Regulation Rendezvous: Meeting The Interoceptive Needs Of Individuals With Autism And Other Low-Incidence Disabilities

When working on developing an individual’s interoceptive awareness, individuals engage in activities that focus on inner feelings, which can make it easier to recognize, make sense of, and manage their own personal internal experiences. During our coaching process, our OT, Lynn DeMange often collaborates with other OTs and educational teams who need help supporting a student’s interoceptive awareness. In today’s Regulation Rendezvous, Lynn shared ideas for Meeting The Interoceptive Needs Of Individuals With Autism And Other Low-Incidence Disabilities. 

Studies indicate that practicing becoming more aware of one's internal signals can lead to less anxiety, make it easier to understand and talk about one’s emotions, and improve one’s ability to handle their feelings.

http://missjennyot.com 

Meeting an individual’s interoceptive needs helps them gain a deeper understanding of themselves. When developing interoceptive awareness, activities should focus on guiding individuals through a process of self-discovery. As Kelly Mahler recommends, this can be achieved through:

1. Paying attention to what one’s body is telling them.

2. Figuring out what those body signals mean.

3. Learning what one can do to change how their body feels

Helping individuals learn about their own unique interoception works much better than past methods that try to tell someone what they "should" be feeling. It's not accurate to say that everyone feels anxiety or hunger in the exact same way. It's different for each of us, so we need to approach it in a way that's tailored to the individual.

Autistic individuals and those with low-incidence disabilities often go through life with their inner feelings being misunderstood, labeled incorrectly, or even dismissed. They can end up feeling internally confused. Plus, the pressure to comply and fit in teaches them to ignore or hide what they're truly feeling just to please others.

So, when we work on interoception with autistic individuals or individuals with a low-incidence disability, often we need to "unlearn" some things before we can really start. This means helping each person feel calm and secure enough to start noticing, reconnecting with, and trusting what their body is telling them again. It's really important to use an approach that understands trauma and focuses on regulation when guiding someone through interoception activities. We need to constantly reassure them that there's no right or wrong way to feel, and that their own inner experience is always real and valid.

Developing interoceptive awareness can work well even for people who don't communicate verbally. To best support non-speaking individuals in understanding their interoceptive awareness, some key first steps include:

• Help them feel calm and secure: Make sure the individual feels safe and regulated, both internally and with your support, so they can tune into their body.

• Keep things consistent: Make the exercises predictable, use similar elements each time, and try to make them a regular part of their routine.

• Use their communication methods: Adapt to how the individual communicates. This might involve using pictures or AAC devices to help them express themselves.

• Believe in their ability: When interoception activities are presented in a way that fits how someone learns, they can do really well. Sometimes things won't go as expected, and that's alright. When that happens, it's better to think it's something about how we taught it, not about the individual's ability to learn.

• Listen to non-speaking voices: Look for resources created by non-speaking individuals to really understand their experiences and how to best support them.

Want to learn more about interoception? Check out these resources:

Interoception Websites and Blog Posts

• https://www.kelly-mahler.com/

• What is Interoception and Why is it Important?

• Regulation Rendezvous-- Interoception

Interoception Journal Articles

• The Emerging Science of Interoception: Sensing, Integrating, Interpreting, and Regulating Signals within the Self

• Interoception and Mental Health: A Roadmap

• Making Sense of Interoception

• Towards a comprehensive assessment of interoception in a multi-dimensional framework

• Interventions and Manipulations of Interoception 

Regulation Rendezvous: Sensory Tips and Tricks

It is essential that school staff take into account how each student processes sensory information so that they can individualize supports to help them stay regulated and ready to learn. In today's Regulation Rendezvous, we will provide some Sensory Tips and Tricks for each of the 8 sensory systems. 

Auditory:

• Allow time to process.
• Research shows that students with autism may need up to 30 seconds of processing time when hearing verbal instructions before they may respond…are you allowing enough processing time for the students you work with?
• Noise-canceling headphones can be a great sensory support for students with auditory sensitivities. Please keep in mind that headphones should be off more than they’re on to avoid the rebound effect of loudness. For students who need this support on a consistent basis, come up with a wearing schedule and have that on their schedule to help staff and the student remember when to have them on and off.

Trotwood ELC, Trotwood

• Did you know that chewing that can be sign of being overwhelmed by auditory input? The physical act of chewing closes our external ear canal and dampens volume. Keep this in mind when working with students who engage in lots of chewing behavior!

Ann Rosenbaum
Orchard Park Elementary, Kettering

Visual:

• Visual information is often processed faster than auditory.
• A visual cue ring can be a great way to reinforce verbal instructions or prompts. Remember, your visual cue ring should have positive cues in addition to the visual reminders and prompts it may have so that the student doesn’t develop a negative association with that tool.

Tactile:

• Light touch has a direct connection to the fight/flight center of brain. If deep pressure input is recommended for a student, be sure all staff is on the same page for how to apply that pressure so we don’t accidentally provide alerting input instead of calming.
• Deep pressure input will always be a calming source of input to the tactile sensory system.
• Unexpected touch can also be very alerting. If you provide hand-over-hand assistance to a student you work with, always be mindful of how you approach the student and talk to them/warn them before you touch them so they can anticipate that touch.
• Often times students present with a low threshold to receive non-preferred tactile input. These students benefit from having alternate ways to participate in activities that may cause them to come in contact with aversive textures (e.g. use paintbrush during “finger painting”, use of a glue stick instead of liquid glue, etc.). Another option could be to have a washcloth or wipe readily available to use for clean-up while working on tasks that may make a student ‘dirty’ to help ease their anxiety during ‘messy’ task activities.

Proprioception:

Heidi Horner
Nevin Coppock, Tipp City

• Only sensory system that is always calming.
• Regulates all other sensory systems.
• When in doubt use proprioception.
• Weighted supports can be an effective way of providing calming proprioceptive input including things like weighted lap pad, weighted blanket, weighted backpack, and weighted vest just to name a few.
• When using a weighted support that a student wears the OT should meet with the team to determine a wearing schedule. This should be clearly communicated to the staff working with the student and, ideally, should be embedded into the student’s daily routine. This ensures that wearing this type of supported is being targeted during sensory rich parts of the student’s day and ensures that it is not being worn too much or too often. Keep in mind – when wearing weighted supports they should be off more than they are on. They also should be individualized for each student by weighing the student and not exceeding 10% of their body weight when using a wearable weighted support. It’s typically best practice to start at 5-7% of the student’s total body weight and then adjust based on data collected by the team.

Pam Locker
Washington Primary, Piqua

Vestibular:

• Rotation and rapid acceleration/deceleration are typically alerting types of input.
• Linear and rhythmic movement is calming.

Helke Elementary, Vandalia

Lori Lovelass
Huber Heights

• Vestibular input has a direct connection to the language center of brain. Pairing vestibular input with targeted speech skills can be a great way to motivate students to practice various language skills.

Gustatory (taste) & Olfactory (smell):

• Consistent problems processing taste and smell is sometimes reflected with over-reactivity responses which could indicate why a student may avoid certain tastes and smell experiences to the point that it interferes with social participation, such as family mealtimes or community gatherings where people are preparing or consuming food.
• Many “picky eaters” frequently insist on eating only certain foods or brands of food. They may seek very familiar food with predictable taste and smell, and have difficulty with the flexibility needed to participate in dining in public settings, where a wide range of new tastes and smells may be present.

Interoception:

• Do you work with a student who doesn’t seem to recognize their own body cues and therefore struggles with toileting, emotional control, or makes frequent somatic complaints? Interoception may be the missing link! Check out www.kelly-mahler.com to have access to additional research and free resources!

Regulation Rendezvous--Interoception: The Eighth Sensory System

Today's Regulation Rendezvous is brought to you by our fabulous Occupational Therapist, Lynn DeMange. In today's post Lynn will be discussing the hot topic of Interoception: The Eighth Sensory System.

Did you realize that you have 8 sensory systems?!  When we think of sensory systems most people commonly think of our 5 main senses: visual, auditory, tactile, gustatory (taste) and olfactory (smell).  Our 6^th and 7^th sensory systems are proprioception (body awareness) and vestibular (movement).  Our 8^th sensory system is our interoceptive system which is our sensory system that gives us information regarding the internal condition of our body.

What Exactly is Interoception?

 The interoceptive system has specialized cells (receptors) that are responsible for collecting important sensory information.  In the case of interoception, the receptors are located throughout most of the tissues in our body.  The information gathered by these receptors is sent to a specific area of the brain called the insular cortex, or insula for short.  The insula translates the incoming messages and enables us to identify our current body states.  In other words, interoception allows us to answer the question, “How do I feel?”

Interoception allows us to experience feelings of tickle, hunger, fullness, social touch, need for bathroom, itch, muscle tension, pain, sexual arousal, nausea, physical exertion, breathing rate, heart rate, thirst and every single emotion. 

Interoceptive Awareness (IA) is the ability to notice sensations and give meaning to the sensations.  The insula is the interoception center of the brain.  Research has found that people with well-functioning insula are more aware of the feelings within the body.  These individuals are described as having good IA.

Good levels of IA are clearly linked to the development of many important skills areas including self-awareness, self-regulation, problem solving, intuition, flexibility of thought, social awareness, and perspective taking.  On the other hand, individuals with reduced IA have difficulty with the same skills which, in turn, can have a significant impact on health, well-being, and successful participation in everyday activities.

Based on substantial research, we now know that the insula, or the interoceptive center of the brain, is significantly impacted in people with Autism Spectrum Disorder (ASD) and that there is brain-based evidence backing the interoceptive experiences reported by individuals with ASD.

Without good IA, good self-regulation cannot exist!

Therefore, IA needs to be a main focus when addressing self-regulation needs.

Interoception Resources

Kelly Mahler, MS, OTR/L is the author of the book, Interoception: The Eighth Sensory System. She has also developed the Comprehensive Assessment for Interoceptive Awareness.

CLICK THE IMAGES BELOW TO BE DIRECTED TO PURCHASING SITE

This assessment includes The Interoceptive Awareness Interview, Assessment of Self-Regulation and The Caregiver Questionnaire for Interoceptive Awareness.

In regards to the Assessment of Self-Regulation the percentage scores are not standardized or normed, but it gives you a calculated number to serve as baseline.

There is a huge need to have a standardized measure of interoception for kids. Kelly is currently working with a few physicians on a large interoception research project and she is hopeful that a side benefit of their work is to have a measure that can be used by others. At this point, that research project is a year or two away from completion.

If you know of anyone looking for a research project, Kelly is happy to share her assessment and interested researchers could at least get normed scores for different ages :)  Kelly welcomes people interested in research opportunities to contact her at mahlerautism@gmail.com.

What Can We Do To Help Develop Interoceptive Awareness?

 1. Be Positive…And Focus on the Positive!

• Establish a concrete concept of positive feeling emotions – just start with 2 or 3 different emotions. For example, start with excited, happy and relaxed/calm.
• Then, connect those identified emotions to experiences that cause those positive feelings.  For example, I become excited when I win the BINGO game in class.  I am happy when my teacher writes a nice note on my test.  I am relaxed/calm when I sit in my beanbag chair and read a book.
• Finally, work on connecting those emotions to a description of the sensation noticed when feeling that emotion.  For example, my heart starts to race when I feel excited!  My body feels warm when I am happy.  My muscles feel loose when I am relaxed/calm.

2. Body Checks

• Body Check Charts make the abstractness of internal sensations more concrete by having a visual structure to represent those internal experiences.
• The Body Check Charts displayed below are examples of visually structured methods for building awareness of body signals.
• More information at www.mahlerautism.com
• Body Check Chart Directions

  

Alternate ideas that can make the process of using the Body Check Chart fun and personalized for a particular student:

• Make a full size Body Check Chart by tracing the person’s body and putting their name on it.
• Pointing to a body part on the chart and asking the person to wiggle the corresponding area.
• Pointing to the body parts in the chart while playing Simon Says.
• Making an observation about the person’s body part (fingers tapping, feet shaking, etc.) and labeling it on the chart.
• Experimenting with sensations of a body part and describing how it feels like touching different textures, tasting different foods, listening to different sounds, etc.

3. Body – Emotion – Cause

• This is a great resource developed by Kelly Mahler!  It’s a visual guide intended to be used for in the moment processing connecting positive feeling body signals and emotions to the cause or context of the situation (see the example below):

We need to know what emotion we are feeling in order to control it!

An individual can be taught 100’s of coping strategies, but it is not until we have a clear indicator of when to use a strategy and which strategy is the best match for the emotion at hand that we will be effective emotion regulators across different situations and settings.

Self-regulation is our ability to control the way we feel and act.  The interoceptive system drives our self-regulation behaviors.  Good interoceptive awareness is absolutely crucial to effective self-regulation!

Want to learn more?

• BrainScience Podcast featuring Dr. Bud Craig

• Advance for Occupational Therapy: 2-Part Interoception Article

• Part 1

• Part 2

• FacebookGroup – Interoception: The Eighth Sensory System

• www.mahlerautism.com