Starting on the Inside: Why Interoception Matters

Most people learned about the senses as a list of five. Occupational therapists work with eight, and interoception has had a firm place on that list for some time now: the sense that tells us what is happening inside our own bodies. A full bladder. A racing heart. A tight chest. Hunger, thirst, tiredness, the queasy churn of anxiety, the warm heaviness of feeling safe.

What interests me is the gap between how well established interoception is in theory and how consistently it makes it into everyday practice. Tactile, vestibular and proprioceptive difficulties tend to be picked up early and planned for carefully. Interoception is more often acknowledged in a report and then quietly assumed to be working.

Interoception is the raw material we use to work out how we feel and what we need. A child who cannot reliably notice a full bladder cannot reliably get to the toilet in time. A child who cannot feel the early flicker of frustration cannot use a strategy to head it off. By the time the signal is loud enough to notice, it is already overwhelming. Emotional regulation, so often treated as a skill to be taught, rests on a foundation of body awareness that we tend to assume is already in place.

I recently enrolled in Kelly Mahler’s online course, Less Compliance, More Interoception, and it has stayed with me since.

When a child is struggling to take part in something, the instinct across most settings is to reach for more structure, more prompting, more incentive. A chart. A reward. A firmer boundary. Mahler’s question is a different one: not how do we get this child to do it, but what does this child need in order to do it successfully?

That question is not new to occupational therapy. It is close to the heart of how we are trained to think. What the course sharpened for me was the sequencing. It is one thing to believe that participation depends on the right support; it is another to make sure that support starts with the child’s access to their own internal signals.

Day to day, this shows up as a shift in what I check first. When I use a rating scale, I now spend longer establishing whether a child can actually detect the state I am asking them to rate, rather than assuming the scale itself is the intervention. When a strategy isn’t being used, my first question is whether the child can notice the signal that tells them it is needed, rather than whether they need more reminders. And when a goal is framed around sitting, waiting or completing, I look harder at what is making participation costly before we agree what success will look like.

These are tweaks, not a change of direction. But they matter, because they put the child’s own body awareness at the start of the process rather than somewhere in the middle. Curiosity first, strategy second, with the child treated as the expert on what is happening inside them.