Internal body
awareness
Interoceptive
awareness refers to the ability to feel the inside of our body with a
high degree of clarity and purpose. Good IA involves clearly sensing the
signals coming from our internal organs, skin and tissues and understanding
what these signals mean. (Kelly Mahler, 2017)
Stages: Build awareness. Connect. Match
terms. Specific levels. Accept all answers. Practice.
Interoception
Activities:
When in a calm state progress through the below activities
doing several trials
in a row, then take a break, and do the activity again later or another day,
for several days. repeatedly,
1. Draw Body. Draw a pic of a body, tape cut
outs of organs on it. Include
blanks. You could start by tracing hands, to get the idea of thinking about one’s
own body. Tracing around a body on to roll paper or with sidewalk chalk is even
better. Add descriptors (see Suggested Descriptors for Each Body Part – page
140 from book by Kelly Mahler, (2016). Model/ let child choose or circle
descriptors in the moment.
2. Lungs. Take a deep breath and hold it. Ask where did the air go?
and point to the word/picture for lungs.
3.
Heart – exercise. After vigorous exercise, stop and place
a hand on the chest: notice and comment how long it takes to decrease rate.
Notice body temperature, too.
4.
Nose/ chest -
breathing rate. After running, playing tag, lifting weights,
notice breath in chest and nose through a tube to accent the rate and sound
5. Mouth – thirsty. Smile
then relax, mouth is tight then loose. Stop
the person attempting to take a drink and ask him what body part told him he
was thirsty. Model: “my mouth is dry, I need a drink”- after lots of exercise, or
time in the hot sun. Tongue presses.
6.
Throat – sick. Cough,
get a lozenge, discuss when to visit the doctor. Mention levels of sick/
soreness. Play with voice levels in a recorder (yelling, whispering, silly).
7.
Jaw – chew. Explore
different foods and label as “chewy”, crunchy”, “wet”, “warm”.
8.
Muscles - Energy level in body: “jumpy”. Excited:
“I feel your muscles getting tight when I tickle you, … now… loosen”.
Pretend to squeeze lemons, tighten forehead, hands, toes, cheeks, lips, jaw,
eyes, shoulders arms, legs, nose, back. (draw cards at random).
9.
Hands. Count fingers, levels. Interlace, feel between
fingers. Use for touching. See skin.
10. Skin. Goose
bumps – “I must
be cold”. Label and model the
feeling and (with permission) touch skin with cotton ball, feather; do deep
massage, tickle. Touch and number various levels of sandpaper. Do
temperature experiments. Touch/ hold an icecube and say “wow that is a #10 kind
of cold” then watch it melt/ heat it up and label the changes. Blow on hand or leave a drop of lotion or sanitizer on
hand. “How does it feel? Itchy? Ignore it. Do something else. Wipe all, press, all done” or “check, clean
hands?, ok? scratch it, then stop”. Pins and needles happens when blood
flow returns to a nerve after being blocked from sitting in one position: shake
it out, change positions. Ask or wonder what color for the skin then dump a can of
paint on the picture. “Oh my this body picture has purple skin all over him. Mention spots, rashes and sores on the skin. Use a box or ballon as the skin.
11. Warm way. Modulation. Just right. Too hot can be an emergency –
boiling water. 20 degrees is room temperature. Lets have a warm session. It feels good.
12.
Neck – warm. A hand on the neck to tell if the
person is warm or cold, comment, lots of trials, then later ask “is your neck
warm or cool?”, then associate with dressing for the weather. Model pleasure to
a warm cloth on the cheeks.
13.
Eyes. At bedtime: sleepy, droopy eyes, voice,
muscles, energy. Dim the lamps and open the curtains while labelling the levels
of light. 1-5. Alert eyes open more.
14.
Eyebrows up in surprise or to show I’m
listening, I’m waiting to hear more.
15.
Hungry – stomach. “ohh,
gurgle, gurgle, my stomach is sore/ tingly/ rumbly. My body warns me, “time to get food ready”
thankyou body. “I feel full – I stop
eating and rest”. Pit of the stomach feeling, welling up; warning, better take
a break or a deep breath and carry on. Hangry – sometimes I feel angry then I
eat then I feel okay.
16.
Nose/ tongue – safety. Explore
smells (mint, vanilla, lavender, citrus, cinnamon), labelling as sour, bitter,
sweat, modelling pleasure and model disgust to rotten meat, dog poo, etc. Nose
warned me: “danger” or “yum- fresh and healthy”.
17.
Ears – sound. Listen to a variety of sounds and label (e.g. slow
music, fast music, loud music, nature sounds, quiet space, loud room, white
noise).
18.
Brain. Ask how does my brain feel?. “Dull – I need to eat”.
“Excited – this is fun”. Anxious? -seek comfort.
What is my brain thinking: “I can check is this okay”.
19.
Body
parts. Do yoga poses according to
body part child suggests. Say "give me your arm", then touch or brush
that. Note: If you do the Wilbarger protocol (brush) over the sacrum it can stimulate a
bowel movement – never on the stomach because you do not want to randomly
stimulate internal organs or on the face as the receptors are too close to the
surface there; press hard to activate deep proprio receptors (depress bristles
fully) but not so hard it is uncomfortable.
20.
Warnings. Make a
list of warnings with end goal in mind of: “I can do something in yellow before
it gets to red; associate with “Aaachoo”, and belly noises: lay your head lightly on child’s tummy and “ask are you
talking belly? (not really, but does make noises)”.
21.
Change
in state. Before and After. Before eating, model “my belly
is empty” then after, “I am nice and full”, same for bladder, bowel, headache, before
and after blowing nose, etc.
22.
Scan. Between every activity, throughout
the day, model with self-talk, “How is my body?”, “do I need anything?”, “Oh I should pee before we start”. “one
minute, I need to …” . Create a body check visual. Pretend to scan each other like Baymax in the movie Big Hero 6. See link below.
23.
Proprioceptive activities throughout the
day. Push, Pull, squeeze, resistive exercise, yoga. This type of input
activates receptors in the joints, muscles, and mechanoreceptors under the skin
to tell us about out body.
24.
Goals of increased interoceptive awareness (IA) include: Go with the flow.
Tolerate uncertainty. Strategies: Supplement predictability, routines, and
sameness with IA over time.
25.
Emotion words. Connector visual ÿ + ÿ +ÿ +ÿ +ÿ = Tired,
irritable, bored, angry, or hungry. E.g. Heavy Muscles + Foggy Brain + Slow
Heart +Droopy eyelids = Tired. Note: The heart
beats fast for both excited and anger making it hard to distinguish between
them.
E Make it experiential- touch body part and have child can touch body part on themself.
Make it visual by pointing to pictures such as body parts and body needs on communication board/device, playing videos, and modelling on yourself;
Make it verbal by modelling the language such as: “I feel pressure down here, my bladder is full, I need to pee”.
Resources:
The BayMax robot scans Hero at 1 minute
50 into this clip from the movie: https://www.youtube.com/watch?v=kUlXr-ZQ-NM
According to Fiene and Brownlow
(2015) individuals with autism can be significantly under-aware of
interoceptive signals, creating a situation where they do not clearly feel
internal body sensations [and therefore limits self-regulation, and results in
emotional outbursts].
Note: Uddin, Supekar, Lynch, et. al.
research findings suggest that a person with ASD can be over-sensitive to
internal sensations (lots of connections in the insula of the brain) until
puberty and then become under-responsive (low connections in the insula).
Here are some links regarding internal body awareness for tasks
like using the toilet
https://docs.wixstatic.com/ugd/b303b5_ab07aaedc04c45b3a96e519fc262ecd1.pdf
https://www.spdstar.org/node/1073
Kelly
Mahler has a nice short description of interoception here:
http://www.autism-society.org/news/ask-expert-kelly-mahler-ms-otrl/
Green grass grows all around for connectors. https://www.youtube.com/watch?v=BnVq2YRpbQc
A TED talk video
about Interoception with Neuroscientist Dr. Sarah
Garfinkel who does a wonderful job at summarizing the role interoception plays
in our emotional and social experience.
https://www.youtube.com/watch?v=hI_gG49sV2s
Resources for autism including using visual strategies in an
individualized way: www.txautism.net
Book with activities and questionnaires by an occupational
therapist: Interoception: The eight sensory system by Kelly Mahler 2017, AAPC publishing, Kansas, (USA).
Mindfulness
is one way to improve interoception starting with taking a deep
breath. Download this Free app: https://www.stopbreathethink.com
Song: https://www.youtube.com/watch?v=rlKupTuXxqA – move your arms up and down and change your
facial expressions as the intensity of the music goes up and down.
Book We’re going on a Bear Hunt: https://www.youtube.com/watch?v=0gyI6ykDwds
