By Matt Harrington, BCBA · Behaviorist Book Club · April 2026 · 12 min read

Interoception and Participation: Clinical Applications for Behavior Analysts Working with Pediatric Clients

Overview & Clinical Significance

Interoception — the sense that informs us about the internal state of our bodies — is increasingly recognized as a foundational process underlying emotional regulation, self-awareness, and adaptive participation in daily activities. For behavior analysts working with pediatric clients, particularly those with autism spectrum disorder or developmental disabilities, interoceptive deficits represent a frequently overlooked variable that may be contributing to behavior that looks like noncompliance, emotional dysregulation, or engagement difficulties.

When a child cannot reliably perceive internal body cues — hunger, thirst, fatigue, pain, the need to use the bathroom, physiological arousal — they are operating with degraded information about their own motivating states. A learner who cannot detect early signs of sensory overload may not exhibit escape behavior until they are in extreme distress. A child who cannot distinguish the physical sensation of anxiety from general physical discomfort may engage in intense avoidance behavior across a wide range of situations without a clear pattern that would emerge through standard functional assessment.

Abigail Hamilton's course introduces clinicians to the basics of interoceptive processing, assessment approaches, and practical intervention strategies for pediatric clients experiencing interoceptive challenges. The course offers 0.1 AOTA CEUs, reflecting its cross-disciplinary relevance — interoception sits at the intersection of occupational therapy, behavior analysis, and sensory integration, making it a topic that BCBAs encounter in collaborative service delivery contexts.

For behavior analysts, understanding interoception is significant not because it falls outside the scope of ABA practice, but because it provides a biological context for many of the antecedent conditions and motivating operations that drive the behaviors they are assessing and treating.

Background & Context

Interoceptive processing refers to the brain's interpretation of signals from internal organs, muscles, and other body tissues that convey information about physiological state. The insular cortex plays a central role in integrating these signals and translating them into conscious awareness of body state. Research in neuroscience and developmental psychology has shown that interoceptive awareness develops over childhood and that this development is related to the emergence of emotional awareness, self-regulation, and social cognition.

Individuals with autism spectrum disorder show atypical interoceptive processing at significantly higher rates than neurotypical individuals. Research published in occupational therapy and pediatric neuroscience journals has examined how interoceptive difficulties contribute to challenges in identifying and communicating internal states — which in turn affects a wide range of behaviors including eating, toileting, sleep, and participation in school and social activities.

For behavior analysts, the concept of interoception maps onto the framework of motivating operations in an important way. MOs are internal states that alter the reinforcing value of stimuli and the frequency of behaviors that produce those stimuli. Many MOs are precisely interoceptive: hunger is the aversive internal state that establishes food as a reinforcer; pain is the aversive state that establishes escape from the painful stimulus as a reinforcer. A learner who cannot accurately perceive their internal states will have unpredictable, difficult-to-identify MOs — which helps explain why some behaviors seem to occur 'out of nowhere' in standard FBA frameworks.

Clinical intervention in interoception has been developed primarily within occupational therapy and is centered on awareness activities: helping clients identify and label internal body sensations through structured practice, self-monitoring tools, and graduated exposure to activities that produce predictable physiological states.

Clinical Implications

For BCBAs collaborating with occupational therapists on pediatric cases, understanding interoceptive processing changes how assessment and intervention are approached. When a learner presents with behavior that appears to be escape-motivated without a clear pattern of specific task demands, the behavior analyst should consider whether interoceptive discomfort (e.g., undetected sensory overload, unrecognized hunger or fatigue) is functioning as an establishing operation for the escape behavior.

Functional behavior assessments may benefit from including interoceptive probes — conditions that systematically vary the learner's physiological state (hunger levels, rest levels, sensory environment) to test whether these internal states are reliably associated with changes in behavior frequency. This is consistent with the FBA literature on biological establishing operations and extends it to include interoceptive processes.

Intervention strategies for interoceptive challenges typically begin with body awareness activities: structured prompts for learners to attend to specific internal sensations (breathing, heart rate, muscle tension) in neutral, low-demand conditions. Visual supports — such as body maps or 'inside-out' feeling charts — can help learners label and communicate internal states before they reach the level of behavioral disruption. These tools can be integrated into ABA programming as antecedent strategies and self-management supports.

Participation in meaningful daily activities is the ultimate goal of interoception-informed intervention. For occupational therapists, this is framed in terms of occupational performance; for behavior analysts, it is framed in terms of behavioral repertoire development and access to natural reinforcers. Both framings share the practical goal of helping a child engage fully in the activities that matter — school, play, social interaction — without their interoceptive challenges functioning as a barrier to that engagement.

Ethical Considerations

BCBAs working in collaborative settings with occupational therapists and other professionals have specific ethical obligations regarding scope of practice and interprofessional collaboration. Code 2.01 requires practicing within the scope of one's competence. BCBAs who have not received training in interoception-specific assessment or intervention should not attempt to implement these procedures independently — but they can and should understand the conceptual framework well enough to collaborate effectively and to refer appropriately.

Code 3.01 on behavior-analytic assessments is relevant: behavior analysts should use assessment approaches that are appropriate to the presenting concerns and that capture the relevant variables driving behavior. If interoceptive factors are plausibly contributing to the behaviors under assessment, the behavior analyst has an obligation to consider them, either by incorporating interoceptive probes within the FBA or by requesting a collaborative assessment with an occupational therapist.

Code 2.04 on referrals requires that behavior analysts recommend other professional services when those services are necessary to address the client's needs. For clients with significant interoceptive challenges, an OT referral — or enhanced collaboration with an existing OT — may be clinically necessary, and the behavior analyst who does not make this recommendation when indicated may be limiting the effectiveness of the behavior program.

Consent for interoception-focused activities is also an ethical consideration. Activities that prompt learners to attend to internal body sensations may produce anxiety or discomfort, particularly for learners with trauma histories. Caregivers should be fully informed about the nature of these activities, and assent from the learner — at a level appropriate to their communication abilities — should be sought before beginning.

Assessment & Decision-Making

Assessment of interoceptive awareness can be approached at several levels. Clinician observation of behavioral patterns that may signal interoceptive difficulty — frequent bathroom accidents despite apparent readiness, eating behavior that does not track hunger cues, emotional dysregulation that is not responsive to standard antecedent interventions — is the first level. These patterns should prompt more systematic inquiry.

Occupational therapists use structured assessments such as the Sensory Processing Measure or standardized interoception checklists to evaluate interoceptive awareness across domains (breathing, heart rate, hunger, temperature, pain, etc.). Behavior analysts collaborating with OTs should understand these tools well enough to integrate the information they provide into FBA and treatment planning. Learner self-report, adapted to the learner's communication level, can also provide important information.

FBA methodology can be extended to test for interoceptive MOs. By systematically varying physiological state conditions (assessing behavior before versus after meals, at different points in the school day, following exercise versus rest) and recording the effect on target behavior frequency, behavior analysts can generate data that either supports or disconfirms the hypothesis that interoceptive variables are functionally relevant.

Decision-making about whether interoception-focused intervention is warranted depends on the convergence of these data sources: behavioral patterns suggestive of interoceptive difficulty, OT assessment findings, FBA data implicating biological establishing operations, and caregiver report of learner difficulties with identifying or communicating internal states. When multiple sources converge, an integrated treatment approach that addresses interoceptive awareness alongside behavior-analytic programming is indicated.

What This Means for Your Practice

BCBAs who expand their understanding of interoception gain a significant advantage in assessment and treatment of behaviors that have previously resisted functional analysis. When standard FBA methods produce an unclear or undifferentiated function — behavior occurring across multiple settings, time periods, and demand conditions without a discernible pattern — interoceptive variables should be explicitly considered.

Collaborating more intentionally with occupational therapists on shared caseloads is one of the most practical actions a BCBA can take following this training. OTs bring specific expertise in sensory processing and interoception that complements the behavior analyst's expertise in functional assessment and behavior change programming. Joint treatment planning sessions that explicitly address how interoceptive findings inform the behavior program — and how behavior program data informs the OT intervention — produce more integrated and effective care.

Building interoceptive awareness activities into existing ABA programs is feasible without requiring specialized OT training. Simple body check-in protocols — brief pauses at the start of a session during which the learner is prompted to identify how their body feels using visual supports — can be implemented by behavior technicians with minimal training. These protocols serve as both an intervention (building interoceptive labeling skills) and an assessment tool (flagging sessions in which the learner is in a high-distress physiological state before demands begin).

Caregiver training is another high-leverage practice implication. Parents and caregivers who understand the concept of interoception and can help their child practice body awareness at home — in routine moments like mealtimes, bath time, and wind-down before sleep — create the repetition necessary for interoceptive skills to develop. Providing caregivers with simple visual tools and a brief training on how to use them extends the intervention beyond the clinic.