism. She's very lucky to have an advocate such as yourself!

  3. Huh, I had never heard of this but it makes a lot of sense. I have a 3 year old who still doesn’t recognize when he’s gone to the bathroom in his pants which is frustrating but knowing that he just may not have developed far enough in that area helps. Great read.

    1. Thank you for your kind words. Once I started reading up on Interoception, a lot of issues that we've made started to make sense!

  4. This is so interesting! I've never heard of our hidden senses before, and it makes total sense how these developing skills can affect little ones differently. It sounds like you're doing an amazing job with O and her therapists!

    1. I am sure that I've learnt about these senses back in my university days but it was probably something that I "filed" in the back of my brain!

  5. I am blown away everytime I read your blog posts. YOu do amazing to understand everything there is to know about this with your little ones and you are doing such an amazing job !

  6. Thank you for this article. Both our boys have ASD and SPD. This article explains our our 5 year old, the youngest. It can get frustrating for his Dad and I. But, I knew it probably was apart of a developmental delay. I have to remind him to eat, drink, and go to the bathroom. Still wears a diaper for pooping. Also, in public and playing with friends he builds up to becoming overstimulated and starts hitting. He seems to be out of his body when this happens. Any how thanks again for this article. It totally makes sense! And, no therapist has ever even mentioned it.

    1. I know exactly how you feel. We struggled for a long time with O and L so the sense of interoception helps to fit all the pieces together. I think in terms of therapy, it is a relatively new concept of how it affects children.

  7. I haven't heard of this, but it makes total sense! It sounds like you're making great progress!

  8. Thank you, this is informative useful and relevant.

  9. Thank you Jenni.

    We also have two kids and one of the is a clearly ADHD/SPD our son. But the older (our daughter) does not have such clear symptoms, except this annoying thing with when to go to the bathroom....It seems for her, we have to help based on your story...hopefully she will be open for it.

    Thanks for sharing!

    1. Thank you so much, I do hope that this information helps your daughter.

  10. I had never heard of this before but it does make sense for kids that have sensory disorders or kids that may have been born early. Very interesting!

  11. I have also never heard of this! This does make so much sense though - I have two kids with sensory issues and this really does put a lot into perspective!!!

  12. As an education major in college, I learned all about sensory disorders, but never ran across this. It was fascinating to learn about, as a teacher and as a mother. Thanks!

  13. Your blog is by far my fav to read! I had no idea about our hidden senses!!!


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