By Tim Aiello, MA, LPC, NCC, ADHD-CCSP, ASDCS
What Is Interoception?
Most people are familiar with the five senses—sight, hearing, smell, taste, and touch—but interoception, our sixth sense, plays a crucial role in everyday life. Interoception refers to the ability to recognize and interpret signals from inside the body, such as hunger, thirst, temperature, pain, and emotional states (Craig, 2002). This internal sense allows us to maintain homeostasis and effectively regulate our emotions and behaviors.
For many neurodivergent individuals, particularly those with Autism and ADHD (AuDHD), interoception can be dysregulated, leading to difficulties with self-awareness, emotional regulation, and basic self-care. This can result in missed hunger cues, an inability to recognize pain until it becomes extreme, difficulty identifying emotions, and struggles with sensory overload. Understanding how interoception is affected by Autism and ADHD can help individuals develop strategies to improve self-regulation and emotional well-being.
Interoception and Autism: A Blurred Connection to the Body
Research suggests that autistic individuals experience interoceptive differences more frequently than neurotypical individuals (Garfinkel et al., 2016). Some autistic individuals have diminished interoceptive awareness, meaning they may not feel hunger, thirst, or the need to use the restroom until the discomfort becomes severe. This can contribute to irregular eating patterns, dehydration, and poor self-care habits. Others experience heightened interoception, leading to intense awareness of bodily sensations. This can result in sensory overload, where minor bodily sensations (such as a slightly elevated heart rate or mild digestive discomfort) feel overwhelming and distressing.
From a Polyvagal Theory (PVT) perspective, autistic individuals may spend prolonged periods in sympathetic (fight-or-flight) or dorsal vagal (shutdown) states (Porges, 2011). When stuck in these states, the nervous system may either amplify or suppress interoceptive signals, making it difficult for individuals to interpret and respond to their bodily needs appropriately. This leads to patterns where individuals may unknowingly neglect hunger, thirst, or rest, only realizing their needs once they become severe. Likewise, heightened interoception can make bodily sensations overwhelming, leading to emotional dysregulation and difficulty distinguishing between physical discomfort and anxiety.
Interoception and ADHD: A Disconnect Between Mind and Body
For individuals with ADHD, dopamine dysregulation plays a significant role in how interoceptive signals are processed (Craig, 2009). Because the ADHD brain prioritizes novelty and immediate stimulation, body signals like hunger, thirst, and fatigue often go unnoticed until they reach an extreme level. Many individuals with ADHD experience hyperfocus, where they become so deeply engaged in tasks that they forget to eat, drink, or take bathroom breaks. Others struggle with recognizing exhaustion, staying up late without realizing how tired they are, leading to disrupted sleep cycles and chronic fatigue. Hunger cues can also be inconsistent, with some individuals feeling no hunger for hours, then suddenly experiencing intense hunger, leading to binge eating or poor food choices.
Executive functioning challenges in ADHD also make it harder to establish consistent self-care routines, leading to poor hydration, erratic eating habits, and disrupted sleep cycles. Many ADHD individuals struggle to develop regular habits around eating and hydration, as these require task-switching and prioritization, which are already challenging due to executive dysfunction.
Practical Strategies to Improve Interoception
Since interoception is closely tied to nervous system regulation, adopting Polyvagal-informed strategies can help improve body awareness and emotional regulation.
Body awareness exercises can help individuals reconnect with their interoceptive signals. A daily body scan can be useful, taking a few moments to mentally check in with physical sensations from head to toe, asking oneself: Am I hungry? Thirsty? Tense?
Proprioceptive activities such as stretching, yoga, or deep-pressure stimulation through weighted blankets can help individuals become more aware of their bodily needs.
External reminders like timers or phone alarms for drinking water, eating meals, and taking breaks can help regulate self-care.
Mapping emotions to physical sensations by journaling emotional states and their corresponding bodily sensations can improve the ability to recognize early signs of stress, anxiety, or fatigue.
Structured self-care routines can ensure bodily needs are met before reaching extreme levels, particularly for those with hypo-sensitive interoceptive signals.
Soothing sensory activities, including deep breathing, grounding exercises, or slow rhythmic movements, can help regulate overwhelming sensations for those with hyper-sensitive interoception.
For those who struggle with task-switching and remembering bodily needs, external reminders can be effective.
Timers or phone alarms can be set for drinking water, eating meals, and taking breaks to help regulate self-care.
Visual cues such as placing a water bottle in sight or setting reminders near a workspace can provide necessary prompts for hydration and nourishment.
Checklists or habit trackers can serve as structured ways to ensure basic needs are met throughout the day, making self-care more manageable and routine.
Mapping emotions to physical sensations is another key strategy. Many neurodivergent individuals struggle to connect feelings with bodily experiences.
Journaling emotional states alongside corresponding bodily sensations can improve the ability to recognize early signs of stress, anxiety, or fatigue.
Practicing emotion labeling techniques helps identify feelings in real-time rather than after they intensify.
Developing a personal emotion-body connection guide, listing what different emotions feel like physically, can serve as a useful reference over time.
Engaging in mindfulness practices, such as deep breathing or progressive muscle relaxation, can help bring awareness to how emotions manifest in the body.
For those who are hypo-sensitive to interoceptive signals, structured self-care routines are essential.
Creating predictable routines for meals, hydration, and rest ensures that bodily needs are met before they reach extreme levels.
Using scheduled reminders or apps can help prompt self-care behaviors, especially for individuals who struggle with internal bodily awareness.
Developing a sensory-friendly eating and hydration plan can make consuming food and drinks more approachable and less overwhelming.
For individuals who experience hyper-sensitivity to interoceptive cues, engaging in soothing sensory activities can help regulate overwhelming sensations.
Practicing deep breathing techniques to activate the parasympathetic nervous system and promote bodily calm.
Engaging in grounding exercises, such as progressive muscle relaxation or using weighted items, to provide a sense of stability.
Using sensory regulation tools, like noise-canceling headphones or fidget items, to create a more comfortable environment for managing overwhelming interoceptive input.
Final Thoughts: Embracing Neurodivergent Body Awareness
For autistic and ADHD individuals, interoception is often an overlooked but essential aspect of self-regulation. Understanding how it functions through the lens of Polyvagal Theory (PVT) provides valuable insights into why some bodily signals feel too muted or too intense.
Rather than trying to force neurotypical habits, it’s essential to create tailored strategies that align with the neurodivergent nervous system. By implementing body awareness exercises, external self-care reminders, and sensory regulation techniques, individuals can foster a healthier connection between mind and body.
Honoring interoceptive differences isn't about “fixing” anything—it’s about learning to work with your nervous system in ways that promote balance, self-awareness, and emotional well-being.
References
Craig, A. D. (2002). How do you feel? Interoception: the sense of the physiological condition of the body. Nature Reviews Neuroscience, 3(8), 655-666.
Critchley, H. D., et al. (2004). Neural systems supporting interoceptive awareness. Nature Neuroscience, 7(2), 189-195.
Dunn, W., et al. (2010). Interoception and self-regulation in ADHD. Journal of Attention Disorders, 14(5), 399-407.
Garfinkel, S. N., et al. (2016). Interoceptive dimensions across cardiac and respiratory axes. Philosophical Transactions of the Royal Society B: Biological Sciences, 371(1708), 20160002.
Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation.
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