Primitive Reflex

Unlocking Potential: How Occupational Therapists Succeed with Primitive Reflex Exercises

Posted onAuthorBarbara B.

Primitive reflexes, the involuntary motor responses present at birth, play a crucial role in early development. These reflexes typically integrate—or fade—as a child matures, making way for more advanced motor and cognitive skills. However, when primitive reflexes persist beyond infancy, they can interfere with a child’s ability to learn, focus, and coordinate their body. Occupational therapists (OTs) across the world are seeing remarkable success by incorporating primitive reflex integration exercises into therapy, helping children overcome developmental delays and reach their full potential.

What Are Primitive Reflexes?

Primitive reflexes include responses such as the Moro (startle) reflex, ATNR (asymmetrical tonic neck reflex), and the Palmar grasp reflex. While these automatic movements are essential for survival and early development, their continued presence can hinder everyday functioning in older children. Unintegrated reflexes may manifest as poor posture, fidgeting, difficulty with handwriting, clumsiness, or struggles with reading and attention.

The Role of Occupational Therapy

Occupational therapists specialize in helping individuals participate in everyday activities through therapeutic techniques. For children, this often involves supporting sensory processing, fine motor skills, and executive functioning. In recent years, many OTs have adopted reflex integration exercises—structured movement sequences that mimic early developmental patterns—to assist children whose primitive reflexes remain active.

These exercises aim to “complete” the developmental processes that should have naturally occurred in infancy. The therapy is non-invasive and movement-based, often designed as playful, rhythmic activities tailored to a child’s age and developmental level.

Evidence of Success

While research into primitive reflex integration is ongoing, clinical outcomes have been compelling. Many OTs report improvements in:

  • Attention and focus: Children who were once easily distracted often show greater ability to sit still and follow instructions.

  • Handwriting and motor control: Reflex integration can help refine fine motor skills by reducing the neurological interference that impacts hand stability.

  • Emotional regulation: Some children exhibit decreased anxiety and better self-control after consistent use of these exercises.

  • Academic performance: Better motor planning and attention can translate into improved reading fluency, comprehension, and math skills.

Case studies and parent testimonials frequently highlight dramatic improvements after just a few months of consistent therapy. For instance, a child struggling with dysgraphia may begin writing legibly after integrating the Palmar reflex, or a child with ADHD symptoms might show better classroom behavior following Moro reflex work.

Why It Matters

The success of primitive reflex exercises underscores the importance of looking at neurodevelopment through a holistic lens. By addressing foundational brain and body connections, occupational therapists can intervene where traditional behavioral or educational approaches might fall short.

Moreover, this method offers a hopeful pathway for children with sensory processing disorders, autism, ADHD, and learning disabilities—conditions often linked with retained primitive reflexes.

Moving Forward

While not every child with developmental challenges has retained reflexes, screening for them is becoming more common in occupational therapy assessments. Tools like the Rhythmic Movement Training (RMT) and the Masgutova Neurosensorimotor Reflex Integration (MNRI) method are gaining traction among therapists seeking effective, science-informed solutions.

Parents and educators working with OTs are encouraged to support consistency at home, where reflex exercises can be incorporated into play or bedtime routines for maximum benefit.

Conclusion

Primitive reflex integration is not a magic bullet, but for many children, it’s a missing piece of the puzzle. Through targeted, consistent work, occupational therapists are helping children rewire the most fundamental layers of their nervous system—laying the groundwork for greater independence, confidence, and success.

Why Do Primitive Reflexes Reappear After Integration

Posted onAuthorBarbara B.

Many people wonder why some primitive reflexes seem to return or even intensify before improving during or after integration therapies. This question intrigued me as well, so I conducted research to better understand the phenomenon. I had previously observed this firsthand with my daughter, who showed no signs of the Landau reflex until I progressed further in integrating her Moro reflex. Then, the Landau reflex became more apparent and noticeable.

Understanding Reflex Reintegration

To gain deeper insights, I consulted Dr. Robert Melillo, a leading expert in primitive reflex integration with over 25 years of experience. His work, supported by multiple studies and shed light on why these reflexes might appear more pronounced before they diminished.

Children with persistent primitive reflexes often have lower sensory awareness and diminished body perception. Initially, physical or auditory stimuli used to test reflex responses may elicit little reaction. However, as integration progresses and neurological connections strengthen, their response to stimulus increases. This heightened response is sometimes misinterpreted as a worsening of the reflex, leading some to prematurely discontinue therapy. In reality, this reaction often indicates that the integration exercises are effectively enhancing brain function. Stopping therapy too soon may prevent full reflex integration.

 

primitive reflexes return after integration

A Key Exception: Incorrect Hemispheric Integration

In some cases, a reflex may genuinely strengthen if hemispheric integration is applied incorrectly. Hemispheric integration involves stimulating one side of the brain to support an underactive hemisphere. If a clinician misidentifies the weaker side and stimulates the wrong hemisphere, the reflex can become more pronounced. However, when the correct hemisphere is stimulated, the reflex response should diminish almost immediately. Dr. Melillo has demonstrated this principle in a compelling YouTube video recorded during one of his conferences.

Why Do Reflexes Reappear After Full Integration?

Some individuals experience the reappearance of primitive reflexes even after completing integration therapy. Several factors may contribute to this:

  1. Incomplete Integration: Reflexes may appear to be fully integrated but may not have been completely resolved. Some parents halt therapy too soon after noticing a reduction in reflex activity. To ensure full integration, exercises should continue for at least a month after no reflex signs are present.

  2. Developmental Changes: The overall neurological health of an individual can influence reflex activity. Conditions such as ADHD, autism, ADD, or sensory processing disorders may indicate broader neurological imbalances. For example, my daughter, who had ADHD, thrived for years after integration but experienced some regression as she entered puberty. Reintroducing reflex integration and hemispheric exercises helped her regain neurological balance. Brain maturation can sometimes lead to slight shifts in neural connectivity, necessitating follow-up treatments.

  3. Neurological Degeneration or Trauma: In aome cases, brain degeneration or damage may cause the return of primitive reflexes. This can occur due to stroke, dementia, seizure disorders, or degenerative brain diseases. Additionally, physical trauma or psychological stress, such as injury or abuse, may trigger reflex reactivation.

Conclusion

In most cases, properly integrated reflexes should not reappear. If a clinician frequently encounters recurring reflexes, extending the therapy duration and employing varied testing methods may be beneficial. Understanding the underlying causes of reflex reactivation ensures that integration therapies are more effective and long-lasting.

Retained Tonic Labyrinthine Reflex

Primitive Reflex Testing

Tonic Labyrinthine Reflex (TLR) is the foundation for head control. Baby needs it to roll, crawl, and later stand and walk. It develops in the womb and continues past the first year of life. It is usually integrated by 3 years. If not, it can cause problems.

When a baby is laying back and the head is tilted back, the baby will stiffen the legs, bend elbows, make fists or curled fingers, and the toes will point. This is normal for an infant. As the baby matures, starts to walk and gains control over the large muscles, the Tonic Labyrinthine Reflex will integrate and disappear.

If the Tonic Labyrinthine Reflex does not integrate, the functions that develop after do not organize correctly.

Retained Tonic Labyrinthine Reflex Symptoms 

  • Poor balance and spatial awareness
  • Tense muscles and toe walking
  • Difficulty holding still and concentrating
  • Muscle tone issues
  • Poor posture
  • Difficulty paying attention when head is down (at a desk or reading)
  • Dyspraxia
  • Poor sense of rhythm
  • Gets motion sickness easily
  • Prefers to walk on toes
  • Speech and Auditory difficulty
  • Spatial issues
  • Bumps into things and people more than normal
  • Even if they don’t display any of these symptoms, it is a good idea to do the quick test on them, as there may be other functions that are affected by it that are still unknown.

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Studies

Check out the latest studies on Primitive Reflex Integration. My favorite is the newest study by Harvard. 

Tonic Labyrinthine Reflex Tests

This is similar to the Landau Reflex Exercise, except with feet up. Have the child lie on their stomach with arms down to the side and legs straight. Have the child raise his head, legs, and arms off the floor while keeping arms and legs straight.

Retained TLR Learning Disability

If they cannot keep both legs straight and hands up, the reflex is most likely still present. Exercises needed!

Retained Tonic Labyrinthine Reflex

 

Another test to check for retained Tonic Labyrinthine Reflex involves tapping the knees with the opposite hand. Have the child stand. Ask them to lift one knee and tap it with the opposite hand. Then lift the other knee and tap it with the opposite hand. If this is difficult for them, the Tonic Labyrinthine Reflex is most likely still present. Exercises needed!

Tonic Labrynthine Reflex Exercises

Retained Spinal Galant Reflex

Primitive Reflex Testing

The Spinal Galant Reflex develops in the womb at about 20 weeks gestation. It helps the baby develop the Vestibular System. In Infancy, the Spinal Galant Reflex, along with the Asymmetrical Tonic Neck Reflex (ATNR), are necessary to help the unborn infant descend down the birth canal. It also helps the baby urinate after birth. You will see the reflex in an infant if you gently stroke down one side of the lower part of the spine. The baby’s arms and legs will sway toward the direction of the stroke almost like being ticklish. If both sides of the spine are stroked at the same time it induces urination. This is normal. However, the Spinal Galant Reflex should be gone by 3-9 months as higher muscle control develops. This is called ‘integrating’. If not properly integrated, it can cause many subtle issues.

Studies

Check out the latest studies on Primitive Reflex Integration. My favorite is the newest ADHD study by Harvard Univ. done on the Melillo Method which incorporates Primitive Reflex Integration. 

Retained Spinal Galant Reflex Symptoms:

  • Fidgety, Hyper Activity, especially if clothes or chair brush their back.
  • If active down only one side, can cause scoliosis, rotated pelvis and lower back pain.
  • Poor concentration
  • Attention problems
  • Bedwetting long after potty training
  • Short term memory issues
  • Fidgeting and wiggly “ants in the pants”
  • Posture problems
  • Hip rotation on one side/possibly scoliosis
  • Low endurance
  • Chronic digestion problems
  • Even if they don’t display any of these symptoms, it is a good idea to do the quick test on them, as there may be other functions that are affected by it that are still unknown.

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Retained Symmetrical Tonic Neck Reflex (STNR)

Primitive Reflex Testing

The Symmetrical Tonic Neck Reflex is present at birth then disappears until about 6 to 9 months. It reappears for a few months to assist in learning to crawl.

You will notice it in a baby if you move their chin down toward their chest. The knees will bend. If you move the head up toward the back, the legs will straighten. Do not confuse this with the Landau Reflex. They are two separate reflexes.

If this does not integrate and disappear by about 11 months, it can cause motor learning and behavior disorders. Simple exercises can solve the problem.

Retained Symmetrical Tonic Neck Reflex Symptoms

  • Poor posture standing
  • Sits with slumpy posture
  • Low muscle tone
  • Ape-like walk
  • Problems with attention especially in stressful situations
  • Vision accommodation and tracking problems
  • Difficulty learning to swim
  • Difficulty reading
  • Dyslexia
  • Usually skips crawling
  • Sits with legs in a W position
  • ADD
  • ADHD
  • Hyper activity or fidgety
  • Poor hand eye coordination
  • Problems looking between near and far sighted objects, like copying from a chalkboard
  • Sloppy eater
  • Rotated Pelvis
  • Even if they don’t display any of these symptoms, it is a good idea to do the quick test on them, as there may be other functions that are affected by it that are still unknown. 

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Studies

Check out the latest studies on Primitive Reflex Integration. My favorite is the newest study by Harvard.

Symmetrical Tonic Neck Reflex Test

Have the child get down on their hands and knees, with neck straight and their body slightly forward enough to put weight over their hands. Now ask the child to lower the head bringing the chin toward the chest for a count of 7 seconds, then raise head up toward their back. Do this several times.

Retained Symmetrical Tonic Neck Reflex test

 

 

Retained Symmetrical Tonic Neck Reflex

Look For:

Back twitching. Back trying to arch up when head is up. Arms bending or body weight shifting back toward their legs when head goes up. If any of these occur the reflex is most likely still present. Exercise needed! 

Symetrical Tonic Neck Reflex Exercises

Retained Palmar Reflex or Grasp Reflex

Primitive Reflex Testing

The Palmar Reflex aka Grasp Reflex is seen when an infant grips around an object that touches their palm. This is normal and helps the baby learn to grip and hang on to things with their hands. The Palmar Reflex develops in the third month of gestation and should disappear at around 3-6 months of age as they gain hand control. It is needed for hand-eye coordination, proper vision, and direction/distance judgement.  If it isn’t properly integrated it can contribute to an array of problems.

 Retained Palmar Reflex Symptoms

  • Poor handwriting
  • Poor pencil grip
  • Poor fine muscle control
  • Poor dexterity
  • Poor fine motor skills
  • Poor vision coordination
  • Slumpy posture when using hands
  • Back aches when sitting
  • Sticks tongue out when using hands
  • Poor pencil grip
  • Poor ability to put thoughts to paper
  • Dysgraphia
  • Speech and language problems
  • Anger control issues
  • Even if they don’t display any of these symptoms, it is a good idea to do the quick test on them, as there may be other functions that are affected by it that are still unknown.

. Read More …

Retained Landau Reflex

Primitive Reflex Testing

 

The Landau Reflex is one that develops a few months after birth and remains until about 12 months old. It is useful in helping the child develop posture. If the Landau Reflex does not integrate (go away), it can cause posture, motor, and memory issues later on.

Symptoms of Retained Landau Reflex

  • Low Muscle Tone
  • Poor Posture
  • Poor Motor Development
  • Short Term Memory Difficulty.
  • Tension in the back of legs, toe walker.
  • Lack of Stimulation in the pre frontal cortex causing attention, organization and concentration problems.
  • Weak upper body
  • Difficulty swimming the breast stroke.
  • Struggles to do a summersault. Knees buckle when head tucks under.
  • Even if they don’t display any of these symptoms, it is a good idea to do the quick test on them, as there may be other functions that are affected by it that are still unknown.

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Retained Asymmetrical Tonic Neck Reflex (ATNR)

Primitive Reflex Testing

The Asymmetrical Tonic Neck Reflex, like the Spinal Gallant Reflex (SGR), helps the infant do their part of emergence through the birth canal and learn hand and eye control. You will notice it in an infant if you gently turn their head to one side. The arm and leg on the same side will straighten, while the arm and leg on the opposite side will flex. The Asymmetrical Tonic Neck Reflex develops at 18 weeks after conception and should be integrated and gone by about 6 months after birth. If not, it can cause motor issues, reading, math, and other learning problems.

The connection between the hand and eyes help develop depth perception and eye-hand coordination. If the ATNR is retained the child will have difficulty walking normally when turning his head or problems writing and reading when head movement is needed, which is always. For example, writing while looking back and forth to the blackboard or a book.

Asymmetrical Tonic Neck Reflex Symptoms

  • Reading Difficulties
  • Dyslexia
  • Hand eye coordination problems
  • Awkward walk or gait
  • Difficulty in school
  • Immature handwriting
  • Difficulty in sports
  • Math and reading issues
  • Poor balance
  • Eye, ear, foot, and hand dominance will not be on the same side
  • Difficulty in things that require crossing over the midline of the body
  • Poor depth perception
  • Shoulder, neck and hip problems
  • Even if they don’t display any of these symptoms, it is a good idea to do the quick test on them, as there may be other functions that are affected by it that are still unknown.

Loading...

Studies

Check out the latest studies on Primitive Reflex Integration. My favorite is the newest study by Harvard.

Asymmetrical Tonic Neck Reflex Tests

Test 1:  Have the child stand facing you with arms and hands straight out in front of them. Ask the child to keep that position while turning their head to one side and then to the other. They should be able to move their head only. Look for elbows to bend or shoulders to turn in the direction of the head. If so, their neck movements are still associated with their shoulders and the reflex is most likely present. Exercises are needed.

Retained Asymmetrical Tonic Neck Reflex Retained ATNR

 

 

Test 2:  You can also have them get down on their hands and knees like a “kitty” with their head straight out and face toward the floor. Ask them to look to one side then to the other side, keeping their neck and arms straight. When their head is turned to the side, look for elbows to bend or the body to shift from one side to the other. If so neck and shoulder movement is still connected. The reflex is most likely present.

Retained Asymmetrical Tonic Neck Reflex 2 Retained ATNR

Asymmetrical Tonic Neck Reflex Exercises