Reflex integration of early childhood (primitive) reflexes

Author: Sebastian Schadow, reflex therapist and coach for children and young people, www.smarte.kids
Review: Eva Laier & Manuela Schwab, founders of the KinFlex Institut für kinesiologische Reflextherapie & Zentrierung GbR

Early childhood or primitive reflexes (such as ATNR, Moro, STNR) are part of the normal early neuromotor repertoire. However, in some children they persist for longer (“retained primitive reflexes”, RPR) and are retained through birth and the rearing process. They are associated with motor, language and academic difficulties - including ADHD symptoms, reading/writing difficulties and fine motor deficits. Controlled intervention studies exist that demonstrate that targeted movement programs reduce reflex activity and produce measurable improvements in certain children; however, the evidence is heterogeneous and many studies are small or have methodological limitations. Conclusion: Reflex screening can be integrated into neurodevelopmental assessment, interventions should be multimodal and evidence-based; further high-quality studies are needed.

• 1. Basics: Development and significance of early childhood reflexes
• 2. Why reflexes are sometimes not triggered or are reduced during birth
• 3. Clinical significance: When are persistent reflexes relevant?
  • 3.1. Screening
  • 3.2. Education & transparency
• 4. Carrying out reflex integrations
• 5. Examples of the possible effects of Persistent reflexes:
  • 5.1. Fear and paralysis reflex (FLR)
  • 5.2. Tonic labyrinthine reflex (TLR):
  • 5.3. Spinal galant
• 5. Effectiveness of reflex integration therapy
• 6. Further reading

1. Basics: Development and significance of early childhood reflexes¶

The human brain develops at an enormous rate during pregnancy and especially in the first year of life. During this sensitive phase, the different areas of the brain connect to form functional networks that form the basis for motor skills, perception, emotion and cognition. At the same time, muscle strength, sense of balance and coordination develop.
Continuous sensory and motor stimuli are necessary for the success of this complex development. Early childhood reflexes (primitive reflexes) are an essential part of this. These functions, which are controlled by the brain stem and occur in a predetermined sequence, are essential for survival in the first months of life, as they ensure sucking, grasping and protective reactions, among other things.
The earlier assumptions that reflexes would generally disappear by the age of three at the latest are considered outdated. Research shows that they are detectable in many school-age children and even adults. Consequences include learning difficulties, attention problems, disorders of balance and coordination, spinal misalignments, migraines, functional organ problems and emotional dysregulation.
Reflex integration refers to the therapeutic process of subsequently inhibiting these reflexes through targeted movements and transferring them into the motor repertoire. International programs such as INPP, RIT, F&W or Kinflex (reflex therapy) have developed their own methods.
Studies document improvements in motor skills, attention and learning performance after such treatments (e.g. McPhillips et al., Lancet 2000; Goddard Blythe 2005; Sieber & Paasch 2015)

2. Why reflexes are sometimes not triggered or are reduced during birth¶

The type of birth has an influence on early childhood reflexes, as does neuronal maturation. In the course of a vaginal delivery, the child is exposed to strong sensory stimuli: Pressure as it passes through the birth canal, temperature changes and hormonal signals (increase in stress hormones and oxytocin). These elements stimulate the nervous system and help to trigger reflexes such as the Moro reflex or breathing reflexes. Additional motor reflexes from early childhood are also activated in order to cope with the journey through the birth canal. The triggering of early infant reflexes can be influenced by external aids such as a suction cup, forceps or caesarean section. A caesarean section, especially if it is planned and performed before the onset of labor, eliminates many of these stimuli. This can lead to weakened or delayed reflex responses. Premature babies and children with birth complications are also more likely to have weakened reflexes. If these early triggers are missing, this can impair the full integration of reflexes later on.
Studies at https://www.adxs.org/de/page/19/1-motorische-symptome-von-adhs, 1.4.2. persistent (primitive) reflexes (RPR) from 2013 show that
persistent primitive reflexes were found in 47 to 51% of patients aged 25 to 45 years and in 73% to 75% of patients aged 65 to 85 years.

3. Clinical significance: When are persistent reflexes relevant?¶

In children with neurodevelopmental disorders (ADHD, reading/writing disorders, developmental delays), several studies found higher prevalences of non-integrated
Reflexes. The observation shows: The persistence of certain reflexes (such as ATNR, Moro, STNR) is associated with difficulties in fine and gross motor skills, bilateral coordination, visuomotor integration, reading and writing, and behavior/attention. These studies provide association data - causality cannot be automatically inferred from them.¹²

3.1. Screening¶

For children with persistent motor, visuomotor or learning/attention problems, standardized screening for RPR (ATNR, STNR, Moro, TLR, Galant) and documentation with validated scales, if available, is recommended.
In the aforementioned reflex integration methods, this is included in the form of questionnaires on the course of the birth and the straightening process. Depending on the method, the reflex patterns are also triggered in order to observe the effects of the respective reflex and to illustrate the change in the child or adult. Alternatively, the existing reflexes can also be checked using kinesiology tests. The reflexes can then be inhibited using the appropriate method, regardless of the test.

3.2. Education & transparency¶

Educate parents and teachers about the latest research to raise awareness

• for these causes of problems with attention, reading and writing, mathematics or abnormal movements
• how the potential benefits, but also the limitations and uncertainties, can be clarified.

4. Carrying out reflex integrations¶

A questionnaire on birth and the straightening process is often handed out via a questionnaire on the corresponding integration method, which provides the reflex therapist with initial clues to
possible reflexes to be processed.
Directly before the treatment, the reflex is tested using kinesiological methods, sometimes also triggered, in order to illustrate the effect to the client before the inhibition.
For integration, certain movement patterns are performed according to the reflex.
Often, bilateral hemispheric stimulation is also performed with music, which additionally inhibits physical stress and facilitates processing.

5. Examples of the possible effects of Persistent reflexes:¶

5.1. Fear and paralysis reflex (FLR)¶

From around SSW 5-7 to around SSW 32

Task:

• Protection against entanglement in the umbilical cord due to solidification
• Slowing of the metabolism in shock reaction
• Ensures the formation and strengthening of muscles in the womb

Signs of the reflex:

• Stress on eye contact
• Low stress tolerance
• Problems with balance
• Sensitivity to touch, light, noise, smell, taste
• Change of position
• Freezing in a frightening situation without being able to react
• Immediate slowing of the heartbeat
• Pale
• Slack muscle tone
• Conflict avoidance
• Separation anxiety
• School anxiety
• Feelings cannot be shown/expressed
• It is not possible to focus attention
• Release of stress hormones damages brain cells
• Constantly excessive adrenaline levels are programmed in the brain

5.2. Tonic labyrinthine reflex (TLR):¶

From about 32 weeks to about 3 - 4 months of age

Task:

• Adaptation of the space conditions in the womb
• Prepares baby for correct handling of gravity during the birth process
• Orientation in space
• Supports the handling of gravity and trains muscles and body awareness

Signs of the reflex

• Effects on overall orientation skills, perception of space and time
• Standing is exhausting
• Slow reaction and slow work
• Poor short-term memory

5.3. Spinal galant¶

Approximately from week 20 to around month 9 of life

Task:

• Movement of the child through the birth canal
• Pressure on spinal muscles causes pelvic movement
• Development of sense of balance and hearing

Signs of the reflex:

• Avoiding tight clothing
• Restlessness
• Hyperactivity
• Poor handwriting
• Concentration problems

Others are listed at https://www.adxs.org/de/page/19/1-motorische-symptome-von-adhs, 1.4.2. Persistent (primitive) reflexes (RPR) are some reflexes and their documented effects and excerpted below:

1.4.2.1 Asymmetric tonic neck reflex (ATNR)

*- Right/left weakness (confusing right and left)

• mirror image writing
• Mirror image reading (confusing b and d or p and q)
• Handwriting
• Child compensates for the pressure on the pen, which impairs handwriting
• spidery
• Very narrow and small
• Difficulties keeping to lines
• Turning the page while writing
• Reclined sitting posture
• Visual perception and fixation disorders87
• Coordination disorder, especially when crossing the midline of the body (movement, posture and writing disorders)87
• Balance problems90
• when the head is turned to the side
• Learning to ride a bike more difficult
• Dyslexia
• Reading and spelling difficulties
• Difficulties in math*

1.4.2.2 Symmetrical tonic neck reflex (STNR)

*- ADHD symptoms

• Hyperactivity
• Attention problems
• Concentration problems
• Organizational problems
• poorly developed sense of time
• Sequence problems (for practical requirements or more complex work instructions)
• Motor problems85
• Difficult rhythmically coordinated movements
• Fluid affected by movements that are100
• require vertical eye movement
• Require control of sitting posture
• Reading and writing posture impaired
• Coordination of upper and lower body movements made difficult, e.g. swimming, rolling
  forwards/backwards
• Push-ups are more difficult because stretching the arms triggers the bend reflex in the legs
• Catching balls made more difficult by
• Lack of eye-hand coordination
• Difficulty estimating distance and time
• Muscle tone
• weak
• stiffened
• Balance problems
• Poor posture*

1.4.2.3 Moro reflex

An excessive, persistent Moro reaction can trigger excessive startle reactions.
This is more common in people who have an increased openness to stimuli, as is typical with ADHD.
An individual case reports of an 18-year-old woman in whom a massive anxiety and panic disorder correlated with a still fully developed Moro reflex. Treatment to regress the Moro reflex showed an improvement in the anxiety symptoms

5. Effectiveness of reflex integration therapy¶

A randomized, double-blind, placebo-controlled study⁴ used a specific movement program that replicated primary reflex movements in primary school children with reading problems.
The intervention group showed a significant decrease in persistent ATNR activity and improvements in reading parameters compared to placebo/control groups. This is one of the few high quality controlled trials in this field.

In recent years, systematic reviews, cross-sectional studies, case reports and smaller intervention studies have appeared indicating a relationship between RPR and ADHD/reading difficulties and possible improvements after motor-oriented programs. Some authors report measurable improvements after 8 to 12-week motor programs, TENS-based interventions, or functional neurological approaches. Other studies show only minor or selective effects. Overall, the effects are often moderate, participant- and outcome-specific.⁵⁶⁷

6. Further reading¶

Article on measurement tools and newer interventions (2025): Description of new scales and pilot interventions. Heterogeneity and the need for standardization are emphasized.⁸

Blomberg, Lind (1986): Movements that heal. VAK Publishers Ltd