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Interoception, the eighth sensory system, is the ability to notice and interpret internal body signals (i.e. hunger, pain, need to use the bathroom, emotions, etc.). For example, you may feel your stomach growl and know it’s time for lunch. Or you may feel your muscles tense and your heart race and know that you’re feeling angry and you need to take a break. 

Many kids who have Autism, ADHD, trauma disorders, anxiety, depression, eating disorders, sensory processing disorders, toileting challenges, or behavioral challenges often experience interoception difficulties. These difficulties can make it difficult for these kids to identify and cope appropriately with their internal sensations which, in turn, makes it difficult for these kids to:

-Identify their emotions and cope appropriately

-Identify pain signals and communicate them to a trusted adult

-Toilet train

-Know when to eat or when to stop eating

-React appropriately to environmental sensory stimuli

These difficulties make it difficult for kids to perform everyday tasks such as grooming, dressing, going to school, playing with friends, eating dinner with their family, and going on community outings. 

Interoception, like any other skill, can be improved with daily practice! We can do this by combining mindfulness and IA builders. At Way to Grow, our occupational therapists use the Interoception Curriculum developed by Kelly Maher, MS, OTR/L to help your child explore and gain a deeper understanding of their inner body signals and emotions. While your child is participating in this program, you will be given weekly handouts outlining how to improve your child’s interoceptive awareness at home. Remember! Everyone experiences the world differently. When we work on interoception with your child, we encourage them to develop and use their own language to describe their internal feelings, even if they aren’t necessarily a “real” word or makes sense to the adults in their lives. For example, your child may describe something as “vibrational”, “aquatic”, or “fuzzy”. The only words we try to steer them away from are neutral words like “good”, “bad”, or “okay”. Instead, we ask “what’s good about it?” to help the child investigate the feeling further. 

The tactile system is responsible for how we feel all touch sensations including vibrations, temperature, textures, and pain.

Activities for home

For those with tactile sensitivities:

Engage in messy play with various mediums including water beads, shaving cream, paint, sand, look for toys dry rice and bean bins.

Crawling through tunnels, playing in the grass, swimming!

Playing dress-up with costumes, don’t forget the hats, scarves, sunglasses, crazy socks and gloves!

Children are more likely to touch novel textures when it is introduced during play.

The sensory receptors inside our mouths are responsible for processing information from texture, temperature, and taste. Oral input can improve emotional/ sensory regulation and give a calming response to the central nervous system.

Ideas for oral input at home for regulation:

Eat crunchy/ chewy foods

Drinking through a straw, especially thicker purees such as smoothies, yogurt, pudding, applesauce, provides resistance for an added regulating benefit.

Cold exposure can activate the vagus nerve resulting in a calming effect as it causes a shift in the parasympathic nervous system (responsible for the “fight or flight” response). Popsicles, ice in drinks, cold compress to the neck or top of head.

Sour foods like lemon and sour candy can increase your alert level. (Try chewing sour gum during a test!)

Blowing bubbles, whistles, pinwheels provide deep breathing opportunities to calm.

Proprioception refers to the ability of our muscles and joints to get input from the world around us to determine where our body is in space. This means that we can sense the movement and positioning of our bodies without having to visually reference each body part. When an individual has a diminished sense of proprioception, they may demonstrate difficulties such as clumsiness, poor coordination, poor postural control, poor force modulation, poor motor planning skills, etc. 

When a child is over responsive to proprioceptive sensory input, the child tends to be very cautious and can experience a lot of anxiety related to movement, weight bearing, hugging others, or being physically moved by others. An over responsive child may be labeled as lazy or lethargic. This child may avoid certain body positions during play or may avoid movement-based activities altogether. Additionally, the over responsive child may also avoid foods that require more force in order to chew. 

On the flip side, an under responsive child (or seeking child) may present with excessive body movements. These children may enjoy bumping, crashing, pulling, tight hugs, or roughhousing. These children may be labeled as “destructive” or “aggressive” due to their poor body awareness and force modulation. In school, these children may have difficulty maintaining an upright seated position in chairs, modulating force during recess, and navigating hallways without crashing into walls or other obstacles. They may also experience difficulty participating in handwriting tasks, often using firm force and fatiguing quickly. 

To improve proprioception in an over-responsive child we encourage deep pressure activities massages, therapeutic brushing, using weighted/ compression garments (i.e. vest, body sock, ankle weights, etc.), and bear hugs/ squeezes as tolerated. At Way to Grow, we will encourage your child to participate in a variety of movement-based activities such as navigating between uneven surfaces, climbing, crawling, inverted head sit ups or i-spy, swinging, and other gross motor challenges in addition to deep pressure activities. These activities will not only increase their body awareness and coordination, but it will improve their confidence and willingness to engage in age-appropriate play activities with their peers. 

To improve proprioception in an under-responsive child, we recommend engaging your child in a variety of heavy work activities. Heavy work is anything that moves the body against its own body weight or added weight. We recommend allowing your child to participate in sports, playing on the playground, running, jumping, climbing, crashing, or moving heavy things. At home, your child can participate in mini obstacle courses, complete animal walks, push weighted items down the hall in the laundry basket, or crash onto pillows. At school, your child can use weighted or compression garments, do chair push ups, or help their teacher with various tasks (i.e, erasing the white board, passing out papers/ books, carrying the lunch box tote, or running errands. This child may also seek oral sensory input and would benefit from chewelry, chewing gum, sucking on hard candy, or drinking thick liquid through small straws.

The sense of vision uses the eyes to collect information in which the brain then interprets. The visual system words closely with the other senses to help use safely navigate and locate objects in our environment.

Visual activities and input help children develop visual perception skills, engage in visual tracking and improve visual attention and eye muscle control.

Activities for home:

play “I spy”

Play “flashlight tag

Mazes, dot-to-dot

For those more sensitive:

High quality sunglasses for outdoor activities

“Safe Spaces” with minimal visuals

Dim lights for calming and relaxation

Information is processed through receptors located in the inner ear, the utricle and saccule. Provides information regarding one’s movement and body position in relation to gravity. The vestibular system contributes to balance, posture and the awareness of one’s orientation in space.

Behavioral response:

Under responsive: require more intense vestibular/movement input to produce a response, but do not necessarily actively seek out the input

Overresponsive: more sensitive to movement or positional changes, producing a more intense emotional or behavioral response

Seeker: actively seek out movement activities, such as swinging, climbing, running, jumping

Avoidant: actively avoid activities that challenge movement or balance or require positional changes such as lying down; may avoid swings or other movement play structures at the park

Activities:

· Swings

· Scooter board

· Bikes or scooters

· Navigating climbing structures

· Bounce house or trampoline

· Climbing up a ramp

For those more sensitive…

· provide increased support, holding at the torso or hips while navigating the environment/obstacles provides increased stability

· If possible, elevate swings only 1-2 inches off the ground for increased comfort. Gradually increase the height over time as comfort improves

· Offer only activities with one type of movement at a time (e.g. swaying only back and forth, or side to side etc.)

· Pair activities with heavy work such as holding a rope or hula hoop while being pulled in a laundry basket or on a scooter board

Auditory system: located in the inner ear, responsible for processing sound vibration and sound waves

Behavioral response:

Under responsive: may not respond to sound input immediately, for instance may appear to not hear their name being called until a loud tone is used

Overresponsive: may demonstrate intense reactions to sounds that others are not typically bothered by; may cover the ears, scream, or cry; may hum to block out background noise

Avoidant: may actively try to escape the sound, such as running away or attempting to stop the sound

Seeker: may appear intensely interested in sounds, or frequently create their own sounds

Activities:

For children who do not appear to notice sounds:

– Vary tones

– Vary volume

– Engage in auditory memory games or memorize simple songs

– Engage in auditory sequencing games

– Engage in auditory discrimination activities, such as naming sounds you hear while on a walk and identifying if they are close or far, loud or soft etc.

For those with sensitivities:

· Use noise cancelling headphones

· Use ear plugs

· Use soft/calm music

· Use calming auditory input such as a rain stick or rice in a plastic bottle

· Pair less preferred sounds with calming input such as deep pressure like a weighted lap pad or heavy work

Gustatory System 

Definition: The gustatory system is our sense of taste. This sensory system allows us to differentiate between different flavors, and identify whether or not something is safe to eat. 

Over-responsiveness: a person who is over-responsive to gustatory stimuli may choose bland foods over intense flavors. They may show strong reactions to foods, including gagging or vomiting. During oral hygiene, they may demonstrate avoidance of toothpaste and mouthwash. 

Under-responsiveness: when a person is under-responsive to gustatory input, they may appear not to notice when food is too hot or too cold. They may also have difficulties recognizing, or appear unaware, when food is on their face. They may demonstrate little to no response to strong flavors that others usually notice (ie. Sour or spicy flavors) 

Sensory Seeker: a gustatory “sensory seeker” often prefers more intense flavors (spicy sauces/seasonings, sour candies, acidic/citrus flavors), temperatures (preferring foods that are extremely hot or extremely cold), and textures (very crunchy/hard foods). This may also be seen through poor oral awareness with overstuffing their mouth. In addition, sensory seekers may mouth non-food items. 

How does this impact daily life: When a child is under/over responsive to gustatory stimuli, or is a gustatory “seeker”, this can impact feeding and mealtimes. Children may be extremely picky eaters, show signs of distress while eating, gag in response to flavors/textures, or appear disinterested during mealtime. This may also impact oral hygiene, with sensitivities to toothpaste or mouthwash flavors. 

Over-responsiveness Strategies: 

-Quiet, calming music during mealtimes to support regulation. 

-Allow the child to be involved in the kitchen! Involvement in meal preparation is a great way to expose children to new foods, and help them feel more comfortable with flavors and temperatures. 

-gradually introduce “try-it” strategies to interact with foods. Start slowly, working from just looking at or touching the food at the child’s comfort level, followed by smelling, kissing, or licking foods. 

-Play with food! This can be done outside of the mouth through messy play, building with foods, creating fun food presentations (ie. Happy face pancakes with fruit). Food play can also be done inside the mouth with activities such as balancing foods on your tongue, using food as “lipstick”, or making “shark bites” or teeth marks on foods. 

Under-responsiveness Strategies:  

-use of vibrating toothbrushes to increase stimuli to the oral cavity during oral hygiene or in preparation for mealtimes 

-sipping cold ice water through a straw or massage cheeks with cold packs prior to mealtime to increase awareness within and around the mouth 

-use of alerting flavors to “wake up the mouth” (mint gum, cinnamon candies, sour candy or citrus juice) 

-allow the child to look in the mirror during mealtimes to increase recognition of food on their face, or show when their mouth is empty vs. full. 

Sensory Seeker Strategies: 

-hard crunchy snacks such as carrot sticks, pretzel rods, raw fruits/vegetables, etc. 

-experiments with various spices and sauces to provide additional gustatory input during meals 

-Add in berries or slices of orange/lemon into water for additional flavor to encourage increased water intake 

-Chewing strongly flavored gum, or use of chewable jewelry to provide increased oral input 

Olfactory System 

Definition: The olfactory system is our sense of smell. The main function of the olfactory system is to detect and identify molecules in the air. The olfactory system works closely alongside the gustatory system in order to perceive flavors when eating. 

Over-responsiveness: a person who is over-responsive to olfactory stimuli often shows a strong reaction to smells that others may not even notice, sometimes to the point of nausea or gagging. They may become avoidant of public restrooms or cafeterias due to various odors. They may also be selective in what they are willing to eat based upon a food’s smell. 

Under-responsiveness: when a person is under-responsive to olfactory input, they may demonstrate little to no response to strong smells. They may have difficulty detecting harmful scents, such as cleaning supplies or expired foods. 

Sensory Seeker: an olfactory “sensory seeker” may show a strong desire to smell objects (toys, clothing, foods, markers/crayons, etc.). They may enjoy strong scents such as perfumes/colognes, markers, soaps, etc. 

How does this impact daily life: When a child is under-responsive to olfactory stimuli, or is an olfactory “seeker” they may be more at risk of consuming unsafe or non-food items due to a lack of perception of unsafe smells. A child that is over-responsive to olfactory stimuli may be a picky eater, or struggle to be in the kitchen when food is being prepared. They may also avoid large settings such as the school cafeteria due to odors, which can impact social participation. 

Over-responsiveness Strategies: 

-Limit heavy scents such as perfumes/colognes, candles, or air fresheners in the child’s room, as they can be overwhelming or distressing. 

-Gradual exposure of different scents, to the child’s tolerance. This can be done through having un-lit candles open in the room for a faint scent, allowing the child to spray perfume/cologne in an outdoor area to decrease the intensity of the smell, and working up to play tasks involving smells (ie. Scented markers, scratch-and-sniff stickers, etc.). 

-Gradual exposure to foods with non-preferred scents, to the child’s tolerance. This includes having the child eat preferred food or engage in play while non-preferred food is in a nearby room, then in the same room, and finally on the same table. 

Under-responsiveness Strategies:  

-Use of “alerting” smells such as peppermint or citrus to increase olfactory awareness and “wake up the nose”. 

– “Guess the Smell” activities, putting various items in container for the child to identify (ie. Flowers, spices, essential oils, cinnamon candies) 

-Take a walk around the grocery store, discussing and identifying various smells throughout the building 

Sensory Seeker Strategies: 

-Coloring with scented markers, scented fingerpaints, scratch-and-sniff stickers 

-Scented playdough, slime, or sensory bins 

-Scented jewelry (essential oil necklaces or bracelets) 

-use of “calming” scents such as lavender for regulation