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InteroceptionResearch the topic of Sensory Processing Disorder and before long, you will discover that there are actually more than the five senses we all learned about in preschool. We already are aware of the standard five senses of sight, hearing, taste, touch, and smell.   If you have a child or student with sensory isms, you have probably heard about the proprioceptive and the vestibular senses.  But did you know there is an eighth sense called interoception?

Occupational Therapist, Teresa Fair-Field, OTR/L, of Sandbox Therapy Group shares, “Interoception is the sense of the internal processes of the body. Some do not consider it a basic sense, perhaps a luxury afforded those in whom it works properly. For the rest of us, with children we have tirelessly tried to toilet train, feed, and regulate, it seems one of the most basic of all.

As a foundational sense, it could be said that we can attend to higher level cognitive and social tasks by virtue of not needing to attend to the background delivery of interoceptive information. Sitting in a class, we can make note of our sense of fullness, our processes of digestion, or need for elimination, then move them to the background to refocus on the task at hand.”

Interoceptive Sense 

The least well known of the senses is the interoceptive sense, which refers to our internal senses.  Any sensations that originate from within the body, like the feeling of hunger and thirst, sickness, heart rate, and the feeling that one needs to use the bathroom all stem from the sense of interoception.

“The interoceptive sense relates to the sensory nerve cells innervating the viscera (thoracic, abdominal, pelvic organs, and cardiovascular system), their sensory end organs, or the information they convey to the spinal cord and the brain.  Therefore, the interoceptive sense includes input regarding the following: heart rate, thirst, hunger, digestion, state of arousal, mood, temperature, respiration, bowel and bladder” (3)

Fair-Field adds, “It is also believed that an individual with sensory processing isms is unsure how to compartmentalize or label interoceptive sensations and to differentiate them from the exteroceptive senses, perceptions from external sources.”

Under-Responsive Interoception

Some individuals are under-responsive to interoceptive input.  Those who are under-responsive may not respond appropriately or quickly enough to interoceptive stimuli.   A child who does not know when he has to use the bathroom or a child who does not drink enough because he does not feel thirst are two examples of how this under-responsivity manifests.

Gwen Wild, OTR/L of Sensational Brain shares, “The interoceptive system is tricky because we don’t have direct access to it. However, there does seem to be a connection between vestibular input and the interoceptive system.

Therefore for under-responders, I tend to use alerting forms of vestibular input such as multi-directional swinging or bouncing on a large ball prior to food or drink times or to increase an awareness of the need to use the restroom.”

Wild recommends the following visual schedule when working on a toilet-training a child who is under-responsive to interoceptive input.  Wild suggests, “Keep children engaged in alerting forms of vestibular input or movement activities in between frequent trips to the bathroom.

 

Over-Responsive Interoception

On the other hand, some individuals with Sensory Processing Disorder may be over-responsive to input from the interoceptive sense.  A child may be greatly distracted by slight changes in body temperature or may struggle with feeling or hearing their heart beating.  These children may experience a constant sense of anxiety.

Fair-Field states, “In the same way that the nervous system of an individual with various isms has difficulty screening out background sensation such as noise, incidental tactile stimulation (i.e. tags and seams), smells, or peripheral movement, such that it interferes with function, so too can interoceptive data become so distracting that a person can focus on little else.”

Wild suggests, “For over-responders, I have found calming vestibular activities to be helpful such as slow and rhythmic rocking or swinging, or prone over a ball to rock gently back and forth between hands and feet.

Explore More >> Feel the Fear: A Treatment for Anxiety

6 Ways to Calm a Sensory Over-Responder

Storytelling to the Interoceptive Sense

Fair-Field recalls, “Back when my son with PDD-NOS was 4 years old, I began listening to him differently to extract cues.  With facilitation and encouragement, to keep him talking in his own descriptive terms, he told me a story while seated on the toilet one evening. He told me precisely how many bowel movements were queued up inside his body, and which were going to be difficult to pass. That was my first clue that I needed to listen to this tale a little more closely than the usual potty chit-chat. He described the difficult ones as “knocking on the door,” but the door wasn’t opening. The door was, quite literally, stuck. By encouraging his story, and developing his control as the storyteller, he was able to “open the door” and complete his toileting successfully and comfortably.”

Fair-Field queries, “What if, by learning the language he used to describe an internal sensation, we could develop stories together that would manage other interoceptive processes; like heartbeat, or respiration. Couldn’t the same method of storytelling work to walk his way through an anxiety response? It surely has important implications given the current research on interoception. (4) It could just as well, and just as importantly, improve his comfort in moving through life.

Fair-Field suggests the following:

Listen

Listen for stories your child already tells. They may not be as “nonsensical” as they seem.

Be a Guide

If you’re having trouble getting going, start with color or shape and size. Offer suggestions, but not too much direction. Your child needs to be controlling the story.

Reframe

Invite further description. “Tell me what you think might be ‘stuck in your toe?’”

Build Upon

Build on previous stories and earlier knowledge. “Remember when you told me about…”

Allow Time

Expect your story to be developed over time. As children are building awareness and language, processing can be quite protracted. See if you can pick up on an unresolved story at a future time, and move it forward.

Share

Tell the stories to your child’s Occupational Therapist or therapy team. They may be able to connect the dots if you’re not sure where to go next or how to interpret what you hear.

Children with interoceptive discrimination or modulation isms may have great difficulty in knowing what their body needs at any given time.  They may have major challenges with potty training, knowing if they are hungry or thirsty or whether they feel sick or are getting better.  Consider facilitating story telling to help children feel more in control over their body processes.  Explore sensory input to the vestibular system to calm or alert the interoceptive sense depending upon the child’s individual needs.

References

(1) “SPD Life.” Impact on the Senses. SPD Life, n.d. Web. 20 Mar. 2016.

(2) Miller, Lucy J., and Doris A. Fuller. Sensational Kids: Hope and Help for Children with Sensory Processing Disorder. New York: G.P. Putnam’s Sons, 2006. Print.

(3) Morris, Michelle. “The SPD Companion, Issue #016– SPD And Potty Training.” The SPD Companion, Issue #016– SPD And Potty Training. Sensory-Processing-Disorder.com, 6 July 2007. Web. 20 Mar. 2016.

(4) Mundy, Peter, Mary Gwaltney, and Heather Henderson. “Self-referenced Processing, Neurodevelopment and Joint Attention in Autism.Self-referenced Processing, Neurodevelopment and Joint Attention in Autism. SAGE Journals, Sept. 2010. Web. 22 Mar. 2016.

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An “Ism” is our coined term synonymous with a “challenge”. Many children, with or without a diagnostic label, experience various challenges throughout their developmental years which are impacting them in the classroom and at home. At Special-Ism, the Ism is our focus. We do not look at the diagnostic label, instead, we look at the Isms and offer solutions no matter the diagnosis.