Interoception & Body Awareness
Why autistic patients may not report symptoms. How to assess differently.
What You Might See
- Not reporting symptoms until severe
- Seeming unaware of obvious discomfort
- "Suddenly" noticing longstanding issue
- Difficulty rating pain on scale
- Can't describe sensation quality
What's Actually Happening
Internal signals are present, but attention is elsewhere.
Accessing interoceptive information requires an attention shift. May not have conscious access until sensation is intense.
This is monotropism in action: When the attention tunnel is pointed outward, internal signals go offline.
Assessment Adaptations
Instead of: Pain scale 1-10
Try:
Functional impact: "Can you do your usual activities?"
Comparison: "Compared to last week?"
Concrete: "Does it wake you up? Stop you mid-activity?"
Behavioral: "What have you stopped doing because of this?"
Systematic Body Scan Protocol
Read slowly. Pause 3-5 seconds between each area.
"I'm going to name body areas. For each one, take a moment to shift your attention there and notice any sensations."
- Head?
- Neck and shoulders?
- Chest and breathing?
- Stomach and digestion?
- Arms and hands?
- Legs and feet?
- Overall energy level?
"Any areas need more attention?"
Why This Works
The body scan explicitly directs attention to internal states, one at a time.
It doesn't assume the patient is monitoring their body in the background (they may not be).
Medication Monitoring
Don't ask: "How are you feeling?"
Do ask:
- "Are you sleeping more or less than usual?"
- "Any new physical sensations?"
- "Changes in appetite?"
- "Energy levels compared to last visit?"
Provide:
- Written summary of what to monitor
- Specific symptoms to report
- Explicit guidance on when to call
Key Principle
Autistic patients may have the same internal signals as neurotypical patients, but different awareness of them.
Check explicitly. Don't assume they'll interrupt if uncomfortable.
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