We Contain Multitudes: IRL Social Skills and the Biopsychosocial Approach to Supporting Autistic and Socially Struggling Teens and Adults
In recent years, the conversation around autism and social challenges has shifted from deficit-based perspectives to those more holistic, compassionate, and neuroscience-informed. The biopsychosocial model—an integrative lens that acknowledges the biological, psychological, and social factors influencing a person’s behavior, development, and well-being—is coming into focus, for providers as well as for families and individuals.
For those who experience social difficulties—whether due to sensory sensitivities, trauma histories, neurodivergence, or chronic anxiety—the biopsychosocial model offers an empowering alternative to pathologizing interventions. Instead of asking the outdated questions, “what’s wrong?”and “what causes autism?” it asks, “what’s happening with this person, and how can we support the whole system they’re living in?”
Understanding the Biopsychosocial Model
At its core, the biopsychosocial model moves beyond reductionist views that isolate diagnosis or behavior. It encourages us to see each person as a complex interplay of nervous system biology, lived psychological experiences, and social environments. For autistic teens and adults—who often navigate the world with heightened sensory awareness, different processing styles, and, at times, misunderstood communication patterns—this model fosters personalized, trauma-informed care.
Rather than solely focusing on behavior modification or cognitive interventions, we consider:
Biological factors: Genetics, neurobiology, sensory processing, interoception (the sense of internal bodily signals), and autonomic nervous system states.
Psychological factors: Emotional regulation, trauma history, anxiety, resilience, and self-concept.
Social factors: Relationships, communication dynamics, inclusion, marginalization, and cultural perceptions of difference.
The Role of Interoception in Social Struggles
A critical, often overlooked, component in social difficulty is interoception—our brain's ability to sense internal states such as hunger, thirst, heartbeat, and the urge to use the restroom. But interoception also plays a powerful role in emotional awareness and regulation.
Many autistic individuals experience interoceptive confusion or overload, making it challenging to identify feelings or bodily cues in real time. This can show up as shutdowns, meltdowns, or an apparent "lack of emotion" when, in reality, the person is overwhelmed or unable to articulate what’s happening inside.
Supporting interoceptive awareness—through practices like parts work (the interoception experiments we encourage with our teens and their parents), orientation to one’s physical and observable environment, body scans, gentle movement, or specialized therapies—can strengthen emotional literacy and social confidence. When we hone the ability to identify what we are feeling in our own bodies, we are all better equipped to communicate, self-regulate, and connect.
Trauma, Neuroception, and Somatic Experiencing
Another essential element of this model is acknowledging the impact of trauma, particularly developmental, relational, or sensory trauma, which is common in individuals who’ve grown up misunderstood, excluded, or repeatedly overwhelmed by their environments.
Dr. Peter Levine’s Somatic Experiencing (SE) framework provides a profound contribution here. Rather than rehashing cognitive stories or focusing on verbal processing alone, SE works with the body's innate capacity to regulate, discharge, and resolve trauma through gentle awareness and movement. It supports clients in reconnecting with the body in a safe, titrated way—especially important for those with histories of shutdown, chronic dissociation, or hypervigilance.
In SE, we recognize that trauma is stored not just in memory but in the autonomic nervous system. Helping autistic or socially struggling individuals access safety in their own bodies—before tackling cognitive or behavioral challenges—can be a game changer.
This leads us to the Polyvagal Theory, a cornerstone of trauma-informed social support.
Social Engagement Theory and Brain Wiring
Coined by Dr. Stephen Porges, the Social Engagement System is a neural platform rooted in the Polyvagal Theory, which describes how the vagus nerve governs our ability to feel safe, connect, or protect.
According to this model, our brain constantly evaluates whether we are safe, in danger, or in life-threatening situations—a process called neuroception. In safe states, we can engage socially, speak clearly, make eye contact, and co-regulate. But when the nervous system perceives threat (even inaccurately, such as from sensory overload or a confusing social cue), it may shift into one or more of the four Fs: fight, flight, freeze, and fawn.
Many autistic or socially struggling individuals live with nervous systems that are chronically dysregulated, often in response to repeated social or sensory threat cues. This is not a sign of weakness or dysfunction—it’s a protective adaptation. After all, the body has one main job: to survive.
Using this knowledge, we can design environments, interventions, and relationships that prioritize felt safety over performance. This might include:
Reducing sensory stressors
Using predictable routines and transitions
Building co-regulation into the classroom or workplace
Prioritizing consent and autonomy
Encouraging deep listening and patience in social exchanges
Putting It All Together: Practical Implications
The biopsychosocial model, enriched by interoceptive awareness, Somatic Experiencing, and Polyvagal-informed strategies, offers a deeply respectful and effective way to support socially struggling individuals. Instead of asking someone to "fix" their social skills, we ask:
Is their nervous system regulated enough to connect?
Do they feel safe and understood?
Are they aware of their internal state, and do they have words for it?
Is the environment working with or against their brain-body needs?
Are we reinforcing a sense of agency and dignity?
Support looks different for everyone. For one person, it may mean reducing visual clutter in their environment. For another, it may involve trauma-informed movement sessions to reconnect with the body. For others, it may be about teaching the adults around them how to co-regulate, validate, and attune.
Conclusion
We must move away from behavioral approaches and toward a framework that honors complexity, diversity, and embodied safety. The biopsychosocial model—supported by insights from interoception, Somatic Experiencing, trauma science, and Polyvagal Theory—allows us to meet autistic and socially struggling individuals not with correction, but with curiosity, compassion, and co-regulation.
In doing so, we don’t just support better social skills—we support healing, wholeness, and the freedom to be oneself in community.