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OT graduate studies interoception and impact on individuals with autism

Most of us grew up learning that humans have five senses, but scientists have shown there are more. There is our ability to feel our muscles and joints and our sense of movement. And then there is interoception.

“That’s your ability to feel the inside of your body – to feel your stomach, your intestines, your heart rate, air hunger when you hold your breath, muscle tension,”explains Kelly Mahler, M.S., O.T.R./L., ’02, a graduate of Misericordia University’s five-year master’s degree program in occupational therapy.

“It helps us feel so many different things inside the body.”Mahler, a pediatric occupational therapist in Hershey, Pa., studies interoception and its impact on individuals with autism. She recently delivered a keynote address on the subject to the American Occupational Therapy Association Specialty Conference on Autism and she is the author of “Interoception: The Eighth Sensory System.”She says that interoception is important to our emotional experience. For example, when your heart is beating fast and you feel shaky, you know you are feeling nervous.

“We have a lot to learn in regards to interoception and autism, but what some of the research is showing is that a lot of people with autism have difficulty with interoception,” Mahler says. “They have a really hard time being able to monitor their emotions. Obviously you need to feel your building anger and building anxiety because that’s when you want to use strategy to help you feel calm again.

People with autism have a hard time feeling these internal signals and using them to put themselves in a calm and comfortable space.”Challenges with this sensory system create physical issues as well. It can impact an individuals’ ability to sense when they need to go to the bathroom or are hungry or thirsty. Mahler’s research focuses on the specific correlations between autism and interoception and developing strategy to improve the sensory system.

“I work with some clients who can go all day long without taking a sip of water or eating because they don’t feel that urge,” Mahler says. “They don’t feel those internal signals. It can have a really drastic impact on their health and well-being.”Mahler is currently working on two research projects related to interoception and autism. With physicians from Penn State Hershey Medical Center, she is measuring what differences exist in the sensory system for individuals with autism. Mahler also is working with graduate students from Elizabethtown College’s occupational therapy program to develop interventions and specific protocols for improving interoception in children with autism. Over the course of her 14-year career, Mahler has become an expert in her field on occupational therapy and autism.

Her books have focused on building friendship skills, hygiene and related behaviors and how children with high-functioning Autism Spectrum Disorder or ASD relate to the world through their senses. “I’m just so passionate about working with people with autism and improving their lives, it’s become easy,” Mahler says. “It’s been a lot of hard work to get to the point where I’m at. Writing a book requires many, many hours. It’s because of my passion and that’s because I’ve been inspired by a lot of amazing colleagues.”

After working in schools as an occupational therapist for another organization, she founded Mahler Autism Services in Hershey to provide support to school-aged children and young adults with ASD. Mahler contracts directly with schools and provides individual occupational therapy, social skill groups, consultation for school districts and presentations on a number of topics. With Mahler Autism Services, she sees 40-50 clients a week individually and in groups. The company grew out of work she began more than a decade ago with several colleagues starting an organization called “Destination Friendship.”

“We provide fun opportunities in the community for people with autism,” she says of the organization, which was eventually brought under the umbrella of Mahler Autism. “Our main purpose is to provide fun and also provide opportunities to meet other people and hopefully form friendships, which can be really challenging a lot of times for a lot of clients.”Mahler knew she wanted to focus on pediatrics while she was studying occupational therapy at Misericordia. But it wasn’t until she met her first client with high-functioning autism that she knew where her career would take her.

“I still remember it clear as day. That just sealed the deal,” Mahler says. “I found him to be such a great person and I think he ignited my passion the moment he walked into my treatment room. He was like ‘Can you help me?’ and ‘I said I’ll try my best.’Back then we knew very little about high functioning autism.”Misericordia gave her the best possible education for entering the field, she says. The program gave students a well-rounded view of occupational therapy at a time when the profession had become “mechanical.”She explains that when she started working in school systems, she was surprised to see so much focus in occupational therapy solely on handwriting, when she had learned there was so much more to consider and work on.

“Our professors at Misericordia really maintained the roots of OT,” she says. “They instilled so much mental health into our curriculum and I really feel like that inspired me to stay true to the roots of occupational therapy. It was so global and more holistic and staying true to the profession. I wouldn’t have traded it for anything. It was an amazing program.”