Neurodiversity
Interoception is the sense that tells us what is happening inside our bodies. When it works differently, as it often does in autistic children, the effects touch everything from eating and toileting to emotional regulation.
Most people know about the five senses. Many people in the neurodiversity world know about the eighth sense, proprioception, the body's sense of its position in space. But there is another sense that is arguably more foundational to daily functioning than any of these, and it receives almost no attention in mainstream conversations about autism: interoception.
Understanding interoception changed how I work with students. Once you understand it, a lot of behaviour that looks inexplicable, a child who does not notice they are hungry until they melt down, a child who cannot identify that they need the toilet until it is urgent, a child who cannot name what emotion they are feeling, starts to make complete sense.
What interoception is
Interoception is the internal sensory system that detects and interprets signals from inside the body. Hunger, thirst, temperature, pain, the need to use the bathroom, heartbeat, breathing, nausea, these are all interoceptive signals. The interoceptive system is also closely linked to emotional experience. The feeling in your stomach when you are anxious, the heaviness in your chest when you are sad, the physical sense of joy, these are interoceptive experiences.
Research led by Dr Kelly Mahler, an occupational therapist who has done significant work on interoception and autism, shows that interoceptive differences are common in autistic people. These differences can mean signals are received too weakly (poor interoceptive awareness), too strongly (sensory overwhelm from internal signals), or inconsistently.
How interoceptive differences show up
- Eating: not noticing hunger until very hungry (leading to meltdowns that turn out to be blood sugar-related), not recognising fullness, not noticing that specific foods cause physical discomfort
- Toileting: not recognising the need to use the bathroom until the sensation is urgent, accidents in children well past the age where these would be expected
- Sleep: difficulty recognising tiredness, difficulty self-regulating toward sleep
- Temperature: not noticing being too hot or cold until significantly affected, wearing the wrong clothes for the weather without apparent awareness
- Illness and pain: not noticing illness or injury until symptoms are significant, difficulty locating pain or describing it accurately
- Emotional regulation: difficulty identifying emotions because the physical signals that correspond to emotions are not clearly received, leading to difficulty naming feelings and therefore difficulty managing them
- Anxiety: sometimes experiencing anxiety as a physical state without recognising it as anxiety, making it very difficult to address
The link between interoception and emotional regulation
This is the connection that I think matters most for families and educators. Emotional regulation depends on being able to notice what is happening in your body, identify it as an emotion, and then take action to regulate. If the interoceptive signal is weak or unclear, you may not notice the physical signs of anxiety, frustration, or excitement building until they have already escalated beyond easy management.
“Emotional regulation depends on noticing what your body is telling you. If those signals are unclear, regulation becomes genuinely harder, not a choice, but a neurological challenge.”
What helps
Interoceptive awareness can be developed. Dr Mahler's interoception curriculum is the most evidence-based resource currently available and is used by many occupational therapists working with autistic children. The approach involves gradually building awareness of body signals through structured activities, not by telling children what they should be feeling, but by creating opportunities for them to notice and explore their own signals.
- Work with an OT trained in interoceptive awareness, this is a growing area and specifically relevant for autistic children
- Use structured check-ins: 'What does your stomach feel like right now? What does your chest feel like?', building a vocabulary for internal experience
- Create predictable eating and hydration schedules, especially for children who do not reliably notice hunger and thirst
- Use visual body maps that children can point to rather than requiring verbal description of internal sensations
- For toileting: timed bathroom visits as a routine, not as a response to urgency
- Connect physical states to emotions explicitly: 'Your heart is beating faster. That might be because you are excited or nervous. What do you think it is?'
Neurodiversity
A note on accuracy:While every effort has been made to ensure the information in this article is accurate at the time of writing, facts, policies and research can change. We're human, and sometimes we get things wrong. If you spot something that needs updating, we'd genuinely love to hear from you.
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Dave Harrison
ESW · Neurodiversity Advocate · Podcast Host
Dave Harrison is currently working in Australian schools as an Education Support Worker. He's the founder of THRVHUB, host of the Different Is Normal podcast, and a parent of a neurodivergent teenager, writing from both sides of the classroom.
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