The Body Keeps Talking. Are You Able to Listen?
Interoception, ADHD, and the Cost of Missing the Signal
A few weeks ago, I was listening to a webinar on ADHD when the speaker said something that stopped me mid note taking. He was talking about interoception, which is the sense that lets us feel what is happening inside our own bodies. Hunger. Thirst. A racing heart. The dull ache before a headache becomes a migraine.
Interoception is often grouped with the other senses we ask about in autism evaluations, but it rarely gets the same attention in ADHD evaluations, even though the two conditions overlap in this area more than we tend to acknowledge.
The speaker described his own experience of developing a serious case of double pneumonia during a stretch of high stress. He had no memory of feeling it coming on. There was no gradual ache, no early warning he could point back to. One day he was fine, and the next he was not, flat on his back with an illness serious enough to require real recovery time. He described the same pattern with sinus infections; getting knocked flat by them more than once without registering the early signs that most people would have noticed and responded to days earlier.
That story matters clinically. If a person cannot reliably feel the early signals of pain, fatigue, or illness, they cannot respond to those signals early. What looks like a sudden collapse is often the end of a process that had been building quietly the whole time.
Two Different Problems That Can Look the Same
Here is where I want to slow down, because I think there are actually two things going on, and they call for different kinds of support.
The first is a perceptual issue. For some people, the interoceptive signal itself is muted or inconsistent. The nervous system is not reliably passing along the message that something is wrong. This is closer to what the webinar speaker was describing. The body is talking, but the message is not coming through clearly, if at all.
The second is a prioritization issue. The signal may be coming through just fine, but it is competing with everything else demanding attention, and it consistently loses. This is what I found myself thinking about as a woman with ADHD. So many of us are holding down jobs, raising children, caring for aging parents, and showing up for our communities. In that kind of life, the body's quieter signals get pushed to the back of the line, over and over, until they are not quiet anymore.
The important thing is that both of these can be true at once, and often are. A muted signal that also has to compete against constant caregiving demands does not stand a chance of being heard until it becomes urgent.
Why This Matters Across the Lifespan
This is not just an adult issue. Children with ADHD can miss the early signs of a stomach bug, a growing injury, or an oncoming meltdown from sensory overload, and caregivers may misread the sudden crash as coming out of nowhere when it was actually building for hours.
Teenagers may push through exhaustion or illness because they never learned to notice the early cues in the first place.
Adults, especially women juggling multiple roles, may not recognize a body that is asking for rest until it forces the issue through illness or injury.
I texted a screenshot of that webinar slide to a friend of mine who also has ADHD, and who, like me, lives with an autoimmune condition. We have spent real time together trying to learn what our own flares look like. What are the antecedents. What does the earliest onset actually feel like, before it becomes an active flare. It is work most people never have to do consciously, because their bodies just tell them and they hear it. For us, learning to notice has had to be intentional.
What This Means for Evaluation and Support
If we only ask "do you notice when you're getting sick" during an evaluation, we may miss the more useful question underneath it: is the signal weak, or is it being crowded out? The intervention looks different depending on the answer.
A weak signal may call for building an explicit body awareness practice, almost like teaching a new skill from scratch.
A crowded out signal may call for something different, like structured permission and support to actually stop and attend to the body before things escalate, along with examining the roles and responsibilities that keep pushing that attention aside.
Either way, the goal is the same. Helping someone build a reliable, trustworthy relationship with their own body's signals, so that pain, illness, and overwhelm get caught early instead of arriving all at once.
