Primitive reflexes are automatic movements and responses that are controlled by the lower brain and spinal cord rather than the cortex. They emerge during specific stages of fetal development and are present at birth in all infants. Primitive reflexes provide newborns with survival reflexes and developmental skills necessary in the first few months of life. For example, sucking and rooting reflexes allow the infant to feed, while the Moro reflex provides a startle response to loud noises.
Primitive reflexes typically start to fade between 4-12 months as the infant’s brain matures and cortical control develops. As higher brain functions come online, primitive reflexes are inhibited and eventually integrated by around 12 months in a normal sequence of development. This allows voluntary, cortical control of movement and coordination.
However, in some children, primitive reflexes are abnormally retained past 12 months when they should have been integrated. This is known as a retained or persistent primitive reflex. Some common examples include:
- Asymmetrical Tonic Neck Reflex (ATNR)
- Symmetrical Tonic Neck Reflex (STNR)
- Moro Reflex
- Palmar Grasp Reflex
- Spinal Galant Reflex
| Primitive Reflex | Typical Integration Period |
|---|---|
| Moro Reflex | 3-4 months |
| ATNR | 6-9 months |
| STNR | 6-9 months |
| Palmar Grasp | 6-12 months |
| Spinal Galant | 9-12 months |
Table 1. Typical integration periods for common primitive reflexes.
When primitive reflexes persist past the normal integration time, they can interfere with the development of voluntary motor control and coordination. Children with retained primitive reflexes often have trouble with skills like crawling, walking, running, and balancing.
Additionally, retained primitive reflexes have been associated with a range of neurodevelopmental conditions including:
- ADHD
- Autism
- Dyslexia and learning disabilities
- Sensory processing disorder
- Developmental coordination disorder
Therefore, identifying and treating retained primitive reflexes is crucial to support normal development and prevent lifelong challenges. Integrating primitive reflexes allows the brain and body to develop more advanced motor and cognitive skills.
The causes of retained primitive reflexes are not fully understood, but may include:
- Genetic factors
- Birth trauma
- Restricted movement as a baby e.g. swaddling, baby carriers
- Stress during pregnancy
- Illness or injury in infancy
According to research, the prevalence of retained primitive reflexes past 12 months of age can range from 5-10% in the general population. However, rates are significantly higher in children with neurodevelopmental disorders like autism or ADHD.
For example, a 2010 study found that 95% of children with autism had retained primitive reflexes, compared to 58% of typical children. The most common retained reflexes were Moro, Spinal Galant, and ATNR.
This highlights the importance of screening for primitive reflexes, especially in at-risk children who already show signs of developmental delays. Formal assessment by an occupational therapist can identify if a child has retained primitive reflexes past the normal age of integration.
II. Identifying Retained Primitive Reflexes
The first step in treating retained primitive reflexes is accurately identifying which reflexes have persisted. While parents may notice some signs at home, formal assessment by a pediatric occupational therapist is recommended to confirm any retained reflexes.
Some common signs and symptoms that may indicate retained primitive reflexes include:
- Poor coordination
- Difficulty crossing the midline of the body
- Poor posture when sitting at a desk or table
- Struggles with sports involving catching, kicking or throwing a ball
- An awkward, immature pencil grasp
- Letter or number reversals when writing
- Difficulty tracking moving objects smoothly with the eyes
- Extreme sensitivity to light touch or textures
- Excessive drooling past 18 months
- Difficulty articulating speech sounds
- Delayed motor milestones like rolling, crawling, or walking
However, it is important to note that these symptoms alone do not confirm a retained primitive reflex. Formal assessment uses specific techniques to elicit each reflex and observe the response.
Assessment Techniques
There are several primitive reflexes that can persist, so a full assessment is needed to identify which specific reflexes are retained. Some examples of assessment techniques include:
Moro Reflex
- Baby is laid on their back and the head is tilted backwards suddenly
- Normal response is extending arms and legs out then bringing them back in
- Retained reflex shows arms extended outwards and unable to come back in
Asymmetrical Tonic Neck Reflex (ATNR)
- Baby is laid on their back and head is turned to one side
- Normal response is slight extension of the arm and leg on face side
- Retained reflex shows arm and leg extension on the face side and arm/leg flexion on the opposite side
Spinal Galant Reflex
- Baby is laid on their side and the back is stroked down the spine
- Normal response is slight hip flexion away from the side stimulated
- Retained reflex shows dramatic hip flexion away from the side stroked
Palmar Grasp Reflex
- Placing finger or object in baby’s palm causes reflex grasp
- Normal response is brief grasp then release
- Retained reflex shows prolonged grasping of the object
By systematically testing for each reflex, a profile can be developed showing which primitive reflexes are still active.
It is important to note that primitive reflexes can return temporarily when a child is stressed, anxious, fatigued or ill. Therefore, assessment should occur when the child is calm and relaxed to avoid false positives. Primitive reflexes are most commonly assessed by occupational therapists around ages 5-7 years.
III. Integrating Retained Primitive Reflexes
Once retained primitive reflexes have been identified through formal assessment, the next step is integrating them through purposeful movements and exercises.
The overall goal is to stimulate the lower brain and spinal cord to inhibit the primitive reflex, allowing voluntary control to take over. Exercises are designed to get the reflex “under control” rather than elicit the reflex response.
With consistent, repetitive movements tailored to the child’s specific reflex profile, even retained primitive reflexes that persist into late childhood or beyond can be successfully integrated. However, the process does take time and commitment.
General Principles
Here are some general guidelines that occupational therapists recommend when starting primitive reflex integration exercises at home:
- Do the recommended exercises for 5-10 minutes per day. More frequent, shorter sessions are most effective.
- Consistency matters. The exercises must be done regularly to get results – primitive reflexes can return if not fully integrated.
- Repetition is key. Each movement may need to be repeated 10-20 times per session.
- Make it fun! Integrating reflexes is hard work. Adding games, songs, and variety keeps kids engaged.
- Focus on one reflex at a time. Work in stages instead of tackling multiple reflexes at once.
- Track progress. Note any improvements in skills or symptoms after 4-6 weeks. Adjust exercises as needed.
- Be patient. Reflex integration is slow – it may take months or years depending on the child. Celebrate small achievements along the way.
Sample Exercises
Here are some examples of simple exercises that parents can do at home to help integrate common retained primitive reflexes:
Moro Reflex
- Have the child lie on their back. Slowly bring their head up and then down again.
- Roll the child from side to side gently while keeping head in line with the body.
ATNR and STNR
- Have the child get on hands and knees and turn the head side to side, keeping the hips still.
- In sitting, cross the midline by touching hand to opposite knee.
Spinal Galant
- Child lies on stomach. Apply gentle pressure down the side of the spine from shoulder to hip.
- Child sits with legs in straddle. Shift weight side to side.
Palmar Grasp
- Gently stroke finger across child’s palm from wrist to fingertips until grasp response fades.
- Play hand games like finger football or thumb wrestling.
Along with reflex integration exercises, activities that promote developmental milestones like crawling, rolling, balancing and crossing the midline are very helpful.
It is critical that retained primitive reflex exercises are done correctly at the recommended frequency. An occupational therapist can provide guidance on tailoring activities to the child’s needs and monitoring progress. Ongoing parent education ensures exercises are done properly at home between therapy sessions.
IV. Supporting Developmental Skills
Along with specific primitive reflex integration exercises, it is crucial to work on developmental milestones and skills that may have been delayed or impacted by retained reflexes.
Supporting overall development in areas like core strength, bilateral coordination, crossing midline, balance, motor planning, and pencil grasp will reinforce reflex integration and improve functional abilities.
Here are some key developmental skills to target:
Core Strength
Retained primitive reflexes often affect posture and core control. Weak core muscles lead to poor stability and problems coordinating the upper and lower body.
- Have the child practice sitting upright with legs crossed or standing without leaning or swaying.
- Do core exercises like bridges, planking, crunches or wall sits. Make it fun by adding races or music.
- Wheelbarrow walking, animal walks like bear or crab walks, and climbing on playground equipment develops core strength.
Bilateral Coordination
Using both sides of the body together in a coordinated way is needed for skills like crawling, walking, running, and sports.
- Play catch, kick a ball back and forth, bounce a ball, and throw at targets to coordinate both sides.
- Jump rope, pat-a-cake, rowing a boat, and drumming improve timing and rhythm between the hands.
- Help the child learn to tie shoes, button shirts, and zip jackets to refine fine motor coordination.
Crossing Midline
Crossing the imaginary line down the center of the body with hands, feet, and eyes supports coordination.
- Reach across the body to touch hand to opposite knee, elbow, shoulder.
- Play basketball and aim to dribble or throw the ball from one hand to the other over the midline.
- Draw or write on paper placed at the child’s midline so their hand crosses over.
Balance
Good balance enables agility, coordination, and body awareness.
- Practice standing on one foot or heel-toe walking along a line. Time how long balance can be held.
- Walk forwards and backwards on a balance beam or along the edge of a swimming pool.
- Play Twister or have the child hold yoga poses like tree or warrior to improve balance.
Motor Planning
Being able to conceptualize, sequence, and carry out unfamiliar motor tasks.
- Give multi-step directions for actions like hopping plus spinning or jumping jacks with claps.
- Play Simon Says and Follow the Leader increasing complexity.
- Set up obstacle courses for the child to navigate around, under, over, and through.
Pencil Grasp
An efficient pencil grasp is needed for legible handwriting.
- Play with tongs, tweezers, eyedroppers, and clothespins to develop pincer grasp strength.
- Provide thick pencils and crayons to promote a tripod grasp with thumb, index and middle fingers.
- Use small pieces of putty or theraputty to shape fingers into the ideal grasp position.
Along with working on developmental skills, making some simple adaptations to the child’s environment can also be helpful.
V. Making Environmental Adaptations
Given the motor coordination and sensory processing challenges associated with retained primitive reflexes, some adjustments to the child’s physical environment can make daily activities more manageable.
Simplify and Reduce Clutter
Too much sensory input is overwhelming and makes it hard to focus.
- Keep rooms, play areas, and desks free of excess toys, materials, furniture, or decorations.
- Store items out of sight in baskets, bins, or closets when not in use.
- Schedule daily tidy up time so clutter does not accumulate.
Allow Extra Time for Transitions
Switching between tasks is difficult due to poor sensory filtering and integration.
- Give 5-10 minute warnings that an activity or location change is coming up.
- Build in extra time for transitions like getting ready in the morning.
- Use visual schedules and timers to help the child anticipate and prepare for changes.
Provide Fidget Items
Fidget toys can help kids self-regulate and focus while sitting.
- Try items like stress balls, resistance bands, velcro strips, silly putty, or finger fidgets.
- Allow chewing gum or crunchy snacks like pretzels during desk work.
- Take regular sensory breaks for jumping, crashing, stomping or other heavy work.
Use Weighted Vests or Blankets
The gentle pressure is organizing and calming.
- Start with 1-2 lbs and only wear for short periods until accustomed to the weight.
- Use during table top activities or while reading, watching TV, or resting.
- Remove if the child becomes agitated or tries to take it off.
Stabilize Desk and Chair
Extra stability enables better sitting posture and hand control.
- Use chairs with solid backs or seat cushions to prevent tipping backwards.
- Place a therapy ball or disc cushion on the chair to improve core strength.
- Use dycem, non-slip mats, or theraband to prevent sliding or movement of desk, chair, or work materials.
With some simple modifications tailored to the child’s needs, the environment can be adapted to support success with daily tasks.
VI. Considering Other Therapies
While occupational therapy is the primary treatment for addressing retained primitive reflexes, other therapeutic approaches can also provide benefit:
Vision Therapy
Targets visual skills like eye tracking, convergence, and focus that are often impaired.
Speech Therapy
Improves articulation, oral motor control, and feeding skills affected by primitive reflexes.
Physical Therapy
Increases strength, endurance, coordination, and balance through exercise.
Medication
May be recommended for co-occurring conditions like ADHD or sensory disorders.
Neurofeedback
Trains the brain to better self-regulate through video games controlled by brain waves.
Nutrition Plans
Some providers recommend specialized diets or supplements to improve symptoms.
Homeopathy
Uses natural remedies chosen for each child’s unique symptoms and temperament.
Other Alternative Therapies
Options like auditory integration training, craniosacral therapy, or aromatherapy.
An interdisciplinary approach combining several therapies often yields the best results. The key is choosing therapies targeted to each child’s specific primitive reflex profile and developmental needs.
Conclusion
Retained primitive reflexes are a more common issue than most parents and providers realize. When present past the first year of life, they can significantly disrupt development of motor, sensory, behavioral, academic and social skills.
Careful assessment is needed to identify which primitive reflexes remain active. With consistent home exercises and activities tailored to integrate specific reflexes, great improvements are possible. But the process does take time and commitment.
Supporting overall development, adapting the environment, and considering other therapies provides a comprehensive approach to treating retained primitive reflexes.
The benefits make the effort worthwhile – integrating primitive reflexes allows children to gain skills needed for school readiness, independence, and reaching their full potential.
Key Takeaways
- Formal assessment determines which primitive reflexes are retained past 12 months.
- Daily exercises and activities can integrate retained primitive reflexes.
- Patience is needed as integration takes months or years.
- Other therapies like vision or speech therapy also help address symptoms.
- Adapting the environment reduces sensory overload and improves function.