Decreased interoceptive accuracy in children with autism spectrum disorder and with comorbid attention deficit/hyperactivity disorder.
Autistic kids—and even typical kids with lots of autistic traits—struggle to feel their own heartbeat, so teach them to notice body signals before stress boils over.
01Research in Context
What this study did
Yang et al. (2022) asked 7- to young learners kids to count their own heartbeats without touching their chest or wrist.
The team tested four groups: autism only, autism plus ADHD, neurotypical kids with high autistic traits, and low-trait neurotypical kids.
Each child did three 30-second trials while a computer recorded real heartbeats. The closer the child’s count, the higher their interoceptive accuracy.
What they found
Children with ASD—whether or not they also had ADHD—guessed their heartbeats much less accurately than low-trait peers.
Even neurotypical kids who scored high on autistic traits showed the same drop in accuracy.
The pattern was large enough to spot by eye; most ASD kids missed by 30-50 % of actual beats.
How this fits with other research
Laposa et al. (2017) saw a similar link: more severe ASD symptoms went hand-in-hand with jumpier skin-conductance. Together the studies say “body signals look and feel different” in autism.
Cai et al. (2018) found that emotion-regulation problems feed anxiety through intolerance of uncertainty. Poor heartbeat sensing may be the first step in that chain—if you can’t feel arousal, you can’t label or manage it.
Taweesedt et al. (2025) showed that extra theta brain waves at sleep onset predicted worse emotion recognition. Add Han-Xue’s heartbeat data and a picture forms: from sleep to skin to heartbeat, autistic physiology can blur self-awareness and social cues.
Why it matters
If a learner can’t notice rising heart rate, they may not request a break until problem behavior erupts.
You can build interoception into your program: pause during tasks, prompt “How fast is your heart?” and show a pulse oximeter read-out.
Pairing biofeedback with coping scripts gives the child a concrete way to say “I feel revved” and use a strategy before escalation.
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Join Free →Start one session with a 30-second heartbeat count, show the real number on a pulse oximeter, and praise any self-talk that links “fast heart” to needing a break.
02At a glance
03Original abstract
Interoception refers to the awareness of internal physiological state. Several previous studies reported that people with autism spectrum disorders (ASD) and adults with attention-deficit/hyperactivity disorder (ADHD) have diverse patterns of interoception, but the extent of literature is limited and inconsistent. This study aimed to investigate the interoceptive accuracy (IA) in children with ASD, children with comorbid ASD and ADHD, and typically developing (TD) children with high and low levels of autistic traits. We administered the eye-tracking interoceptive accuracy task (EIAT) to 30 children with ASD, 20 children with comorbid ASD and ADHD, and 63 TD controls with high and low levels of autistic traits. Parent-report scales concerning ASD and ADHD symptoms were collected. ASD children with and without comorbid ADHD both exhibited lower IA than TD children. Reduced IA was also found in TD children with high-autistic traits relative to those with low-autistic traits. IA was negatively correlated with autistic and ADHD symptoms. Atypical cardiac interoception could be found in children with ASD. Difficulties in sensing and comprehending internal bodily signals in childhood may be related to both ASD and ADHD symptoms. LAY SUMMARY: The present study examined interoceptive accuracy (IA) in children with autism spectrum disorders (ASD), children with comorbid ASD and attention-deficit/hyperactivity disorder (ADHD), and typically developing (TD) children with high and low levels of autistic traits. ASD children with and without comorbid ADHD both exhibited lower IA than TD children. TD children with high-autistic traits exhibited decreased IA compared to those with low-autistic traits. These results have implications for understanding sensory atypicality found in ASD and ADHD.
Autism research : official journal of the International Society for Autism Research, 2022 · doi:10.1002/aur.2679