Autism and Anxiety: the Role of Interoception

Interoception, the ability to recognize  bodily signals like heart rate, hunger, temperature..., is often a significant  source of  stress and anxiety in autistic youth.  

They may struggle to control the overload their body is experiencing by being unable to recognize the physical symptoms they are experiencing, leading to a potential crisis when the build up becomes too much.

Or, an autistic youth may go without eating or drinking anything for an entire school day.  A student may wear clothes that are inappropriate to the weather, seeming not to recognize heat and cold.  

Or, some may experience both depending on the situation and stimulus. 

The study that I used for this episode explores the issue and presents effective ways to lessen to impact of interoceptive weaknesses.

Here are links to resources used in the episode:

file:///Users/davidpoeschl/Desktop/ASD%20and%20anxiety/Autism%20and%20Anxiety%20-%20Autism%20Research%20Institute.html

https://www.google.com/search?q=Experiences+of+interoception+and+anxiety+in+autistic+adolescents+%E2%80%93+CRAE&oq=Experiences+of+interoception+and+anxiety+in+autistic+adolescents+%E2%80%93+CRAE&gs_lcrp=EgZjaHJvbWUyBggAEEUYOTIHCAEQIRiPAjIHCAIQIRiPAtIBCDE0ODVqMGo3qAIAsAIA&sourceid=chrome&ie=UTF-8

Thanks to  soundimage.org for the free access to the AI generated music used in this podcast (https://soundimage.org/) 

Transcript

In my experience working with parents and students with autism over the years, one of the primary similarities the kids presented was and is anxiety.  This is so universal that in Great Britain one of the hallmarks of autism is anxiety.  Studies there indicate that at least 50% of autistic individuals suffer from high levels of anxiety.  However, those estimates are likely an undercount.

In working with parents over the past five or so years in the role of advisor, I am surprised in those few instances that anxiety does not play a central role in problems like school avoidance and meltdowns in school and at home.

Anxiety is self-reinforcing in many cases.  The fear of school, along with the reality that it is in actuality, a very tough place to navigate, adds to the anticipatory fear.  

The article I found that addresses this in a way that I was not familiar with resonates as a viable way to both measure and to ameliorate the symptoms.

The study I will be reading from is titled, “Experiences of interoception and anxiety in autistic adolescents”

Anxiety is a well-documented challenge, with studies estimating that at least 40% experience at least one anxiety disorder. Autistic adolescents are nearly twice as likely to have an anxiety disorder compared to their peers. While social interactions and sensory overload are commonly discussed contributors to this anxiety, another crucial factor deserves more attention: interoception. This is our ability to tune into our internal bodily signals, such as heart rate, breathing patterns, and feelings of hunger.

For autistic adolescents, this ability can be hyperactive (feeling every tiny change in the body) or underactive (barely noticing bodily cues until it’s too late). Both extremes can contribute to anxiety.

Some participants reported a heightened awareness of bodily sensations that felt overwhelming and anxiety-inducing. Rather than providing helpful feedback, these sensations contributed to sensory overload, making it difficult to focus on anything else. Instead of remaining in the background, bodily signals became an unavoidable focal point, often intensifying feelings of distress. This cycle of hyperawareness and anxiety created a reinforcing loop, making it even harder to find relief.

“The physical response is exceptionally scary… it feels like you’re dying.” 

At the opposite end of the spectrum, some participants experienced hypoawareness, struggling to detect bodily signals until they became extreme. This led to missing early signs of anxiety, making it more difficult to manage emotions before reaching a crisis point.

Basic physical needs were also frequently overlooked, with some unable to recognize sensations like hunger or thirst until they became severe. As a result, they might go an entire day without eating or drinking, unaware of their body’s needs until discomfort set in. This disconnect often led to exhaustion, heightened anxiety, and difficulty maintaining overall well-being.

Many also described fluctuating between heightened and reduced awareness, with their ability to tune into bodily signals shifting depending on stress levels, environment, or sensory load. These unpredictable changes made it even more challenging to maintain a consistent connection with their physical state, further complicating emotional regulation.

Common experience among participants was catastrophizing bodily signals, particularly those associated with anxiety, such as an increased heart rate. This often created a self-reinforcing cycle of panic.

For some, interoceptive signals were misinterpreted as signs of a medical emergency, leading to overwhelming fear and a sense of impending danger.

A small number of participants described neutral or adaptive interpretations of their bodily signals, showing an ability to recognize and manage them effectively. One participant noted that while these signals can sometimes trigger anxiety, they can also help to reduce it. This suggests that teaching autistic adolescents to reframe their interoceptive experiences could be a valuable strategy for managing anxiety.

Many participants reported that high-arousal situations sent their interoceptive awareness into overdrive, making them hyper-aware of every bodily sensation when anxious. One described feeling everything in their body all at once in intense moments. This overwhelming flood of sensations could amplify distress, trapping individuals in a vicious cycle where anxiety and interoception fuel each other.

These insights suggest that reducing the need to mask isn’t just about comfort—it’s about reclaiming bodily awareness and managing anxiety before it spirals out of control. Reducing the need for masking and having support to tune into bodily signals could both help with anxiety management.

This is me again.  The study concludes that better understanding interoception could lead to new approaches for managing anxiety in autistic adolescents.

Finally in the article, the authors suggest several  ways to teach interoception awareness.

Self-awareness training: Helping autistic teens recognize and name their bodily signals early could be a game-changer.

Tech tools: Smartwatches that track heart rate might help those with low interoceptive awareness notice anxiety building up before it becomes overwhelming.

Reframing bodily signals: Teaching autistic individuals with cognitive behavioral techniques to interpret bodily cues in a neutral (rather than fearful) way may help break the cycle of anxiety helping those who struggle with catastrophizing 

Addressing the role of masking: Supporting autistic individuals in reducing the cognitive load of masking should help them maintain better interoceptive awareness and self-regulation.

This one is from me.  Cognitive Behavioral Therapy (CBT) has been shown to be very effective with several areas of difficulty for autistic individuals.  Interoception awareness and management fits well with CBT.

Anxiety is an issue that becomes more important as the levels increase in an individual.  Before it becomes debilitating, it is vital that interventions are provided.  Any of the above suggestions are worth trying, but I encourage parents to seek out professional help, particularly from the child’s school, as that is the primary institution responsible for helping.

From accommodations to psychological therapy, the schools have a responsibility to provide an education to their students.  This means that any accommodation or service that allows a child to access their education should be available to them.