Interoception is the ability to perceive and understand internal bodily sensations, which play a critical role in regulating emotions, behaviors, and overall well-being. It includes recognizing sensations like hunger, thirst, pain, heartbeat, and body temperature. Interoceptive awareness is essential for maintaining homeostasis and responding appropriately to the body's needs. However, for individuals with Fetal Alcohol Spectrum Disorder (FASD), interoception can be significantly affected, leading to a range of challenges in their daily lives.
Fetal Alcohol Spectrum Disorder (FASD) is a diagnostic term used to describe impacts on the brain and body of individuals prenatally exposed to alcohol during pregnancy. FASD is a lifelong disability. Individuals with FASD may experience challenges in their daily living, and need support with motor skills, physical health, learning, memory, attention, emotional regulation, and social skills. Each individual with FASD is unique and has areas of both strengths and challenges.
We often think of the five senses of vision, hearing, taste, smell, and touch/proprioception. However, there are two additional senses. These are vestibular and interoception.
The Link between Interoception and FASD:
Interoception is an integral part of self-awareness and is closely linked to emotional regulation and decision-making. It allows individuals to understand their emotional states and respond appropriately to stress and anxiety. For individuals with FASD, the disruption of interoceptive processing can lead to several challenges:
Emotional Regulation Difficulties: Impaired interoception can make it challenging for individuals with FASD to recognize and understand their emotional states. As a result, they may struggle to manage and express their feelings appropriately, leading to emotional outbursts or withdrawal. Sensory Sensitivities: Individuals with FASD may experience heightened or diminished sensitivity to certain bodily sensations, such as pain or hunger. This altered perception can impact their ability to interpret and respond to sensory stimuli in their environment. It is important to not that an individual can be heightened in one area such as pain but diminished in another area such as hunger. Bodily signals can be too small or weak or signals can be too big or strong. Impulsivity and Decision-making: Interoception plays a crucial role in decision-making processes by providing internal cues that guide choices. Impaired interoception in individuals with FASD can lead to impulsive behaviors and difficulties in making sound decisions. Self-Awareness and Safety: Interoception helps individuals recognize when they are thirsty, hungry, or unwell, prompting them to take appropriate actions to maintain their well-being. For those with FASD, reduced interoceptive awareness may lead to difficulties in recognizing when they need help or are in dangerous situations.
Interoception Interventions for FASD:
Recognizing the impact of impaired interoception in individuals with FASD, there is a growing interest in developing interventions to address these challenges:
Interoceptive Training: Interoceptive training involves activities and exercises aimed at enhancing an individual's awareness and understanding of internal bodily sensations. This may include mindfulness practices, breathing exercises, and guided activities to help individuals tune into their bodily cues. This type of training can be done with an older child or a child with adequate of cognitive ability. Adaptations will need to be considered for a younger child or a child that is developmentally younger. Sensory Processing Therapy: For individuals with FASD who experience sensory sensitivities, sensory processing therapy can be beneficial. This therapy helps individuals process sensory information more effectively, reducing aversive responses to stimuli. Social Skills/ Social Language Training: Given the social challenges faced by individuals with FASD, social skills training can help them improve their emotional recognition and understanding, fostering better interpersonal relationships. Parent and Caregiver Education: Educating parents and caregivers about the interoceptive challenges faced by individuals with FASD can help them provide appropriate support and accommodation in daily life. Caregivers can learn about adaptations that can be done for younger children to help raise awareness. (Example: for a child to sense the need to use a toilet, have them wrap their arms around abdomen while sitting on toilet and apply gentle pressure or wipe their bottom first to draw attention to that area) This can also include helping them do daily tasks and use supports such as visuals or first/then strategies. Older children can build skills such as body mindfulness and body awareness.
Why Behavioural Interventions Can Be Harmful:
If only behaviours associated with lack of interceptive awareness are the focus, harm can be done. Since behavioural strategies rely heavily on the use of rewards and consequences, there is concern about its potential impact on an individual’s self-determination and wellbeing. For example, if an individual is thirsty and is unable to recognize that feeling and becomes distress, a consequence for the exhibited behaviours does not fix the feeling of thirst and may escalate the behaviour. In addition, responding in a punitive way does not teach an individual how to recognize the feeling of thirst and may negatively impact an individual’s self-esteem and emotional wellbeing.
Conclusion:
Interoception plays a critical role in regulating emotions, behaviors, and overall well-being. For individuals with FASD, impaired interoception can lead to difficulties in emotional regulation, decision-making, and self-awareness. Understanding the link between interoception and FASD can pave the way for targeted interventions and support to help individuals with FASD navigate their daily lives more effectively.
It is essential for healthcare professionals, educators, and caregivers to consider the impact of impaired interoception in individuals with FASD when developing personalized intervention plans. By addressing these challenges early and providing appropriate support, we can improve the overall quality of life and well-being of individuals living with FASD.
