ADHD and interoception: the bodily signals we overlook

ADHD is usually associated with inattention, impulsivity, and hyperactivity. In recent years, however, research has begun to pay more attention to another aspect of ADHD: interoception.

Interoception is the ability to perceive signals coming from within the body. Hunger, thirst, fatigue, pain, muscle tension, body temperature, fullness, changes in heart rate, or the need to use the bathroom are all part of this system. Most of the time, these signals remain in the background and only capture our attention when they become strong enough.

Several recent systematic reviews have found that people with ADHD may show lower interoceptive accuracy compared with people without ADHD. In other words, they may have more difficulty accurately perceiving and identifying internal bodily signals. This does not mean that the body stops sending signals. The signals are still there, but the brain may register or interpret them differently.

Interoception is not unique to ADHD. Changes in interoceptive processing have also been described in autism spectrum disorder, anxiety disorders, eating disorders, chronic pain, and functional neurological disorders. In the context of ADHD, this topic is important because differences in the perception of bodily signals may help us understand some everyday difficulties not only through attention and executive functioning, but also through the brain-body relationship.

When bodily signals are noticed late

For some people with ADHD, everyday life may look like this:

Hunger becomes noticeable only when it reaches an overwhelming level.

Thirst is not felt until a headache begins.

Physical fatigue is overlooked and eventually leads to sudden exhaustion.

The need to use the bathroom is clearly felt only when it becomes urgent.

These situations are often interpreted as poor self-care, carelessness, or lack of discipline. In many cases, however, they may be related to differences in how internal bodily signals are perceived.

Of course, this is not true for everyone with ADHD. Occasionally forgetting to eat or drink is not, by itself, evidence of impaired interoception. Like many characteristics associated with ADHD, the ability to perceive bodily signals also exists on a spectrum.

Interoception and emotional awareness

Interoception shapes not only our physical awareness, but also our emotional experience.

Every emotional state is accompanied by changes in the body: a faster heartbeat, changes in breathing, muscle tension, a feeling of warmth, gastrointestinal reactions, and many other physiological changes. Noticing these changes is one of the ways we recognize what we are feeling.

When these signals are felt less clearly or noticed later, emotional awareness may also be delayed. A person may recognize increasing stress only once they are already experiencing intense tension. Irritability, emotional flooding, or anxiety may seem to appear suddenly. Yet the body may have been sending signals of distress long before that point.

At the same time, reduced interoception is only one part of the picture. Emotional regulation in ADHD is shaped by the interaction of many cognitive, biological, and environmental factors. Interoception can help us understand this process more clearly, but it does not explain it on its own.

Why this matters in clinical practice

Understanding interoception can change the way we think about everyday difficulties.

Instead of asking:

“Why don’t I feel when I need something?”

it may be more helpful to ask:

“Which signals am I overlooking?”

This small shift in perspective moves a person away from self-blame and toward curious observation.

This perspective also helps explain why many interventions for ADHD rely more on external structure than on internal signals. Timers, scheduled meals, hydration reminders, planned breaks, wearable devices such as smartwatches, and daily routines can provide additional support when internal bodily signals are not noticed consistently.

These are practical ways of adapting to the way the nervous system functions, rather than fighting against it.

Can interoception be improved?

Research in this area is still ongoing. However, early findings suggest that interoceptive awareness can be strengthened through certain interventions and sustained practice.

Strategies that may be helpful include:

Regularly checking in with the body throughout the day.

Mindfulness practices focused on bodily sensations.

Breathing exercises.

Gentle movement practices such as yoga or tai chi.

Establishing consistent routines for eating, drinking, resting, and sleeping instead of waiting until hunger, thirst, or fatigue becomes intense.

The goal is not to feel every signal from the body perfectly. The goal is to recognize important signals before they turn into discomfort or overload.

These approaches should not be viewed as replacements for evidence-based ADHD treatment, but as complementary strategies. For many people, the best outcomes are achieved through a combination of behavioral strategies, psychotherapy, lifestyle adjustments, and, when necessary, medication.

To conclude

ADHD is not only about attention. For some people, it is also about the relationship between the brain and the body.

Interoception does not explain every difficulty associated with ADHD, and it is not impaired in everyone with the condition. Nevertheless, current scientific evidence suggests that it is an important, yet often overlooked, part of the clinical picture.

Understanding this can help replace self-criticism with a more observant perspective. Before explaining the difficulty immediately as a lack of motivation or discipline, it may be more accurate to ask: are internal bodily signals being noticed clearly enough?

Sometimes the body has been communicating with us all along. We simply have not yet learned to recognize its signals.

References

Bruton, A. M., Levy, L., Rai, N. K., Colgan, D. D., & Johnstone, J. M. (2025). Diminished interoceptive accuracy in attention-deficit/hyperactivity disorder: A systematic review. Psychophysiology, 62(2), e14750. https://doi.org/10.1111/psyp.14750

Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., Feusner, J. D., Garfinkel, S. N., Lane, R. D., Mehling, W. E., Meuret, A. E., Nemeroff, C. B., Oppenheimer, S., Petzschner, F. H., Pollatos, O., Rhudy, J. L., Schramm, L. P., Simmons, W. K., Stein, M. B., … Interoception Summit 2016 participants. (2018). Interoception and mental health: A roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004

Klein, M., Witthöft, M., & Jungmann, S. M. (2025). Interoception in individuals with autism spectrum disorder: A systematic literature review and meta-analysis. Frontiers in Psychiatry, 16, 1573263. https://doi.org/10.3389/fpsyt.2025.1573263

Kutscheidt, K., Dresler, T., Hudak, J., Barth, B., Blume, F., Ethofer, T., Fallgatter, A. J., & Ehlis, A.-C. (2019). Interoceptive awareness in patients with attention-deficit/hyperactivity disorder (ADHD). ADHD Attention Deficit and Hyperactivity Disorders, 11(4), 395–401. https://doi.org/10.1007/s12402-019-00299-3

                                                                © 2026 by Shabnam Sadigova