Interoception and Proprioception

Interoception — a topic so rare that not even my Word spell-check dictionary contains the word. But possibly one of the most important things for adopters to know about.

This blog is going to be about quite a complicated issue with adopted kids. How does your brain know what you are feeling physically, and how does it know where you are in space and time? What happens when those things don’t work and why would they not work? Well I’m not a neuro-biologist (although sometimes I wish I was — I’m certainly getting the lived experience by being an adopter), but I’ll do my best to explain.

Imagine you are feeling hot. How does that manifest itself exactly? It is hard to describe really, you are just feeling hot. Maybe you could break it down a little bit by saying that you feel wetness on the skin from sweating, or you are feeling a bit light-headed, or thirsty. But why do you ‘feel’ thirsty? It is often a feeling of a dry mouth. But how do you know it is dry without touching?

I’m not going to go too far down that rabbit hole. There are probably whole academic disciplines dedicated to it but I don’t know the biochemistry that well. The concept of interoception is this though; it is how your brain knows what is going on inside your body. It is another sense that processes signals from the body’s internal organs, which the brain then interprets to give you your sense of your current physical status. It then releases hormones to mitigate. I’m guessing feeling hot might be a signal from thermoreceptors that the temperature of the blood is rising for instance (thanks BBC Bitesize), but what those receptors are exactly and where they are located I don’t know and in a sense it doesn’t matter. What matters is that they are connected to the brain, which controls the release of hormones that open sweat pores (for instance).

But babies and toddlers don’t have interoception. Or rather it is still developing. They can’t regulate their body temperature very well which is why a parent has to do it for them and show them how what clothes they wear can help. They don’t know when they need the toilet, which is why we put them in nappies and toilet train them. They don’t know when they are starting to feel hungry, resulting going from running around flat out to being exhausted in the space of a few minutes.

If a parent doesn’t help their children do these things in the early years then things can go wrong quite quickly. Your brain is a learning machine, working on overdrive at that age. The connections between neurons will form themselves into patterns that in some cases will last the rest of your life. This is especially true of the hypothalamus that is the part of the brain that connects to the autonomous systems such as breathing or metabolism, and is the interpreter of a lot of these internal signals. If these connections are not encouraged to form then the signals can easily be misinterpreted or even not get through at all. As the child gets older these misfiring connections become more embedded and difficult to change.

I think a lot of adopters are initially surprised at how much of this ‘baby stuff’ you have to do when you adopt. Obviously most kids of school age will already know when they need the toilet, or are getting too cold. But a large number of adopted children won’t, and by that time won’t learn easily either. So as a parent you still have to do it for them and tell them when they are cold etc, which of course by that age of becoming more independent can quite easily be met with vehement denials and resistance, until it is too late and they’ve soiled themselves or collapsed from heat exhaustion. This is the ‘carer’ part of being an adopter, and not really what most people are probably thinking about when they think of being a parent to school-age kids. For most parents this period lasts a couple of years after birth. For adopters this can be many years, maybe 10 or more, of battling with the results of severe neglect. It is sometimes mistaken for regression (I’ve written a post about that last year) but in this case it isn’t psychological, it is biological. All you can do is the same as you would for a baby. You won’t get any thanks for it from your kid, they are too embarrassed themselves; but it is something you must do. Eventually (fingers crossed) they will develop this internal sense.

There are some occupational therapy exercises for interoception (if your child is cooperative), but actually these are based on other OT treatments which is for another sense that is perhaps better known: proprioception. Proprioception is your knowledge about where your body is in time and space. It allows you to know where your hand is when your eyes are closed for instance, or walk without falling over, or timing a catch of a ball correctly. It is your sense of knowing and understanding that you are a physical object with certain parameters and abilities.

If your sense of proprioception is poor then this is most often shown by you being clumsy and lacking coordination in physical tasks. You might well be covered in bruises from bashing into furniture as you walk past, as you haven’t judged the space you have to walk around. It is a complicated sense and like interoception a toddler doesn’t really have it. They have to learn how to interact with the world, and what they need to do with their body to do that. The more activity you have the better that sense will develop. Again, it is all about the neurons in the brain getting into the right pattern, and actually this sense continues developing way beyond the early years but it is important to get a good start to make those neural connections go in the right direction initially. Needless to say most adopted children will not have had that good start. If you’ve not been played with, and had little physical interaction with others or even with toys then that start will be delayed.

The classic way of dealing with this as an adopter is again simply going back to the early years activities that they’ve missed out on. Soft play centres. Sand play. Water play. Hide and seek. Pushing toy prams around. Pat-a-cake. They really need those basic tasks in order to help develop more complex ones later. Easy to say that (thanks social workers), but much harder to do with a recalcitrant 8 year old who wants to play Minecraft and not do baby stuff. So try the ‘going-out –on-an-adventure’ routine instead. Sometimes they are willing dupes for that. I managed a whole year of wading down streams in my local National Trust park with my son. Reckon he’d still like it if I could prise him away from Fortnite. Failing that you might well find that therapy sessions do that kind of thing. Sometimes doing it as a family but supervised by a professional feels more serious and grown up, and so more likely to get cooperation.

But in all likelihood that lack of proprioception will still be there all through life. They are unlikely to become grand-slam winners in tennis, but tennis lessons (or any sport) will definitely help them so if you can afford the lessons try a few different things out. You might be surprised what sticks, in my son’s case it was fencing and gymnastics which I never expected at all. If they are quite niche so what? I suspect you’ve already realised that parenting life as an adopter is not going to be the football-dad or dance-mum that UK society cliché seems to expect us to conform to.

I think a lot more education around interoception and proprioception needs to be targeted all parents and carers, preferably right from birth. But it is especially needed in adoption training as we are the people who have to pick up the pieces when the previous parents have failed.