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1. Motor Symptoms of ADHD

1. Motor Symptoms of ADHD

Last updated:

Review: Waldemar Zdero, M.A. in Psychology

Hyperactivity is a common symptom of ADHD, but not all people with ADHD are hyperactive.

In children, hyperactivity manifests as constant fidgeting, getting up, or running around.
In adults, hyperactivity decreases, but restlessness and certain behaviors such as drumming the fingers, tapping the feet, or biting the nails may still occur. Motor hyperactivity may decrease over time, while inner restlessness persists or becomes more apparent. There is ongoing debate as to whether inner restlessness is a separate symptom and whether it is related to problems with drive.

Men, whether or not they have ADHD, show higher levels of induced hyperactivity than women on the Quantified Behavioral Test. Both men and women with ADHD have twice the baseline hyperactivity and three times the induced hyperactivity compared to those without ADHD.1

Conclusion: These findings suggest that women with ADHD experience hyperactivity to the same extent as men, which calls into question the assumption that hyperactivity varies by gender. This could lead to more accurate and timely diagnoses and reduce the burdens and comorbidities associated with ADHD in women.

Hyperactivity and restlessness are also symptoms of stress. Stress hormones such as CRH can cause restlessness. Gross motor problems, such as clumsiness and coordination issues, are common in ADHD-HI and ADHD-C. Fine motor problems, such as poor handwriting and difficulties with fine motor tasks, may also occur. It is unclear whether fine motor problems can be improved by ADHD medication.

Data from the ADxS.org symptom test showed that motor hyperactivity decreased with age, while restlessness and attention problems persisted.

While it is widely recognized that attention problems in ADHD are primarily a motivational issue (a lack of self-motivation)—since intrinsically interesting topics can capture attention, whereas intrinsically uninteresting topics cause attention problems—it is largely unknown that this also applies to motor restlessness. A time-lapse video showing a person with ADHD watching a video that is intrinsically interesting to them and one that is not, illustrates that hyperactivity issues are caused by motivational factors just as much as attention problems are.

1.1. Hyperactivity

Motor hyperactivity is a very common symptom of ADHD. However, hyperactivity is not a mandatory symptom of ADHD. There are people with ADHD who suffer greatly from their symptoms but who were not hyperactive as children and are not characterized by inner restlessness as adults.

1.1.1. Motor Hyperactivity as a Symptom of ADHD

Motor hyperactivity is a characteristic of ADHD-HI and ADHD-C. In ADHD-I (predominantly inattentive), hyperactivity is less pronounced.2
Hyperactivity often subsides during adolescence. The literature indicates that hyperactivity in adults usually transforms into a form of inner restlessness. This will be a topic for discussion.

There have been isolated reports that hyperactivity in children with ADHD does not occur in new situations.34 5 This could be because new (interesting) stimuli increase arousal, causing dopamine and norepinephrine levels to rise as long as the interest in novelty persists.6 This is consistent with the regulation of hyperactivity by motivation described in the introduction
This distinguishes human ADHD hyperactivity from hyperactivity in ADHD model animals, where, for example, it occurs only in new situations (DAT-KO rodents; see there) or develops only with age, but then persists not only in new environments (SHR, see there).

The fidgeting and constant movement seen in people with ADHD could be understood as an internal correction of vigilance (internal baseline arousal) and low dopamine levels. Movement increases dopamine levels.78 People with ADHD who are forced to sit still give incorrect answers (even) more frequently than when they are allowed to move.7 Similarly, participating in sports before school (to work off motor restlessness) improves academic performance.7
Children with ADHD showed shorter reaction times on the Stroop Test and improved self-efficacy when engaging in physical activity (cycling). In children without ADHD, the results remained unchanged.9 The authors concluded that hyperactivity in ADHD may be a compensatory mechanism for upregulating hypoarousal in the PFC in order to support executive functions and self-efficacy.

1.1.2. Manifestations of motor hyperactivity

  • For toddlers:
    • Prolonged childhood defiant phase
    • Possibly accompanied by excessive, genuine, real outbursts of anger
  • In children:
    • Constant fidgeting with hands and feet or sliding around in the chair (DSM-IV/5)
    • Frequently stands up in class and in other situations where one is expected to remain seated (DSM-IV/5)
    • Frequently runs around or climbs excessively in situations where this is inappropriate (in adolescents or adults, this may be limited to a subjective feeling of restlessness) (DSM-IV/5)
    • Often has difficulty playing quietly or engaging quietly in leisure activities (DSM-IV/5)
    • Is often “on the go” or acts as if he or she were “driven” (DSM-IV/5)
    • Often talks excessively (DSM-IV/5; classified as a symptom of impulsivity in ICD-10). Verbal diarrhea can still be observed in some adults
  • In adults:
    • Hyperactivity (external/physical) decreases by up to 60% in adults10
    • Physical restlessness in adults, if present, may now be only mild
      • High-frequency foot tapping (or an accompanying pulse that is deliberately suppressed)11
      • Finger drumming (or the urge to do so, which is deliberately suppressed)11
      • Nail-biting12
      • Biting one’s lips
      • Cross your legs / wrap them around a chair leg to restrict movement12

1.1.3. Age-related decline in motor hyperactivity

The data from the ADxS.org symptom test show the following changes across age groups:

Age group Motor hyperactivity Restlessness Attention problems
5–9 years (n = 9) 0.70 0.80 0.75
Ages 10–14 (n = 15) 0.72 0.68 0.83
Ages 15–19 (n = 48) 0.45 0.62 0.81
Ages 20–29 (n = 373) 0.49 0.70 0.81
Ages 30–39 (n = 492) 0.49 0.74 0.83
Ages 40–49 (n = 301) 0.46 0.74 0.78
Ages 50–59 (n = 158) 0.46 0.72 0.80
60–75 years (n = 32) 0.42 0.74 0.72
Men (n = 630) 0.52 0.73 0.81
Women (n = 823) 0.45 0.72 0.80

As of June 2020. The values listed reflect the severity of the symptoms relative to one another.
Limitations on the validity of the findings:

  • There are few data sets involving participants under the age of 20, and far too few involving participants under the age of 10 to draw a reliable conclusion.
  • No distinction was made between ADHD-I and ADHD-C/ADHD-HI, so the (random) ratio of ADHD-I to ADHD-C/ADHD-HI may skew the data when group sizes are small.
  • Only those data sets in which the symptom test indicated the presence of ADHD were analyzed.
  • This is an unvalidated online self-test (screening).

The data can be discussed in light of the hypothesis that attention problems in children up to age 15 are not yet fully developed and that motor hyperactivity subsides in adulthood. However, they suggest that hyperactivity does not transform into inner restlessness, but rather that inner restlessness also exists in children and simply subsides to a lesser extent than hyperactivity. Once motor hyperactivity has subsided, inner restlessness simply seems to become more apparent.

Inner restlessness could be described as the “little brother” of hyperactivity.

An interesting point to consider is whether the inner restlessness that, according to the data, may already be present in children—given that, unlike hyperactivity, it does not seem to subside or subsides only slightly—might indicate that inner drivenness could be a symptom distinct from hyperactivity.
From the perspective of the original (potential) benefit of stress symptoms (original = before humans became sedentary), it may have been helpful for children to develop a greater willingness to move in dangerous situations so that they could flee more effectively alongside the group. Adults benefit less from hyperactivity, since they are the ones who must combat the stressors. When combating stressors, an increased urge to move is no longer as important as it is for children (who can contribute little to fighting the stressors); instead, the focus shifts to doing everything possible to combat the stressor and not resting until the danger has been overcome.

A parallel to this is that attention problems in adults can also decrease significantly or even resolve completely (albeit less frequently or to a lesser extent than hyperactivity and impulsivity),13 without any shift to a different symptom profile being reported in these cases. However, our data show, at most, only a very slight decrease in attention problems among adults.

It is questionable whether “inner drivenness” or “inner drive” might actually fit better under the heading “motivation problems” and could serve as the counterpart to a lack of motivation there, just as distractibility (shifting one’s focus of attention too easily) and task-switching problems / hyperfocus (difficulty shifting the focus of attention) form counterparts within the umbrella term “attention problems.” One argument against this is that lack of motivation correlates strongly with ADHD-I and less so with ADHD-HI, whereas distractibility and task-switching difficulties correlate equally with both ADHD-HI and ADHD-I.

1.1.4. Hyperactivity as a Symptom of Stress

Hyperactivity and restlessness are known to be typical symptoms of severe stress, as is the tendency for thoughts to focus on the stressor during times of stress (ruminating, going over things in one’s mind).
Symptoms of stress associated with hyperactivity include:

  • Restlessness1415
    Inner restlessness is a typical symptom of the final stages of burnout.16
  • Restlessness1718
  • Restlessness19

The stress hormone CRH, which is released by the hypothalamus in the first increment of the HPA axis, immediately triggers an urge to move. Increased locomotor activity is a direct effect of the stress hormone CRH.2021221915

Symptoms that are directly caused by stress hormones themselves may nevertheless also be ADHD-specific symptoms. Chronic stress and ADHD both cause their symptoms through a deficiency of dopamine and norepinephrine in the brain.

1.2. Gross Motor Skills Problems in ADHD

Gross motor skill problems are a symptom of ADHD.2324 25 26 27 28 29 30 They are already present in toddlers31 and are associated with sleep problems in children.32 More than half of people with ADHD are said to have gross and fine motor skill problems.3334
Gross motor and fine motor disorders should be considered separately from motor hyperactivity.

Forms:

  • Clumsiness
    • Frequently bump into things/get caught on things
    • Manual clumsiness, as well as poor aiming and catching skills, in children with ADHD correlate with the ADHD score35
  • Many accidents (clumsiness meets rush)
    • Frequent injuries (especially ADHD-HI)
    • Bruises
  • Coordination problems (dyscoordination)
    • E.g., not learning to ride a bike until age 6
    • E.g., difficulty maintaining balance or standing on one leg36373839
      • Balance problems in children with ADHD (ages 4 to 6) predicted the severity of core ADHD symptoms35
      • Even among young adults40
      • Balance and bilateral coordination (including manual dexterity) are the most commonly reported areas of motor impairment in ADHD41
  • Difficulties in Controlling Force

Initial data from the ADxS.org online symptom test (as of October 2018) suggest that gross motor problems occur far more frequently in ADHD-HI with hyperactivity than in the ADHD-I subtype. Studies confirm the link between gross motor problems and hyperactivity/impulsivity.42

Motor problems, in the form of deficits in interpersonal (automatic) (motor) synchronization, may contribute to the development of social problems. Interpersonal synchronization requires good motor control and is also important in the development of mother-child relationships.43
Interpersonal synchronization plays an important role in the acquisition of social cognitive skills during development.4445 In ADHD, the extent of interpersonal synchronization between mother and child correlates with the level of functioning in preschool children with ADHD.46
Another hypothesis suggests a link between impaired eye control (control of gaze direction and saccades (eye movements)) and ADHD symptoms such as attention problems and impulsivity.47

Symptoms related to gross motor skills (catching and throwing a ball) and balance are reported to be more pronounced in ADHD-I > ADHD-C > ADHD-HI than in non-affected individuals.48

1.3. Fine Motor Skills Problems in ADHD

Problems with fine motor skills are a symptom of ADHD.2549 50 More than half of people with ADHD are said to have problems with both gross and fine motor skills.33
Fine motor and gross motor disorders should be considered separately from motor hyperactivity.

Four- and five-year-old children with ADHD were more likely to have developmental delays in fine motor skills than in gross motor skills; this was even more pronounced among four-year-olds than among five-year-olds.
Among 5-year-olds, poorer fine motor skill development was more strongly associated with ADHD severity than gross motor skill development.51

Forms:
Activities that require precise hand-eye coordination are made more difficult

  • Handwriting Problems52
    • Scribbled handwriting5354
    • A disproportionately high increase when taking dictation under time pressure55
  • Problems with the
    • Drawing
    • Children find it difficult to color in pictures neatly55
    • Clothing (Children)
    • Eating with cutlery and others
    • Straight cuts with scissors (children)
      * Inserting small screws

Problems with fine motor skills should

  • may be more pronounced in younger children (ages 6 to 9) than in older children (ages 10 to 13)56
  • occur more frequently in ADHD than in ODD/CD57
  • is more common in ADHD-I33
  • more pronounced in ADHD-I than in ADHD-C, more pronounced in ADHD-HI than in ADHD-C, and more pronounced than in those without ADHD48
  • occur with roughly the same frequency in ADHD-HI and ADHD-I58
  • more common in ADHD-C than in ADHD-I and ADHD-HI56
  • be gender-neutral56
  • can occur in both the dominant and non-dominant hand56

Between 28% and 67% of people with ADHD also showed improvements in their fine motor skills as a result of ADHD medication3359

Children and adolescents with ADHD between the ages of 7 and 17, as assessed using the Functional Dexterity Test (FDT) to measure fine motor skills in the hands, showed a shorter processing time for both the dominant and non-dominant hands, a higher processing speed on the Pegboard Test, more total errors, and a longer FDT time. Although children with ADHD were faster, they were at a disadvantage in terms of processing errors and total processing time.60

1.4. Motor Development Disorders

1.4.1. Developmental Coordination Disorder (DCD, Dyspraxia)

An online survey of German parents (n = 149) found a significantly higher prevalence of DCD (over 50%), even among parents who had never heard of DCD.61 A larger study (n = 755) found Developmental Coordination Disorder (DCD, dyspraxia) in 34% of boys and 29% of girls with ADHD.30
Children with DCD were more likely to exhibit ADHD symptoms.62
In an online survey of university students (aged 29 and under) in Japan, 7.4% of participants were found to have dyspraxia (≥ 32 points on the AAC-Q, mean 36.2). 17.6% scored ≥ 27 points. Participants without DCD scored an average of 19.5 points. ADHD was found in 3.2% of participants. The AAC-Q scores correlated strongly with the results of the ADHD Developmental Disorder Difficulty Scales Short (r = 0.65), moderately to strongly with the ASD Developmental Disorder Difficulty Scales (short form) (r = 0.55), and moderately with mental health problems as measured by the UPI (r = 0.41). The findings are consistent with other studies that found DCD in 7 to 9% of all young adults.63

1.4.2. Persistent (primitive) reflexes (RPR)

During the ontogenesis of the CNS, functions that develop later tend to replace the earlier ones once higher increments of CNS development have been successfully reached.64 So-called primitive reflexes, including the asymmetric tonic neck reflex (ATNR) and the symmetric tonic neck reflex (STNR), are early childhood (primitive/primary) reflexes that, in normal development, are superseded by more advanced functions and subsequently regress.
It is true that many healthy children also exhibit persistent (retained) primitive reflexes (RPR).65 However, RPRs often correlate with developmental delays and

  • ADHD66 67 68
  • ASS6667 69 70
  • Dyslexia66
  • Tourette’66
  • Learning disability66
  • sensory processing disorders66
  • Cerebral palsy7172
  • Parkinson’s73
  • Zika virus syndrome74
    • Children with congenital Zika virus syndrome exhibited abnormal persistence of primitive reflexes (94.7%), impaired cognitive development (95.1%), delayed neuropsychomotor development (between 92.8% and 100%), hypertension (between 74.7% and 90.1%), and impaired speech development (between 68.42% and 100%)75 showed abnormal persistence of primitive reflexes74
  • other neurological behavioral disorders.76 RPR appears to be associated with delayed maturation and neuronal developmental disorders.6677
  • Premature births78

ATNR and STNR can still be measured in adulthood.79 In older age, primitive reflexes even seem to increase again.

  • Persistent primitive reflexes were found80
    • 47 to 51% of people aged 25 to 45
    • 73% to 75% of people aged 65 to 85
    • No correlation with cognition was found
  • A palmomental reflex was observed66
    • in 6% to 27% of young adults aged 20–50
    • among 28% to 60% of people over the age of 60
  • Snout reflex66 (also known as the orbicularis oris reflex; triggered by lightly tapping the closed lips along the midline and manifested by a contraction of the lip muscles (pouting, protrusion of the lips, resembling a beak or snout).
    • among 13% of people aged 40–57
    • among 22% to 33% of people over 60
  • Sucking reflex, which is also associated with frontal lobe disorders66
    • in more than 6% of healthy individuals aged 73 to 93

Persistent primitive reflexes (ATNR, STNR, Moro) resulted in (average age 17.5 years) significantly lower success rates in technical and tactical plays, including a 15.5% to 31.8% reduction in passing success rates, as well as significantly poorer defensive actions and tackles.81 Two-thirds of high-performance youth soccer players exhibited active primitive reflexes. Among those playing in an age group higher than their actual age, the rate of unintegrated primitive reflexes was elevated.82

RPR can also (re)appear in later life, e.g., due to degeneration (dementia, Parkinson’s disease)8384 , a lesion of the frontal lobe, or damage to the corticospinal tract.66

Training the primitive reflexes improved eye control.85 Even in adults, it is still possible to reduce primitive reflexes with a daily practice of 5 minutes over a period of one to one and a half years.67

A study found an increased prevalence of persistent reflexes in n = 14 children with learning difficulties:86

  • ATNR 100%
  • STNR 100%
  • Tonic lateral reflex (TNR) 100%
  • Moro reflex 92.8%
  • Spinal Galant reflex 64.2%
  • Rooting reflex 64.2%
  • Palmar reflex 64.2%
    • Stroking horizontally across the palm applies light pressure. An active palmar reflex causes the palm to close or form a fist.
  • Sucking reflex 57.1%

In ASS, which is characterized by abnormal lateralization, long-range underconnectivity, a higher ratio of functional qEEG connectivity between the left and right sides, and short-range overconnectivity, a reduction in persistent primitive reflexes (RPRs) (two from the group consisting of the asymmetric tonic neck reflex, symmetric tonic neck reflex, spinal Galant reflex, Babinski reflex, Palmer grasp reflex, Search Reflex, and Tonic Neck Reflex) through unilateral transcutaneous electrical nerve stimulation (TENS) with a change in the qEEG in the beta, delta, theta, and gamma bands toward normalization of the U-curve typical of ASS.87
In ASS, increased persistence of the snout reflex and the visual search reflex was observed, but not of the tactile search reflex, the sucking reflex, or the grasping reflex.88

A reduction in persistent reflexes is consistent with the treatment goals for developmental delays. Persistent reflexes could be a biomarker for developmental disorders.89

A case study of three individual cases reports the resolution of persistent primitive reflexes in three adult alcoholics through the use of the NDMA antagonist acamprosate.90

1.4.2.1. Asymmetric Tonic Neck Reflex (ATNR)

ATNR:91

  • When the head is turned to the side, a reflex follows
    • Stretching the limbs (arms and legs) on the side facing upward
    • Bending the limbs (arms and legs) toward the back of the head
    • Test: The subject gets down on hands and knees (blindfolded so that visual orientation does not skew the results). The subject’s head is positioned in the midline, with the face parallel to the floor. The knees and hips are bent as far as possible. The subject should relax and then hold their arms straight, keeping their elbows unbent. With the head in a neutral position, and with the examiner positioning the head to the right and to the left, the flexion of the elbows is measured.
  • Prenatal care during weeks 16 through 18 of pregnancy92
  • Purpose:
    • prenatal
      • Building muscle tone
      • Reducing oxygen demand by slowing down the circulatory system in the event of oxygen deprivation67
    • Support for active labor (rotation)
      • Pushing contractions cause oxygen deprivation and trigger ATNR67
    • Support for eye-hand coordination, which begins after birth
  • is gradually incorporated between the 3rd and 9th months of life through crawling on the stomach92
  • should have completely disappeared by the end of the first year of life; otherwise, it may be a sign of developmental delay

The Children’s Primitive Reflex Integration Measurement Scale (CPRIMS) was developed to measure, among other things, ATNR and STNR.93
A failure of ATNR and STNR to resolve increased the risk of motor92 and psychological64 problems.

Excessive reflex responses and persistence of the ATNR are considered pathological signs of organic brain damage (e.g., cerebral hypoxia in newborns) and interfere with normal motor development.94
Possible signs of ATNR developmental delay (usually several):91

  • Underdeveloped laterality
    • Lack of lateralization / ipsilateral (same-side) movement patterns
    • Alternating preference for dominant hand or leg
      • ADHD is associated with a higher prevalence of non-right-handedness (left-handedness, ambidexterity)95
    • unspecified guide eye
      • Possible consequences (especially under stress):
        • poor eye tracking
        • impaired or confused visual perception
        • LRS (reading and spelling difficulties)
    • Undetermined dominant ear = Lack of determination of ear preference = Change in the preferred ear for hearing
      • Possible consequences (especially under stress):
        • Problems with sound processing
        • problems with auditory sequencing
        • Mixing up and omitting letters, numbers, and mathematical symbols
        • LRS
  • Right-left confusion (confusing right and left)
  • mirror writing
  • mirror-image reading (confusing b and d or p and q)
  • Handwriting
    • The child compensates for the pressure on the pen, which affects their handwriting
    • scrawled
    • very cramped and small
    • Difficulty staying within the lines
    • Turning the page while writing
  • Reclining sitting position
  • Scoliosis9296
  • Disorders of eye-hand coordination94
  • visual perception and fixation disorders94
  • Coordination disorders, particularly when crossing the body’s midline (movement, postural, and writing disorders)94
  • Balance problems97
    • when the head is turned to the side
    • Learning to ride a bike is more difficult
  • Dyslexia
  • Reading and spelling difficulties
  • Difficulties in math

Studies have found a correlation between persistent ATNR and

In children (ages 8 to 11) with persistent ATNR and LSR, the ATNR symptoms were reduced by imitating the reflex movements.106

1.4.2.2. Symmetrical Tonic Neck Reflex (STNR)

STNR:

  • A reflex pattern consists of two movements
    • The child is on all fours, with its head raised, one arm straight and the other bent
    • Lower your head, bend your arms, and straighten your legs
  • When the head moves forward (chin to chest) or backward (head tilted back), there are consequences91
    • Movement of the upper half of the body in the opposite direction to the lower half
    • Extending the upper body causes the lower body to flex, and vice versa
    • Bend your head forward -> Bend your arms, straighten your legs
    • Bend your head backward -> Your arms straighten, your legs bend

The STNR influences the further integration of the tonic labyrinthine reflex. It strengthens the back and neck muscles and is important for proper posture.

If the STNR is not sufficiently integrated, the child will move around by sliding on their bottom or simply sitting until they learn to walk. Children who have never crawled on all fours usually have an active STNR.

The STNR is crucial for the development of vision, balance, and eye-hand coordination.

STNR:91

  • develops from the tonic labyrinthine reflex, which becomes apparent at the beginning of the 9th week of pregnancy
  • STNR is particularly pronounced from the 6th to the 8th month of life92
  • a close connection to the vestibular system
  • an important transitional phase leading up to crawling
  • trains accommodation (the eyes’ ability to adjust to different distances)

The STNR should be integrated between the 9th and 11th months of life and, as the child grows, be completely replaced by more mature motor coordination.92

The Children’s Primitive Reflex Integration Measurement Scale (CPRIMS) was developed to measure, among other things, ATNR and STNR.93
A failure of ATNR and STNR to resolve increased the risk of motor92 and psychological64 problems.

Motor immaturity in the form of movement patterns resulting from persistent STNR correlates with:91

  • ADHD symptoms
    • Hyperactivity
    • Attention problems
    • Difficulty concentrating
    • Organizational problems
    • a poorly developed sense of time
    • Sequencing problems (in the case of practical requirements or more complex work instructions)
    • motor problems92
  • difficulty with rhythmically coordinated movements
  • Fluid that impairs movement, which107
    • require vertical eye movements
    • Require monitoring of sitting posture
  • Impaired reading and writing posture
  • Difficulty coordinating the movements of the upper and lower body, e.g., swimming, forward/backward rolls
  • Push-ups are more difficult because extending the arms triggers the flexion reflex in the legs
  • Catching balls is made more difficult by
    • poor hand-eye coordination
    • Difficulty estimating distance and time
  • Muscle tone
    • weak
    • stiffened
  • Balance problems
  • Poor posture
  • Difficulty keeping your back straight
  • Weak upper arm strength
  • Sitting in a W-position or wrapping your legs around the chair legs
  • When reading or writing, the child leans over the book and supports their head with their hand
  • Lack of or barely any crawling (toddlers)
  • Difficulty with accommodation and visual focusing at different distances (impairs reading ability)
  • Perceptual difficulties
    • visual
    • spatial

Among girls with ADHD, bilateral motor coordination—which is closely linked to the asymmetric and symmetric tonic neck reflex—proved to be a significant predictor of several subparameters of academic performance (participation, task support, and physical tasks). Among boys with ADHD, balance was a particularly significant predictor of physical and cognitive functioning.108

1.4.2.3. Moro reflex

The Moro reflex (startle reflex) occurs in response to sudden, startling stimuli between the 2nd and 4th months of life, manifesting as the spreading and subsequent drawing back of the arms and legs, often supported by a cry.

Triggers: Sudden movements, loud noises, changes in position, bright light
Response: Spreading of the arms and legs, followed by tensing and often screaming, increased heart rate, activation of the sympathetic nervous system
Meaning: triggers the first breath after birth; helps the baby hold on or protect itself in case of danger
Delay: Usually occurs between the 2nd and 4th month of life, but may persist longer in some children

A small study found an increased prevalence of a persistent Galant reflex in ADHD.109
A persistent Moro reflex is a sign of neurological problems.105

An excessive, persistent Moro response can trigger exaggerated startle reactions. This is particularly true for people who are highly sensitive to stimuli, as is typical in ADHD.67
One case report describes an 18-year-old woman in whom a severe anxiety and panic disorder correlated with a fully developed Moro reflex. Treatment aimed at reducing the Moro reflex resulted in an improvement in her anxiety symptoms.67

1.4.2.4. Galant Reflex

A small study found an increased prevalence of a persistent Galant reflex in ADHD.109

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