Appendix III
Troubleshooting active primitive reflexes

Part Three was partly about the primitive reflexes. Briefly I mentioned was the fact that they don’t always ‘disappear on cue’ and that this can lead to problems in learning, attending and behaving. Seeing if a child has an active primitive reflex and strategies to integrate that reflex form the focus of this appendix.

Finding the information I’ve reproduced here was one of the great professional journeys Mum and I have taken over the last eight years. For many years we had just tested and treated children for two primitive reflexes. Then we came to the Murchison and discovered that more than these two reflexes could be kept past infancy. Once we’d worked this out, we began looking for information on how to treat children who’d kept a swag of primitive reflexes.

It was difficult to find because there was such a valuable market in selling reflex integration programs to parents. Practitioners can charge as much as $6000 per child for a program — and you, the parent, will still be doing the bulk of the work. We were amazed to discover that what should be the birthright of every human is subject to commercial confidentiality clauses. But not all practitioners refused to share. In this appendix you will find the knowledge developed by Australian occupational therapists, teachers and teacher’s aides of the movements and strategies that will help your child.

You might be thinking, ‘But surely the prescribing of movement sequences and carrying out a program will take a professional?’ It definitely does help if you can see a professional to assist with working out what movements and games your child needs. But with waiting lists in excess of two years within the public system, and the high cost of private consultations, this is not something that is accessible to all parents. As for the carrying out of the program, the best results occur when parents work with their own child.

Parents are the better therapists for their own child because of the chemistry of attachment. Just as babies learn better from a secure attachment, so does a child. The ‘feel good’ from having a parent involved means a greater release of oxytocin, and so learning happens faster.

A retained reflex in action

David is a puzzle to his sporty parents. How can he be so different from them? Balancing their way around the outskirts of the oval on the low pine rail fence that surrounds it was a favourite game for them both as children. David, at seven, won’t do it without a parent on either side, holding his hands. His posture is slightly stooped and his muscle tone and endurance are low. He gets carsick even on short journeys.

David’s teacher has expressed concern that David’s bank of sight words is not translating into smooth reading. Not only that, but he can’t pick out words that he should know in a sentence: David has told her that ‘the words keep shifting’. She has noted that his ‘cooped up’ posture seems to be interfering with his ability to do jigsaw puzzles or colour-in. If the pieces or pencils aren’t right in front of him he doesn’t pick them up. She says she has to remind him to ‘take a deep breath’ to get his best performance out of him. That cooped-up posture is contributing to shallow breathing and less oxygen getting to his brain. Finally, his teacher has gently pointed out to his stunned parents that it almost certainly no coincidence that David’s headaches always occur before his physical education class.

What is responsible for David’s difficulties? He has retained the tonic labyrinthine reflex, which babies normally work through in the first months of life during ‘tummy time’. He has kept this reflex because the rented house where he grew up had cold cement floors and rough carpet in the lounge room. As a baby he did not like being on the floor, and his mother, not surprisingly, did not like him being there either.

With the intention of ensuring that he was off the cold floor she kept him in his pram. Later, still wanting to keep him warm but also wanting him to be active, she purchased a walker and a jolly jumper. David spent a great deal of his ‘awake time’ in both pieces of equipment from four months onwards. He walked at 15 months and never crawled. The end result is that, rather than having integrated this reflex in infancy, David is suffering the typical consequences of a strongly retained tonic labyrinthine reflex.

Untreated, David’s difficulties will increase in impact. The absence of the postural reflexes will mean that he doesn’t have the grace of his peers. In fact, he has the kind of awkwardness that increases the likelihood that he will be targeted by bullies. As reading texts get harder and the print smaller, he will battle more and more with reading. All text work, especially mathematics written vertically, will be hard for David.

Looking down for David is accompanied by the sense that he’s about to fall, due again to the action of the reflex, and this is translating into a fear of heights. No little boy wants this, so he has a deep and growing sense of disappointment in himself.

It is important to remember that the persistence of a reflex is not an all-or-nothing thing. At one end of the continuum you have the person with cerebral palsy, at the other the normal adult with a ‘shadow’ of a reflex that is barely detectable by a trained clinician. In fact, most of us have one or two primitive reflexes that persist in a shadow form. It is only the most physically coordinated among us, such as our ballet dancers and elite athletes, who have entirely integrated all their reflexes. But otherwise normal, healthy children can experience negative effects from the retention of a primitive reflex.

Why might a child keep a reflex, apart from having missed movement sequences in infancy? Some children just need to spend longer working towards integrating reflexes than others for genetic reasons. You might like to consider your own school days and see if you can relate to any of the markers listed below also.

In trying to help a child with a retained reflex, bear in mind that reflexes are normally integrated doing something meaningful: achieving a milestone. Movements to help with reflex integration need to be kept as meaningful as possible. There are some people who believe that the movements required need to be carried out ‘exactly right’. Mum and I don’t believe that, because babies aren’t that precise in their movements. It is more important that the movements need to be kept meaningful. The best way to do this is to make them fun.

The ideas for activities are not just for parents, there are growing numbers of teachers who have replaced the Perceptual Motor Program with reflex integration programs in reflection of the fact that more children require ‘earlier’ skills to be addressed. The bad news is that, although children can integrate a retained primitive reflex later in life, it is much harder to do so. It’s easiest for everyone, particularly children, if reflexes are integrated in infancy.

Could my child have an active primitive reflex?

You need to ask:

These are some of the general markers of primitive reflex activity in an older child. Ask yourself:

If you agreed with points in this list, then please keep reading. If you have opened the book here (which is where my friend Cindy says she’d be starting), please consider reading the beginning of Part Three, which is all about how movement normally develops.

Starting with the gatekeepers

In 2003 education researchers at the University of Western Australia asked boys with ADHD to bring a friend without ADHD in to be tested for primitive reflexes. They found that the boys with ADHD had active primitive reflexes. Their friends did not. The researchers also found that if the primitive startle reflex was present, then that child would also have more reflexes. The startle reflex was a gatekeeper to higher development.12 Throughout the book I’ve talked about the startle reflex but I did not mention another, even earlier reflex that may also act as a gatekeeper.

A stressful in-utero environment or birth trauma or some kind of in-utero accident is also considered to potentially lead to children who also keep the precursor to the startle reflex, which is called the fear paralysis reflex. This reflex is simply that ‘freeze’ that occurs in many of us in situations of great terror: although we want desperately to move, we cannot. For many people it is something they only experience in dreams. And, at a guess, it may be something that is ‘retriggered’ as part of panic attacks. It is barely mentioned in the wider research literature, although it is discussed on the internet, and as it is not something I have personally treated it is only getting the briefest of mentions here.

If you have a toddler who faints through holding her breath or seems to suffer occasional ‘paralysis’, you might like to investigate the fear paralysis reflex as a possible cause. (Adults very occasionally report these symptoms too, often coupled with hypersensitivity to sensation.) The fear paralysis reflex has also been suggested as a cause of sudden infant death, and the research reports suggesting this also strongly support recommendations to sleep babies on their backs.13

Sally Goddard, the Irish therapist who remains the most influential writer on the role of primitive reflex activity in learning, also links muteness (inability to speak) to the fear paralysis reflex. There is a treatment path available, so it is certainly something for parents of such children to consider.14 Children who still have a fear paralysis reflex will not have been able to fully develop their primitive startle reflex, so they are one step further back on the journey.

We are going to focus more on the primitive startle reflex as it appears at this present time to be a far more common issue. You might be wondering why children from normal home environments might have a startle reflex retained. The answer to that is not at all clear, but the children that the UWA researchers were testing actually lived around the university, which is very much inhabited by middle-class families. Certainly with no generational poverty.

The strongest piece of connected research reinforces that there is no safe level of drinking in pregnancy. This shows that children whose mothers use alcohol, even at very low levels, both startle abnormally in the womb and for longer afterwards.15 And supporting the idea that it is the startle reflex that contributes to some of the behaviours of disorganised attachment, mothers who drink are more likely to have children showing disorganised attachment.16

This is not to say that all children with ADHD had mothers who drank while pregnant. It has not been researched in humans, but clinicians and non-drinking parents have said to us that they suspect high doses of MSG in takeaway food at the wrong time during pregnancy might have been a factor. In rats similar effects from MSG have certainly been found, and, supporting clinicians’ views that healing is possible, these effects are not necessarily permanent. The rat’s development is very delayed, but not permanently damaged.17

If your child has a fear paralysis reflex she is likely to have difficulties with the startle and all other primitive reflexes. If your child has a startle reflex, then it is most likely she will also have retained most other primitive reflexes.

Identifying and integrating the primitive startle reflex in an older child

As you will see, this profile is very similar to a child with a lack of right brain development, met in the last appendix. Look for:

Parents and teachers always need to consider this as an explanation when a child comes from a home with a history of domestic violence or has lived in a war zone or through a natural disaster.

How can parents and teachers help?

What will help this child cope in the school setting?

The tonic labyrinthine reflex backwards retained

In the classroom there are always children who tip their chair backwards. Some children will be doing it to focus better — the feeling of falling backwards, with its echoes of the Moro, remains highly alerting throughout life. But if a child is always tipping back her chair, then losing control of herself and the chair, you should start suspecting not devilry but an active tonic labyrinthine reflex backwards. If the child has a lot in common with Jane in the following example, then it should be considered the most likely suspect:

Four-year-old Jane is a very busy little girl. She bounces on tippy-toes and wriggles incessantly. She is charming, her verbal skills are excellent and she talks a great deal. The careful observer will note she employs these verbal skills to save her from actually having to ‘do’ very much. Her dad calls her his Muppet-Puppet and that is simply because, from early on, Jane has reminded him of a puppet. Her movements are jerky and her limbs are a little stiff. As she runs on her toes across the oval it looks for all the world as if someone is rapidly working strings above her. Despite her speed, Jane is not an athletic kid. If something catches her attention when she is running she will ‘trip over her own feet’ and she never seems to get her hands up to protect her face in time. Like David she gets carsick easily. She does not like looking at books or doing puzzles; her parents say that she is their ‘free-range daughter’.

Jane has a retained tonic labyrinthine backwards. Her body is still dominated by the straightening and arching muscles on the back of her torso, so there is a profound imbalance between her front and back muscle compartments. As a baby, Jane learned to roll early to get where she wanted to go, and then began pulling herself into standing. She didn’t sit at all. She was cruising (walking by holding onto furniture) very early and walking at ten months. Not having crawled she hasn’t developed the near vision required for books and puzzles. Whenever she looks up her body extends a little more, her toes straighten and she trips.

Why is this little girl so busy? Our sense of self comes from feeling ourselves to be ‘in our body’ and knowing where we are in space. Jane is never quite sure; the constant ‘tripping’ of the reflex is interfering with her balance sense and there is a mismatch between the visual and balance information she has. Movement, though, provides information through touch receptors, about what is her body and what is not her body. This little girl races through a world that spins disorientatingly around her, constantly moving in an attempt to keep her sense of self intact in an unreliable world.

Does my child have a tonic labyrinthine reflex still in operation?

Remember that children may either have a TLR forwards, where the child has stronger ‘curling up’ than ‘straightening out’ muscles or a TLR backwards, where the reverse is the case. It’s all about an imbalance between the two muscle groups.

Ask yourself:

How can parents and teachers help? Remember that you are seeking to provide the movement sequences that the child missed or didn’t have enough of as a baby:

How do I help a child with an active TLR cope with school?

The asymmetrical tonic neck reflex retained

Donald is six. He is a dear little boy with a cooperative nature. He wants to do well in school. He succeeds pretty well, except for when he must put pencil to paper. He carefully holds the pencil the way he has been taught, tightens his hold into a ‘death grip’ and bends his head over his paper. All sorts of ideas are boiling in his head ready to be translated to paper! But within short order, his hand stretches itself out straight. He lets go of his pencil and looks at his outstretched hand and then his attention switches to out the window where the school principal can be seen, walking across the lawn with visitors.

Luckily, before the principal can notice him looking out the window, Don’s teacher (who understands the activity of the asymmetrical tonic neck reflex) catches his attention and reminds him to use his non-writing hand to hold his book. And as soon as both arms are bent his attention returns to his writing. Unfortunately, he is five minutes behind the other children yet again.

There is a lot of controversy about when the asymmetrical tonic neck reflex should have been integrated by a child — some people saying at six months14 and others in the school years.19 While it may not sound very interesting, this argument underlies a far more controversial topic. By proving that an active ATNR is found in normal children, critics of movement programs seek to rebuff claims that such programs help children succeed in school, particularly with reading.20 Equally, by showing primitive reflex activity in children who have problems in school, researchers hope to promote movement programs.21

Unfortunately, the research from both sides can be contaminated by the fact that these competing sets of researchers often have programs to sell to parents and teachers. I have seen movement programs contribute greatly to improvements in children’s reading, however. I have also found a correlation between the children who are struggling with school and the presence of the ATNR in whole class screens. And there have been a number of studies that support this.14

So how could prescribing movement improve reading skills? I believe that better impulse control and attention (both are critical for the development of a good working memory) happens in part by the child becoming ‘free’ from the constraints of the primitive reflex movements. There is a lot of support for this theory. Research shows that both children with ADHD and those with reading difficulties (often called ‘dyslexia’) show particular movement difficulties.22, 23, 24 For example, if a child still has an active ATNR it keeps both sides of her body doing opposing things. This makes bilateral movement very difficult, and bilateral movement builds the bridge between the right and left sides of the brain. This has huge implications for reading. The bridge between the two hemispheres is called the ‘corpus callosum’, and scientists have found that there are quite clear differences here between the brains of readers and non-readers.24,25 The difference occurs in a part of the corpus callosum which they think connects up with the part of the brain responsible for eye tracking.26

If your child is struggling to read, I believe that, among the other issues (see Appendix V: Troubleshooting reading) you need to consider an active ATNR. Little boys are more likely to retain this reflex; something else for parents of boys to bear in mind.27

Does my child have a retained ATNR?

The way therapists check for an ATNR is to ask the child to go upon all fours, knees bent and fingers and thumbs pointing forward. If the hand is out to the side the child will be ‘locking’ her elbows. Then we explain to the child that we are about to turn her head to the side, and ask her consent to do this. If the elbow on the ‘skull side’ of her head bends, that is the ATNR in action. You might like to check this on your child. Also, ask yourself:

How can parents and teachers help?

How do I help a child with a retained ATNR cope with school?

Children who are still sucking at school

So connected are the hands and mouth that we find that children who still have rooting and suck reflexes also have their involuntary grasp (Palmar) reflex as well. For this reason we have grouped the reflexes together here, because helping to integrate one will help in integrating the others.

Does my child still have a Palmar reflex and rooting/suck reflex?

Ask yourself:

How can parents and teachers help?

The spinal galant retained

This reflex has only the briefest mention in Part Three, to say that baby needs time on her back to integrate this reflex. So what happens if your child has kept it?

Lauren appears to have ‘ants in her pants’. When she’s sitting down, she’s squirming about on her seat. When she’s wearing shorts with a waistband that is a bit tight she also squirms. She drives her teacher mad with her inability to ‘listen with her whole body’. The sitting very still that denotes attentive listening doesn’t seem to be possible for Lauren.

Her walk is a bit unusual, as though she is ‘hitching up’ one hip as she walks. And, although seemingly unconnected to her physical peculiarities, this little girl also has great difficulty remembering. Her memory is so poor that sight words that she knows on Friday have vanished by Monday, much to her distress. She loses maths facts overnight. The continued action of the spinal galant also makes it difficult to develop the mature reflexes required for fluency in movement. Now in Year Four, she’s struggling to master the skills required for sport in upper primary. On top of everything else, she sometimes still wets the bed.

This is an extreme example, but as a clinician I have met two children like Lauren.

One of the interesting aspects of this reflex is the question posed about just why it has such an effect on short-term memory. Does it impact simply by decreasing attention span, which has a negative effect on working memory? Or is there something else going on as well? There is the barest hint in the research reports that the spinal galant may be used by babies in the womb to respond to and remember sounds.14, 28

Does my child have a retained spinal galant reflex?

Therapists ask children (or adults) to go onto hands and knees and then trace down one side of their lower spine with something soft like a feather or a brush. If they wriggle involuntarily to that side, then the reflex is still present. If the reflex hasn’t been found after three ‘strokes’ then it isn’t there.

Also, ask yourself:

How can parents and teachers help?

The symmetrical tonic neck reflex retained

This was the reflex that gave baby a ‘bend at the hips’. Of course, children who bum shuffle or bear crawl or only crawl very briefly haven’t released this reflex. So how does this involuntary movement pattern affect older children?

If they are looking down, their arms bend and their knees straighten. If they are looking up, their arms straighten out and their knees bend. Imagine sitting at a desk. You look up in response to the teacher and your arms straighten, taking your hands from your work. When you look back down at your work, your arms bend but your legs and hips straighten, making sitting on a chair most uncomfortable. These children are consequently extraordinarily restless; being asked to sit and write unleashes an unconquerable urge to wander about the room.

With all the difficulties these children have in sitting and balancing, they often resort to the W-sitting we mentioned earlier. The position is bad for backs, knees and ankles: some long term W-sitters have needed surgery to loosen up ligaments in later life.

The STNR has been explicitly linked to ADHD by some researchers.14 So will a program of movement designed to integrate primitive reflexes such as the STNR help every single child with ADHD? No. It will certainly help some, but only those for whom the primitive reflex is still active.

When Mum and I began working with children many years ago, she would only find about one child who had an active STNR every year or so. It was one of the more unusual findings. In the Murchison where we now work, it is more common than not. And, as children are spending less and less time crawling, it is an increasingly common finding around Australia.

Does my child have an active STNR?

Therapists test for an STNR by asking a child to go upon hands and knees and then bending her head gently up and down. If the child resists the movement or her hips, knees and elbow straighten or flex based on head position, the reflex is still active.

You might also like to ask yourself:

How can parents and teachers help?

This reflex is still best integrated by the same movements used by infants on the way to crawling and by crawling itself.

As each of these different reflexes fits into place — no longer active but lying tame in your child’s brain — she will add the adult reflexes to her movement repertoires. Teachers and parents have found time and time again that these movement patterns really do help their children get ready for learning. (Circus, Brain Gym and the Alexander Technique also contain these same movement elements.)

But remember, just as she did when she was an infant, your child will require lots and lots of these movement experiences for the change to happen. Before starting I recommend you line up 21 consecutive days on which to put in the program. This will help doing the program to become a habit for you and your child. You might see changes in as little as six weeks but my experience is that it takes about 14 months on a program to see permanent change. And when your child has a growth spurt you may find you need to do the exercises again.