Turkish Validity and Reliability of Multidimensional Assessment of Interoceptive Awareness in Youth

ABSTRACT

Introduction:

Interoceptive awareness is defined as the processing of internal bodily signals and one’s tendency to perceive these signals. In our study, it is aimed to conduct Turkish adaptation, reliability, and validity analysis of the Multidimensional Assessment of Interoceptive Awareness in Youth (MAIA-Y).

Methods:

275 young people between the ages of 11–17 participated in our study. Confirmatory factor analysis (CFA) was applied to confirm the factor structure of the Turkish version of MAIA-Y (MAIA-YT). Divergent validity was evaluated with Pearson correlation matrix plot. Internal consistency was determined using the “Cronbach’s alpha” value. Paired sample t test or Wilcoxon test, Spearman’s Correlation Coefficient, Intraclass Correlation Coefficient (ICC) value and Bland-Altman graphical approach were used to evaluate test-retest reliability. The significance value was set at a p-value of <0.05.

Results:

In our study, the fit measures are determined as χ²/df=1.612, CFI=0.898, GFI=0.869, TLI=0.882, IFI=0.901 and RMSEA=0.047, according to CFA. In accordance with the Pearson correlation matrix plot, there is a negative relationship between MAIA-YT subscales and State-Trait Anxiety Inventory for Children. The Cronbach’s alpha coefficients for internal consistency were found to be between 0.303–0.792 for the subscales of MAIA-YT and 0.793 for the whole scale, and in general the MAIA-YT was found to have reliable internal consistency. Intraclass correlation coefficients for test-retest reliability were found between 0.515–0.731. According to the Bland Altman graphs, the agreement between the test-retest results was found to be at a reliable level.

Conclusion:

The MAIA-YT is a valid and reliable instrument for evaluation of interoceptive awareness in Turkish adolescents.

INTRODUCTION

The term interoception is defined as the transmission of sensation regarding the internal bodily state from the body to the brain (1). According to Garfinkel et al., interoception is considered a three-dimensional model and examined under “interoceptive accuracy”, meaning the objective ability to detect internal stimuli, “interoceptive sensitivity”, referring to the perception of one’s own ability to detect internal stimuli and “interoceptive awareness”, standing for the metacognitive awareness of internal perception (2). In other words, interoceptive awareness (IA) is defined as the tendency to perceive internal bodily signals such as heartbeat, hunger, thirst, pain and breathing (3).

Highlights

• In recent years, the concept of interoception has been intriguing in psychiatry.

• Interoceptive skills may be difficult to measure in young people.

• MAIA-YT is a valid and reliable tool to assess interoceptive awareness.

In recent years, interoception has received increasing attention in clinical research and in these studies, it has been suggested that changes in IA are associated with various medical problems such as altered pain sensitivity (4), hypertension (5), and obesity (6). Differences in interoceptive functioning are also associated with many psychiatric disorders (3). These include mood and anxiety disorders (7), eating disorders (8), and neurodevelopmental disorders such as tic disorders and autism spectrum disorders (9,10).

It is believed that the levels of IA may alter depending on age and interoception needs to be understood as a dynamic feature of development (3,11). According to the findings of the study of Khalsa et al., it is suggested that IA decreases with age (12). In addition, it should be taken into consideration that it may be difficult to assess the IA levels of youths who experience radical bodily changes, especially during adolescence (13) and this challenge becomes particularly apparent at a younger age (14). This suggests that age-specific methods should be developed to measure IA in young people.

Different aspects of interoception have different assessment methods. Interoceptive accuracy, which is one of the areas of interoception, is measured by objective behavioral tests such as heartbeat perception, stomach perception, and respiratory perception tests (15,16). IA, which is usually measured through self-report methods, depends on cognitive processes such as subjective evaluation of interoceptive sensations and evaluations associated with awareness of it (17). There are several instruments that have been used so far to measure IA. One of them, the Body Perception Questionnaire, is a unidimensional biological assessment of a person’s IA of anxiety-related sensations (18). A subscale of the Eating Disorders Inventory, which often focuses on hunger/satiety sensations or emotional awareness rather than a comprehensive bodily awareness, has been used to measure IA in the past, especially in studies conducted in the field of eating disorders (19,20). Considering the limitations of other available scales, it has become apparent that there is a need for a comprehensive and multidimensional scale to measure IA.

In 2012, Mehling et al. developed the Multidimensional Assessment of Interoceptive Awareness (MAIA), which comprehensively assesses IA and measures its different dimensions. The MAIA is a self-report scale consisting of 32 items and eight sub-dimensions including “Noticing”, “Not-Distracting”, “Not-Worrying”, “Attention Regulation”, “Emotional Awareness”, “Self-Regulation”, “Body Listening”, and “Trusting” (21). An updated 37-item questionnaire called MAIA-2 contains five new items to increase the scale’s reliability (22). Afterwards, by modifying the adult MAIA, Jones et al. developed the Multidimensional Assessment of Interoceptive Awareness in youth (MAIA-Y) as an appropriate instrument for measuring IA in youths (14). In this study, it was shown that the MAIA-Y, which consists of 8 sub-dimensions, 32 items and a 6-point Likert structure, has acceptable psychometric properties in the 7–17 age range. Additionally, in this study which evaluated young people aged 7–10 and 11–17 separately, they found that the reliability of the three subscales (Noticing, Not-Distracting, Not-Worrying) was weak, especially in the younger age group (14).

To the best of our knowledge, our study is the first adaptation and reliability and validity study of the MAIA-Y scale in a different language. The purpose of this research was to translate the MAIA-Y into Turkish and evaluate the psychometric properties of the Turkish version, known as the MAIA-YT, in order to use the scale among Turkish youth. It was hypothesized that the eight-factor structure of the MAIA-YT would be as valid and reliable in the Turkish youth sample as it was in the original scale.

METHODS

Participants

This study was a cross-sectional study. The sample size of this study was determined according to the Rule of Thumb. According to this approach, it is accepted that for validity and reliability analyses, it will be sufficient to work on individuals 10 times the number of items in the scale (23). Thus, the 32-item scale was applied to 313 young people aged 11–17, who did not have a chronic disease and who applied to Ankara Bilkent City Hospital Pediatrics Outpatient Clinics and who participated in our study. Thirty-eight participants were excluded due to missing data and as a result, 275 participants were included. All the participants were healthy, native, young Turkish people who volunteered to participate in the study and gave their consent. We have asked young people and their families who volunteered to participate in the study whether they had any history of mental or medical illness, and young people without a history of chronic illness or mental disorder were included in the study. The study was conducted at Ankara Bilkent City Hospital from May 2023 to October 2023. Ethics committee approval was received for the research from Ankara Bilkent City Hospital Ethics Committee, dated 25.04.2023 and numbered E2–23–3958. Written consent was obtained from the adolescents participating in the study and their mothers. All study procedures were carried out in accordance with the Declaration of Helsinki.

Procedure and Translation of MAIA-Y

Two native bilingual Turkish speakers, one of whom had knowledge of the scale and the measured variable and the other who did not, translated the English MAIA-Y into Turkish. The two translated versions were compared by the authors and an English language expert, and a corrected translated version was established. The translated Turkish version was back translated into English by a native Turkish speaking English teacher. After comparing the back-translation with the original English version, differences were identified by the authors and the translation process was completed by making changes in the Turkish version accordingly. Afterwards, the scale was filled out by ten young people and feedback about the scale were received in the pilot study we conducted. The authors thoroughly examined and assessed each item to identify any possible challenges in comprehension and variations in meaning pertaining to language and terminology. Finally, adjustments were made to the MAIA-YT and the final translated version was formed.

Although the study in which the psychometric properties of the original MAIA-Y scale were evaluated was conducted in the 7–17 age range, it was decided to conduct our study in the 11–17 age group for the following two reasons. The first of these is the low reliability of the three subscales of the MAIA-Y in the 7–10 age group in the study conducted by Jones et al. (14). The latter one is that during interviews with a sample group of ten young subjects, we discovered that the scale items were difficult for this age range to comprehend.

Instruments

Young people participating in our study was evaluated with the Turkish version of MAIA-YT and the State-Trait Anxiety Inventory for Children (STAI-C). In order to evaluate the test-retest reliability of the scale, the MAIA-YT was given to 73 participants 2 weeks after the first completion of the scale.

Multidimensional Assessment of Interoceptive Awareness in Youth (MAIA-Y): The original version, MAIA is a 32-item questionnaire including eight different subscales. It is designed to assess multidimensional aspects of IA that may be particularly relevant to clinical situations (21). Jones et al. adapted the MAIA used in adults to children and adolescents and showed that the youth form (MAIA-Y) consisting of 8 sub-dimensions, 32 items and a 6-point Likert structure has acceptable psychometric properties in this age group. The sub-dimensions of MAIA-Y consist of “noticing” which refers to recognizing unpleasant, pleasant, and neutral bodily feelings, “not distracting” which indicates an inclination to not deny or divert attention from feelings of discomfort or pain, “not worrying” which implies a propensity to feel discomfort or pain without worrying or becoming distressed emotionally, “attention regulation” which remarks the capacity to maintain and regulate focus on bodily sensations, “emotional awareness” which points out comprehending the relationship between bodily sensations and emotional conditions, “self-regulation” which refers to the capacity to control discomfort by paying attention to bodily sensations, “body listening” which means actively observing the body to gain insight and “trusting” which shows perception of one’s body as reliable and safe (14).

State-Trait Anxiety Inventory for Children (STAI-C): The divergent validity of the MAIA-YT was evaluated using the Turkish version of the STAI-C in our study. The STAI-C, which aims to measure permanent and momentary individual differences in anxiety predisposition, was developed by Spielberger in 1973. The scale consists of two subscales with twenty items in each. While the state anxiety scale measures state-specific symptoms or transient anxiety, the trait anxiety scale aims to measure anxiety generalized to various conditions. For each item in the scale, there are three response options that can be evaluated between 1–3 points. Thus, a score between 20–60 can be obtained from both subscales. Turkish adaptation study of STAI-C was conducted by Özusta in 1995 and Cronbach’s alpha coefficients were found as 0.82 for the State Anxiety Scale and 0.81 for the Trait Anxiety Scale (24).

Statistical Analysis

Analyses were performed using the free and open-source software R (version 4.3.1, https: //cran. r-project. org), IBM Statistical Package for Social Sciences (SPSS) program for Windows version 23.0 statistical package (Chicago, IL), and AMOS (23) by an academic biostatistician. In the factor analysis, we used Bartlett’s Sphericity test to check the factorability of the correlation matrix. We obtained Chi-square=2930.951, p <0.001. Thus, it can be said that the correlation matrix is suitable for the factor analysis. In the factor analysis, we evaluated whether the sample examined is suitable for the factor analysis with the Keiser-Meyer-Olkin (KMO) sample adequacy measure. We obtained KMO=0.837. Since the KMO measure is higher than 0.80, the sample size is considered sufficient. The validity (structural) and reliability (internal consistency, test-retest reliability) of MAIA-YT (32 items) were evaluated. Confirmatory factor analysis (CFA) was applied to confirm the factor structure. Overall model fit was evaluated using several fit indices as the Chi-Square Statistic (χ²), comparative fit index (CFI), root mean square error of approximation (RMSEA), goodness fit index (GFI), Tucker-Lewis index (TLI), and incremental fit index (IFI). Divergent validity was assessed with the Pearson correlation matrix plot created using the MAIA-YT and STAI-C scales. Pearson correlation coefficients were graded as follows: r ≥0.90–1.0 excellent, 0.70–0.89 good, 0.40–0.69 moderate, 0–0.39 poor (23). The Pearson correlation matrix plot was drawn using the “metan” package (25). Internal consistency is related to whether the measurement of a result is homogeneous. We evaluated internal consistency using the “Cronbach’s alpha (α)” value. If α is <0.60, the internal consistency of the scale is defined as low, if α is between 0.60–0.79, the scale is defined as reliable, and if α is 0.80 and above, the scale is defined as highly reliable (23). To examine the test-retest reliability, Spearman’s correlation, paired sample t test or Wilcoxon test was performed to determine whether there was a statistically significant difference between the first and second test values. The Intraclass Correlation Coefficient (ICC) value was used to evaluate the test-retest reliability. The ICC values vary between 0.00 and 1.00 and are interpreted as if it was <0.5=Poor agreement, 0.5 to <0.75=Moderate agreement, 0.75 to <0.90=Good agreement and 0.90–1.00=Excellent agreement (26). We used Bland-Altman graphical approach to evaluate the agreement, using “BlandAltmanLeh” package (27). The significance value was set at a two-tailed p-value of <0.05.

RESULTS

The scale was normally applied to 313 participants, missing data of 38 participants were excluded, the sample consisted of 275 young people aged 11–17 (mean=14.87, SD=1.96). Among the young people who participated in the study, 59.6% (n=164) were female and 40.4% (n=111) were male. The mean age of the girls was 15.14±1.85, while that of the boys was 14.74±2.07.

Results of Validity Analysis

In our study, construct validity of the MAIA-YT was evaluated and confirmatory factor analysis was applied to confirm the factor structure. The original eight-factor structure (14) was fitted to the modeling data (n=275) and the fit measures were provided (Final model in Table 1, Fig. 1). Some fit measures were acceptable (GFI=0.869, IFI=0.901, RMSEA=0.047), whereas others showed poor fit (CFI=0.898 and TLI=0.882). Considering the modification indices given in Table 1, it was concluded that the values are at an acceptable level in terms of the fit of the measurement model. As a result, we confirmed a valid scale structure consisting of 32 items and eight dimensions.

Table 1.

Confirmatory factor analysis (CFA) results

Parameter	Acceptable range	Initial model	Final model
Chi square fit test	CMIN/df ≤3	1.846	1.612
Comparative fit index	0.95≤CFI ≤0.97	0.856	0.898
Goodness of fit index	0.85≤GFI ≤0.90	0.849	0.869
Tucker-Lewis index	TLI ≥0.90	0.836	0.882
Incremental fit index	0.90≤IFI ≤0.95	0.859	0.901
Root square mean error of approximation	RMSEA ≤0.05	0.056	0.047

CFI: comparative fit index; CMIN/df: chi-square/degree of freedom; GFI: goodness of fit index; IFI: incremental fit index; RMSEA: root mean square error of approximation;

TLI: Tucker-Lewis index.

Figure 1.

Diagram of confirmatory factor analysis (adjusted model).

According to the Pearson correlation matrix plot (Fig. 2) used to determine divergent validity, there is a significant negative moderate correlation between trusting and self-regulation subscales of the MAIA-YT and the STAI-C state anxiety score and a significant negative low-level relationship between noticing, attention regulation, body listening subscales of the MAIA-YT and state anxiety score of the STAI-C. In addition, it is determined that there is also a significant negative low-level relationship between attention regulation, trusting, self-regulation, body listening, not worrying subscales of the MAIA-YT and trait anxiety score of the STAI-C.

Figure 2.

Correlation matrix between the MAIA-YT and STAI-C subscales.

MAIA-Y: Multidimensional Assessment of Interoceptive Awareness in Youth, STAI-C:State-Trait Anxiety Inventory for Children

Results of Reliability Analysis

In our study, the internal consistency of the MAIA-YT scale was evaluated with Cronbach’s alpha coefficients. The Cronbach’s alpha coefficients obtained as a result of the analysis were 0.599 for “Noticing” subscale, 0.303 for “Not-Distracting” subscale, 0.640 for “Not-Worrying” subscale, 0.776 for “Attention-Regulation”, 0.673 for “Emotional-Awareness”, 0.769 for “Self-Regulation”, 0.754 for “Body-Listening” and 0.792 for “Trusting” (Table 2). Cronbach’s alpha coefficient of the whole scale was found to be 0.793 and this value indicates that the scale is reliable.

Table 2.

Findings on reliability analysis

	Cronbach’s alpha	ICC (95% CI)	rs	p-value
F1	0.599	0.706 (0.573–0.803)	0.615	0.089a
F2	0.303	0.555 (0.378–0.693)	0.556	0.747b
F3	0.640	0.648 (0.495–0.761)	0.640	0.641b
F4	0.776	0.615 (0.454–0.738)	0.577	0.347b
F5	0.673	0.515 (0.329–0.663)	0.545	0.956b
F6	0.769	0.731 (0.607–0.821)	0.722	0.710b
F7	0.754	0.667 (0.520–0.775)	0.689	0.785a
F8	0.792	0.641 (0.487–0.757)	0.673	0.438b

^a: paired sample t-test;

^b: Wilcoxon test; CI: confidence interval; F1:noticing; F2:not-distracting; F3:not-worrying; F4:attention-regulation; F5:emotional-awareness; F6:self-regulation; F7:body-listening; F8:trusting; ICC: intraclass correlation coefficient; r_s: Spearman correlation coefficient.

In order to evaluate the test-retest reliability of the MAIA-YT scale, 73 participants completed the scale once more 2 weeks after the first completion of the scale. To determine whether there was a statistically significant difference between the two values, the subscales of the MAIA-YT that did not fit the normal distribution were evaluated with the Wilcoxon test and those that fit the normal distribution were evaluated with the paired sample t test. According to the analyses, no statistically significant difference was found between the two assessments (p>0.05). In addition, Spearman’s correlation coefficients were obtained to determine the relationship between the two measurements, and it was shown that there was a moderate positive relationship between the previous and subsequent assessments. The ICC coefficients for test-retest reliability were found between 0.515–0.731 (Table 2). Finally, the fact that the data points in the Bland-Altman graphs in Figure 3 are very close to the zero line indicates that the agreement between the test-retest results is at a reliable level.

Figure 3.

a–h. Noticing test-re test results Bland-Altman graph. (a). Not-Distracting test-re test results Bland-Altman graph (b). Not-Worrying test-re test results Bland-Altman graph (c). Attention-Regulation test-re test results Bland-Altman graph (d). Emotional-Awareness test-re test results Bland-Altman graph (e). Self-Regulation test-re test results Bland-Altman graph (f). Body-listening test-re test results Bland-Altman graph (g). Trusting test-re test results Bland-Altman graph (h).

DISCUSSION

In our study, confirmatory factor analysis, divergent validity, internal consistency, and test-retest reliability analyses showed that the MAIA-YT scale is a valid and reliable instrument that can be used to measure IA in Turkish adolescents. The results of the validity and reliability analyses are discussed below in the light of the relevant literature.

In our study, confirmatory factor analysis indicated that the original eight-factor structure of the MAIA-YT showed an acceptable model fit. While adapting the MAIA for young people, Jones et al. preserved the original eight-factor structure and found that in the 11–17 age group, while some indices were adequate, CFI and TLI values were below acceptable levels, similar to our study. Although Jones et al. found that some model indices were less than ideal, they suggested that the eight-factor structure of the MAIA scale is acceptable in the young population (14). In a study conducted in adolescents and adults with eating disorders, it was observed that the RMSEA of the original eight-factor structure of the MAIA indicated an acceptable model fit, while the TLI and CFI were just below the acceptable model fit (28). In the literature, it is seen that the original eight-factor structure is preserved in other forms such as MAIA-2 and in versions of MAIA translated into different languages as Danish, French and Chinese (22,29–31). It is known that modification indices such as CFI and TLI are sensitive to sample size (32–34). In our study, as in other studies in the literature, it is believed that the fact that these two indices are just outside the acceptable range relative to other indices may be related to sample size. It was considered that eight-factor structure of the MAIA-YT was acceptable for Turkish youth between the ages of 11–17, as in the original MAIA-Y.

In our study, it is found that there is a low to moderate negative relationship between the subscales of the MAIA-YT and the STAI-C. In the development study of the MAIA, the STAI-C trait anxiety scale was used by Mehling et al. to measure the divergent validity of the MAIA, and it was shown that there was a low to moderate negative correlation between the MAIA subscales and the STAI-C trait anxiety (21). According to the French translation and validation of the adult MAIA study by Willem et al., there was a negative correlation between trait anxiety and the MAIA subscales, mostly on self-regulation and trusting (30). In contrast to our study, in a study evaluating the psychometric properties of the Portuguese version of the adult MAIA scale, a statistically significant positive relationship was found between the STAI trait anxiety and noticing, attention regulation and emotional awareness of the MAIA, and between the STAI state anxiety and attention regulation and self-regulation of the MAIA (35). It was thought that the differences between the results may be due to the number of items in the scale, factor structure and the different subscales obtained. Based on these findings, it was thought that the MAIA-YT scale is negatively related to anxiety but measures a different construct.

The internal consistency of the MAIA-YT was evaluated with Cronbach’s alpha coefficients and the alpha value of 0.793 obtained for the whole scale indicated the scale’s internal consistency is reliable. In our study, while the internal consistency of six out of eight subscales was reliable, the not-distracting subscale (α=0.303) showed poor internal consistency, and the noticing subscale (α=0.599) was just below the reliable level. In the studies of Mehling et al. (21) who developed the original MAIA and Jones et al. (14) who adapted the MAIA for young people aged 11 to 17, Cronbach’s alpha values for the subscales were 0.69 and 0.52 for noticing, 0.66 and 0.44 for not-distracting, 0.67 and 0.52 for not worrying, 0.87 and 0.78 for attention regulation, 0.82 and 0.69 for emotional awareness, 0.83 and 0.70 for self-regulation, 0.82 and 0.73 for body-listening, and 0.79 and 0.79 for trusting, respectively. The Cronbach’s alpha values obtained in our study were similar to the values obtained in the adaptation study of the MAIA for young people. If examined in more detail, the alpha value we obtained for the not-distracting subscale (0.303) was lower than the value obtained in the original MAIA-Y study of Jones et al. (0.44), while the reliability of the noticing subscale is better (0.599) than that was found by Jones et al. (0.52). Jones et al. found that the alpha values of three of the eight subscales (the noticing, not distracting and not worrying) was below the acceptable level (14). The internal consistency of these three subscales was also found to be lower than the other subscales in Mehling et al.’s original MAIA study (α=0.66–0.69) (21). In the French and Chinese translations of the MAIA scale, especially the not worrying (α=0.57 and α=0.46, respectively) and not distracting (α=0.42 and α=0.58, respectively) scales were shown to have the lowest internal consistency, while in our study, the not worrying scale reached above the acceptable level (30,31). It is thought that the low internal consistency of the not-distracting subscale may be related to the low number of items and reverse scoring. However, while utilizing the MAIA-Y, Jones et al. advised against eliminating scales because low internal consistency reliability does not negate the significance of the MAIA-Y’s subscales’ relationship to important outcome variables (14). Specifically, studies demonstrated the usefulness of the not-distracting subscale in distinguishing between patients experiencing pain and those undergoing mind-body training, a clinically expected difference, as well as in research on pain management and depressive symptoms (36–38). Thus, Jones et al. recommended not to eliminate these subscales, and the original structure of the scale was preserved in our study.

In our study, test-retest reliability of the MAIA-YT was measured by different statistical and graphical methods as the Bland-Altman plot and the ICC coefficient. The constructed Bland-Altman plot showed a good reliability, suggesting that the MAIA-YT scale is reproducible and consistent over time. In addition, the ICC values of the subscales of the MAIA-YT were between 0.515 and 0.731 and accordingly, the test-retest reliability of the scale was found to be at a moderate level. In particular, the ICC values of emotional awareness (0.515) and not-distracting (0.555) subscales were relatively lower than the other subscales. According to the ICC values obtained by administering the French version of the adult MAIA at two-month intervals, it was observed that the test-retest reliability was low (0.41) for the not-distracting subscale and ranged between moderate to good (0.53–0.79) for the other subscales (30). In the Chinese translation study of the adult MAIA, where there was a two-week interval between two measurements, as in our study, the overall test-retest reliability of the scale was found to be moderate to good, with the lowest ICC value being not-distracting (0.50) (31). In the Portuguese version of the MAIA scale, the lowest ICC values were found for noticing (0.574), not-distracting (0.521), and attention regulation (0.590) subscales (35). As in our study, in the translations of the MAIA scale into other languages, it is observed that the test-retest reliability of the not-distracting subscale is low compared to the other subscales. It is thought that this situation may be related to the difficulty of understanding the items of the not distracting subscale (e.g., item 6:I distract myself when I feel uncomfortable or feel pain.). In our study, unlike the studies in the adult age group and in different cultures, it is seen that the test-retest reliability of the emotional awareness subscale is low compared to the others, and it is thought that this situation may be related to the change in emotional awareness depending on the cultural context and age (39). Therefore, according to both the ICC coefficients we have obtained and the Bland-Altman graphs we have drawn for each sub-dimension, it can be said that the test-retest results are in the moderate agreement range.

There are several limitations of our study. First of all, it is believed that the sample size in our study may not have been sufficient. We believe that there is a need to investigate the psychometric properties of the MAIA-YT scale in more detail in a larger sample of Turkish youth to improve some model indices affected by sample size such as CFI and TLI. In the study by Jones et al., in which they adapted the MAIA for youth, they found the reliability of the some of the subscales to be low in the 7–10 age range, therefore, participants aged 11 and over were included in our study (14). In future studies, it is suggested that the MAIA-YT be adapted for the scale items to be more easily understandable for younger sample. Another important limitation of our study is that we could not conduct a convergent validity analysis because, to the best of our knowledge, there is no comparable scale in Turkish for measuring a similar structure in the 11–17 age group.

As a result according to our study, it is found that the MAIA-YT is valid and reliable instrument for evaluation of interoceptive awareness in Turkish adolescents aged between 11–17. In order to evaluate interoceptive awareness in younger ages in future studies, reliability and validity analyses of the MAIA-YT scale between the ages of 7–10 may contribute to the literature.