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Interoception: The Eighth Sensory System is an interesting book written by an author with her finger on the pulse of autism research. Kelly Mahler, an occupational therapist specializing in Autism Spectrum Disorders (ASD), provides an accessible introduction to interoception (the ability to perceive the internal state of one’s body) and its association with social-emotional abilities such as empathy and emotional regulation. This captures the idea that sensing internal bodily changes is related to the ability to understand and regulate oneself, and thereby understand and interact with other people (Chapter 1). This is followed by an explanation of why impaired interoception seemingly underlies many difficulties in ASD with a view to help autistic individuals understand their condition (Chapter 2). Drawing on her experience as a school-based therapist, Mahler includes a series of instruments to measure interoceptive ability (Chapter 3) and ‘how-to’ exercises to improve interoception for managing socio-emotional problems (Chapter 4). Interesting vignettes about autistic individuals are interspersed throughout the book, highlighting daily difficulties which may be due to interoceptive failure (e.g., emotional outbursts), including strategies for how such problems can be controlled. The book finishes with an incisive conclusion about why interoception is important for understanding ASD (Chapter 5). Interoception has been neglected by psychologists and rarely been addressed directly in autism research. The book is therefore timely, novel, and it has attracted positive buyer reviews. It is supported by a complimentary foreword written by Professor A.D. (Bud) Craig who is the world’s foremost expert on interoception. Like Craig, I was impressed with Mahler’s grasp of contemporary research, some of which has been conducted bymy group leader and his collaborators (see Bird and Cook 2013). The book contains many hypotheses that are currently under investigation, reinforcing hopes that our research holds translational value. The text is very wellwritten and transforms complex concepts—usually found in neurobiological research articles—into an accessible format. Taken together, it has potential for researchers, autistic individuals, parents and therapists to better understand and manage ASD. Because of growing interest in the clinical relevance of interoception, and the books intuitive format, it is expected that Mahler’s ideas may be adopted by researchers and clinicians alike. However, this may be premature and there are some caveats that warrant discussion. First, the author does not mention research showing that interoception was, using a measure of cardiac perception, found to be similar in children with and without ASD (Schauder et al. 2015). While Mahler cites research on impaired interoception in autistic adults that was published after Schauder et al.’s (2015) study, it is unfortunate this important research was ignored given that the book is built on the premise that interoception is impaired in children with ASD. There may be reasons underlying Schauder and colleagues’ result (lack of appropriate control tasks or because autism and control groups were matched for alexithymia perchance; see below), however these issues were not discussed. The reader should therefore be aware that cardiac perception (as found in in the book for measuring and training interoception) in children with ASD may be comparable to typical children, and also that there is currently no evidence that interoception can be improved & Punit Shah punit.shah@kcl.ac.uk

journal of autism and developmental disorders

Interoception: The Eighth Sensory System: Practical Solutions for Improving Self-Regulation, Self-Awareness and Social Understanding of Individuals with Autism Spectrum and Related Disorders