Today we’ll wrap up Lena’s story with learning about how her interoception processing differences impede her ability to self regulate, and how her parents can support her. If you want to catch up on parts 1-3, click here and scroll through each post.
So far, we’ve talked about why transitions felt so hard for Lena, and how movement played a huge role in helping her regulate… until it didn’t. Today, I want to zoom in on something that was quietly influencing all of these challenges behind the scenes: interoception.
Fair warning- today’s email is long, but it’s worth the read if you have a similar child.
What is interoception, and how was Lena impacted?
Interoception is our ability to feel internal body cues, like hunger, fullness, needing to use the bathroom, fatigue, or thirst. For many kids, these signals are received clearly and allow them to take care of their needs in a timely manner. For Lena, those signals were unreliable or easy to miss.
On the intake form, Lena’s mom shared something that really stood out to me:
“I still struggle with knowing what to feed her every day and when. She doesn’t feel or report hunger like typical children so she’ll continue to play.”
To add to that, Lena’s parents also identified that
“Dysregulation from hunger is what we see the most. When she gets to that point it’s hard to come back from.”
The few things they found that helped in this case was putting her in front of a screen to get her to eat–a last resort option they were hoping to move away from.
Lena’s eating habits
What I made very clear to her parents was that Lena wasn’t refusing meals because she was being stubborn. Her nervous system was really working against her. Remember, Lena had a diagnosis of Pediatric Feeding Disorder and potential PDA profile (linked with her autism diagnosis). This combination makes feeding a level 100 challenge. By the time her body displayed behavioral signs of hunger, it meant her nervous system was already tapped out, and if her parents even dared to suggest eating (an external demand), she would double down on her refusal.
To add to that, Lena’s parents note that once she tipped into dysregulation, it was hard to come back. Hunger, fatigue, and sensory overload were building up quietly in the background, and then showed up as hyper-silliness, resistance, or explosive reactions. It makes sense that they had to “pull out the big guns” with screens in order to neutralize her nervous system so she could actually eat.
The same thing was happening with bathroom cues. Lena could go hours without peeing if she wasn’t prompted (keeping her parents on edge for a UTI). But prompting her often caused pushback (common for PDA profiles). Interestingly, when her parents stopped asking her to go throughout the day, she started initiating on her own more often.
That tells us something important: external pressure was interfering with her ability to tune into her body’s cues, not helping it.
Routines weren’t working
In theory, consistent, predictable routines for toileting and eating are a great solution. But for kids like Lena, rigid routines can actually increase stress if they don’t align with what the body is saying. At the same time, having no structure at all leaves parents feeling like the entire day revolves around avoiding the next meltdown.
