Understanding Interoception: A Missing Link in Emotional Regulation for Autistic Children

As occupational therapists, we know how vital it is to look beyond surface behaviors when supporting autistic children. Increasingly, research and clinical practice are pointing toward a powerful, often overlooked sense, interoception, as a root factor in emotional regulation, behavior, and daily functioning. But what is interoception, and why does it matter?

What is Interoception?

Interoception is our body’s internal sensory system. It helps us notice physical sensations like hunger, thirst, pain, fatigue, and the need to use the bathroom. It also plays a key role in identifying emotions: think of that tight feeling in your chest when anxious, or the butterflies in your stomach when excited.

For many autistic individuals, interoception cues can be missed, misinterpreted, or overwhelming. This contributes to difficulty identifying and responding to emotions, a phenomenon linked to a condition known as alexithymia, or the reduced ability to recognize and describe feelings.

When children can't detect early cues like rising frustration or sensory overload, they’re less able to regulate their responses, leading to shutdowns, meltdowns, or withdrawal.

What the Research Says

A 2022 study published in Occupational Therapy International examined the effectiveness of The Interoception Curriculum, a 25-week school-based program designed by occupational therapist Kelly Mahler. The study included 14 autistic children and found statistically significant improvements in both interoceptive awareness and emotional regulation by the end of the program.

Notably, improvements were found not only in emotional control (such as managing frustration or anxiety), but also in homeostatic skills, like recognizing hunger or pain and taking action (e.g., asking for a break or food).

This supports what many OTs observe in practice: when children better understand their internal signals, they are more equipped to advocate for their needs and regulate their emotions.

Bringing Interoception Into OT Sessions

If you’re a parent or therapist looking to integrate interoceptive work, you don’t need to wait for a formal curriculum to start. Here are a few simple and effective interoception activities used in therapy:

1. Body Check-Ins

Encourage children to tune into how their body feels in the moment. Use visuals or body maps to ask:

• “What does your tummy feel like right now?”

• “Are your muscles tight or relaxed?”

Start with simple language like "heavy," "buzzy," or "warm" rather than emotion labels.

2. Movement + Reflection

After a sensory or movement activity (e.g., bouncing on a therapy ball or playing with water), pause and ask:

• “What do you notice in your body now?”

• “Do you feel more calm or more awake?”

This builds body-emotion connections over time.

3. Emotion Matching

Use storybooks, short videos, or role play to discuss how characters might feel physically when they’re sad, excited, or nervous. This helps bridge cognitive understanding with embodied awareness.

4. Interoception Journals

Track how kids feel before and after meals, rest, or play using pictures, emojis, or checkboxes. This helps them begin to connect actions (like eating or resting) to improved feelings in the body.

5. Pause + Tune In

Use short, regular prompts like:

• “Let’s check in with our bellies before we start.”

• “Give me a thumbs up/down if your body feels ready.”

This can become a calming and grounding habit.

A Foundational Skill, Not a Quick Fix

Helping a child improve interoception isn’t about eliminating meltdowns or teaching compliance. It’s about empowering them with tools to understand their own body on their terms.

As the recent study concluded, supporting interoception may be a key to reducing emotional dysregulation in autistic children. For many families, this shift from “fixing behavior” to fostering self-understanding is transformative.

Final Thoughts

Interoception-based support is a powerful, compassionate approach that aligns with neurodiversity-affirming practice. It centers the child’s unique experience and offers practical tools to support self-regulation, participation, and wellbeing.

Whether you’re a caregiver noticing big emotional responses in your child or a therapist looking for new tools, interoception work offers a promising path forward, one body signal at a time.

References:

Mahler, K., et al. (2022). Impact of an Interoception-Based Program on Emotion Regulation in

Autistic Children. Occupational Therapy International, https://doi.org/10.1155/2022/9328967

Learn Play Thrive Podcast, Episode 95: Autism & Interoception with Kelly Mahler