Teaching interoceptive awareness

Interoceptive awareness is the ability to notice the sensory information that the brain receives internally from the body.  These messages come from the interoceptive receptors in our body.  Kim explains interoception further in this article.  If you haven’t already, you may want to read it first.  In this post we will explore

  • Why every needs to be aware of interoception!

  • Concepts children need to learn

  • Stages of interoceptive awareness

  • How to teach interoceptive awareness

boy sitting with dog title helping introceptive awareness

Teaching interoceptive awareness

Interoceptive awareness is the ability to notice the sensory information that the brain receives internally from the body.  These messages come from the interoceptive receptors in our body.  Kim explains interoception further in this article.  If you haven’t already, you may want to read it first.  In this post we will explore

  • Why every needs to be aware of interoception!

  • Concepts children need to learn

  • Stages of interoceptive awareness

  • How to teach interoceptive awareness

Why interoceptive awareness is important

As Kim explained in the article on interoception, processing of interoception is essential to be able to self-regulate.  If you’re not noticing sensations like hunger, needing the toilet or pain, you won’t take action to change them.  And, you may be uncomfortable as a result.  Or, you might get hangry and lose our temper more quickly!

What interoceptive sensations do we need to be aware of?

The interoceptors give the brain information about the following internal sensations.

  • Hunger (or fullness)

  • Need for the toilet

  • Tiredness

  • Internal stress or heightened arousal

  • Internal pain/discomfort

  • Internal temperature

  • Feelings and emotions

  • Awareness of the effect of external messages on internal state

The five stages of interoceptive awareness

Developing interoceptive awareness

As we gain even more interoceptive awareness, we are able to take proactive management steps.  For example, if you know that leaving your assignment to the last minute will result in significant anxiety, you might plan to do it the week before.  Or, if you know that your child might find a birthday party overwhelming, you might plan in advance to go for a shorter time. And, you could ensure that they have done some calming and regulating activities before and after they go.

Interoceptive awareness and development

The ability to manage interoceptive signals typically  improves through each stage children mature.  A baby will notice hunger and cry, but they can’t name or manage this sensation by themselves because they don’t have the maturity.  A toddler knows something is up, but often temper tantrums are the result of lacking the language to describe their need.  Teenagers often don’t understand the impact of their choices straight away!  Even adults miss cues sometimes.

Ongoing development across the stages is normal.  However some children don’t progress through the stages as they mature and need extra help.

girl looking up and screaming

Kim reflects

One thing I have noticed time and time again is children incorrectly identifying anxiety as feeling sick.  So, they have a sensation in their tummy, they have noticed something.  They might be able to name and describe it as a sore tummy. However, they have associated the feeling of sick to it rather than the feeling of anxiety.  These children often want to stay home from school as they feel sick and the need help to identify the differences between feeling hunger, sick or anxious, and in some cases needing the toilet.

How to teach interoceptive awareness

When supporting children with poor awareness, you need to consider all stages.  Some children (and adults!) might be great at noticing, naming and understanding feelings, but not be able to understand the impact or manage.  Other children might need help initially with noticing.  Children with language processing difficulties may need more support with naming both sensations and feelings.

Each child is different.  This interoceptive tracking sheet page is a useful free assessment tool to help identify which stage a child might need help with for each sense.

Noticing interoceptive sensations

Noticing sensations is best done in real time when the sensation is present.  So, if it’s a hot day and the child has been running around with their jumper on and their cheeks are hot, they can touch their cheeks.  Or, hot and cold water can be used to teach children the difference between the two sensations.

Internal sensations like hunger or needing the toilet can be trickier to teach.  For some children, video can be a great tool to help them to see what their body might do when they are feeling sensations.  This only works for externally shown movements, like jiggling about if they need the toilet, yawing when tired, or grimacing if they are uncomfortable.

Naming sensations

Strategies to support vocabulary will be different for each child.  Children with specific language difficulties or autism may need extra help from their speech and language therapist (SALT).  The SALT can advise on specific strategies that will meet their needs, which might include sign or symbols.

Adults can reinforce sensations when they occur.  So, if the child hurts themselves give language like that looks sore, or it hurts.  The adults can also give perspective to how big the hurt is – so that was a big hurt, or a little hurt.  And, give language for the position on the body, such as you have hurt your leg.

It can also sometimes help if adults externalise the sensations they are feeling.  So, my tummy feels a bit sore, I think I am hungry.  Or, I’m yawing I think I am tired.

Linking sensations feelings

Linking to feelings often requires good emotional vocabulary.  This might need to be taught.  Mirrors or videos can be used to look at their own face and body when naming emotions.  Games like charades where children have to name the emotion can also be fun.  There are picture cards available and children’s books and Disney films are great for identifying emotions!  Some children will need help from their speech and language therapist as well.

sausages and tomato on a plate

Only one sausage

One child Kim supported would always become very dysregulated when hungry.  One week, he arrived to lunch very late as he was refusing to come to the lunch hall.  Then, he only received one sausage for lunch, as the cook has made his plate with only one.  This upset him further, as he would usually ask for two.  Next time he was hungry for lunch, Kim was able to reflect with him about what occurred the previous time.  He remembered that if he was late and the cook made his plate, he might only get one sausage!  This reflection helped him to understand the impact and manage the situation.  He went straight down to line up for lunch so that he could ask for his two sausages!

Understanding impact

Stories are a great way to help children to understand the impact their choices can have.  Children’s books and Disney films can be used to show children the impact that different choices may have had.  For example, in the opening scene of Nemo, Nemo gets so excited that he gets stuck in a piece of coral. This is a great scene to discuss and think about the impact of being too excited.

You can use any story where the characters ignore or pay attention to their feelings.  You can ask children what they think might happen so they are predicting.  Or, once they know the outcome you can reflect with them on what the character could have noticed.

You can also use comic strip conversations to map out real life situations with children.  When drawing the comic strip, identify what you were noticing in their behaviour before the situation happened.  Give them the language to name what you were noticing.  Colours can also be used to show the feelings getting bigger.

Managing

Once children have been able to notice, name, link and understand impact you can help them to manage and make different choices.  It is important to remember that children will need adult support initially before they can self-regulate.  This is called co-regulation and Kim explores it further here.

Teaching children to manage temperature, toileting, tiredness and hunger often involves repetition and reinforcement.  Whilst you can talk about management strategies, children with difficulties often need these reinforced in real time.  You can also talk about it when you have to manage your own internal sensations.

Some children may not be able to fully understand the impact, but with visual cues and consistent practice, they can still learn to make different choices and manage.  The visual cue might be as simple as pictures of ‘hungry’ and ‘food’ set up like a now and next board.  Or, a picture cue for the toilet.  Programmes like the Zones of Regulation will use colours to prompt children to manage their arousal levels.  Kim is developing a new sensory regulation curriculum and will be looking for test schools in 2022.  You can register your interest here if you would like more information when we are looking for test schools.

One key thing about teaching interoceptive awareness is being very aware of your own internal sensations and responses!  Humans are social animals and we mirror the responses around us.  So, if are you trying to support a child to calm down, it’s important you are also using strategies to keep yourself calm as well.

Supports to teach interoceptive awareness

There are a number of different programmes available to help to teach interoception and emotional regulation.  Each of these has their pros and cons.  Some are written for children with higher language levels and do need adapting for younger children.

  • Ready to learn is a free programme.  The manual outlines a step by step curriculum with activities and  recommendations.
  • Child Therapy Services have a number of resources and trainings available to help to support emotional regulation.  They are great for younger children and are very reasonably priced.
  • The RULER approach has some fantastic resources for students, the training is expensive ($USD6000 for three staff).  The book Permission to Feel by it’s author Mark Brackett gives a good overview.
  • Many schools use the Zones of Regulation.  The book (approx £50 on Amazon) outlines a weekly curriculum.  This needs to be adapted for younger students.  It is also critical that staff reinforce that all zones are OK, rather than focusing on an expectation of students to be in the Green Zone all of the time.  (Which may sound obvious, but unfortunately this is not always practically applied).
  • The Interoceptive Curriculum provides a clear structure for teaching all stages of interoceptive awareness ($USD159 + postage).

Opportunity to test Kim’s new curriculum

Kim will also be launching her regulation curriculum in 2022.  She is taking expression of interests from schools who would be interested in testing the curriculum for free in return for providing feedback.  You can register you school’s interest here.  Kim will be in touch in April 2022 with more details.  Registering doesn’t mean you are definitely committing, it just means you will be the first to hear when more information is available.

Photo credits

  • Boy with dog –  Sam Lion Pexels 5732534
  • Girl – Stephen Andre Pexels 9305112
  • Sausages  – Mali Maeder Pexels 929137

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