How Come They're Never Cold (or Hungry or...). Interoception May Be the Answer.

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

Summary

David Poeschl discusses the link between interoception (awareness of internal bodily signals) and anxiety in autistic adolescents, summarizing a study on how hyperawareness, hypoawareness, and fluctuating perception contribute to emotional distress. He concludes by offering practical strategies to improve interoceptive awareness and reduce anxiety.

Key takeaway

Anxiety in autistic adolescents

Anxiety is nearly twice as common in autistic adolescents compared to their peers, and in Great Britain it is considered a hallmark of autism. (David Poeschl)

David Poeschl noted that social interactions and sensory overload are commonly discussed, but interoception is an overlooked factor.

Hyperawareness of bodily signals

A heightened awareness of internal sensations (e.g., heart rate, breathing) can become overwhelming and anxiety-inducing, creating a reinforcing loop that makes relief harder to find. (David Poeschl)

Participants reported bodily signals becoming an unavoidable focal point, intensifying distress rather than providing helpful feedback.

Hypoawareness and missed cues

Struggling to detect bodily signals until they become extreme leads to missed early signs of anxiety, making emotional regulation difficult and causing exhaustion from overlooked needs like hunger or thirst. (David Poeschl)

David Poeschl explained that some individuals might go an entire day without eating or drinking, unaware of their body's needs until discomfort sets in.

Fluctuating and misinterpreted awareness

Interoceptive ability can shift unpredictably depending on stress, environment, or sensory load, and signals are sometimes misinterpreted as a medical emergency, causing overwhelming fear. (David Poeschl)

A few participants described neutral or adaptive interpretations, suggesting that reframing bodily cues could help manage anxiety.

Strategies for teaching interoception

David Poeschl recommends self-awareness training to recognize bodily signals early, using smartwatches to track heart rate, teaching cognitive-behavioral reframing of cues, and reducing the cognitive load of masking to improve self-regulation. (David Poeschl)

He emphasized that reducing the need to mask is not just about comfort—it is about reclaiming bodily awareness and managing anxiety before it spirals.

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, the most common, and sometimes most debilitating, issue is anxiety.  

This is so universal that in Great Britain, one of the hallmarks of autism is anxiety. 

I’ll be summarizing an article that looks at one of the major underlying causes of anxiety in children with autism.

The study is titled, “Experiences of Interoception and Anxiety in Autistic Adolescents”

Here is the summary:

Anxiety is a well-documented challenge for autistic adolescents. They 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.

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.

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 it.

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.

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.

That’s the end of the summary.  I hope this information gives you a bit more insight into the complex world of neurodiversity.