#306 - Curious About Primitive Reflexes? Answering Common Questions!

by Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC April 30, 2024

#306 - Curious About Primitive Reflexes? Answering Common Questions!

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Curious About Primitive Reflexes? Answering Common Questions!

We are answering questions that we’ve received inside our primitive reflex digital course, Assessment And Integration Of Primitive Reflexes For Improved Independence In Daily Activities.

One of our favorite things about our digital course is that you can ask questions inside the course, start discussions, and get feedback!

In today’s episode, we talk about how to base a treatment plan and goals around retained primitive reflexes, how to test for reflexes when the child struggles with following instructions, the difference between ADHD and retained primitive reflexes, how to prioritize the reflexes during integration, and more!

Tune in for the full conversation!

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Curious About Primitive Reflexes Answering Common Questions

As a parent or caregiver, it's understandable to have inquiries concerning your child's development. We will address several questions recently posed regarding primitive reflexes.

Is Therapeutic Intervention Needed For Reflexes Scoring One Or Above When Assessing?

When assessing retained primitive reflexes, we use a scoring system from zero to four. A score of zero means the reflex is fully integrated and doesn't impact function, while a four indicates the reflex is significantly retained and affects the body with visible signs. 

For example, if a child scores one on a Moro reflex test and their symptom tracker shows challenges linked to the Moro reflex, it's best to focus therapy on the Moro reflex, even with the low score. This method relies on evaluating the overall situation.

We suggest using our course's primitive reflex screening to assess issues. It's important to use clinical judgment and experience to determine if symptoms are due to this reflex or other problems.

Do you have a list of functional reflex integration goals that insurance often approves?

No, we don't use a one-size-fits-all approach because each child is unique. Our clinic focuses on function-based goals related to a child's daily activities (ADLs and IADLs) to ensure insurance covers our goals and assessments.

Primitive reflex testing is crucial for spotting functional issues noted by the family and understanding their impact on the child. Based on these observations, goals should be incorporated into the treatment plan.

If a child struggles with understanding, how do we guide them when testing the Moro reflex?

We must combine our clinical expertise and a caregiver's checklist to evaluate a child's functionality, mainly their Moro reflex. By refining our approach, we can gain better insights. 

  • Does the child struggle to lie on their back? 
  • Do they show discomfort or anxiety? 
  • Maybe they have issues with Praxis, finding it hard to move their body into certain positions? 

It is important to directly engage with the child, demonstrate behaviors, use visual aids for clear representation, and be aware that the child's reaction may not be accurate due to tension or confusion about expectations. Thus, using checklists, physical evaluations, and interpreting body language and reactions enhances our understanding. 

How Effective Is It To Integrate Reflex When Offering More Than Minimal Help To Ensure Precise Form Accuracy?

This question comes from a course module showing how to perform an integration exercise. We focus on active participation, encouraging children to engage independently instead of guiding them through every step.

If a child struggles with an exercise, it is critical to offer support. The goal is to slowly reduce the assistance as the child regularly practices, improving their coordination and skill.

This approach also helps integrate reflexes. Achieving integration takes daily effort and might take longer for some children than others who learn the concepts more quickly.

How Can You Tell If A Child's Symptoms Suggest Retained Reflexes Or ADHD?

Integrating primitive reflexes involves distinguishing between causation and correlation, aiming to address reflexes linked to potential ADHD symptoms. We will focus on the Symmetrical Tonic Neck Reflex (STNR), the Asymmetrical Tonic Neck Reflex (ATNR), and the Spinal Galant reflex due to their connections to ADHD symptoms, striving for a comprehensive understanding and approach.

While monitoring ADHD symptoms for any signs of improvement, engaging in reflex integration exercises is beneficial. Additionally, we are focusing on improving ocular motor skills, which play a key role in diagnosing ADHD. 

Our goal is to observe significant progress by honing these reflexes. Should challenges persist, we will delve deeper into sensory processing and further explore the possibility of an ADHD diagnosis, ensuring a comprehensive approach.

Remember, ADHD affects executive function, which can't fully operate until primitive reflexes in the lower brainstem integrate. These reflexes block access to higher cognitive functions, especially those controlled by the prefrontal cortex.

What's The Ideal Age For Primitive Reflex Activities?

Research suggests reflexes should be integrated by age three. Exercises for children five and older that enhance physical and bilateral coordination, like the starfish or lizard, may be easier for three and four-year-olds with significant assistance.

Concerns about primitive reflexes often arise around age five, not because they weren't present earlier but because they're more noticeable when a child reaches school age and faces higher expectations. Numerous children who need intervention often go unnoticed, falling through the cracks.

How To Identify If A Child's Facial Movements Stem From A Retained Reflex Or Sensitivity?

When evaluating someone's rooting or palmar reflex, we closely observe their facial expressions or hand movements for reactions. This should be guided by the person's occupational profile, which should be reviewed before the reflex tests to identify sensitivities.

Consider this: a lasting rooting reflex often leads to mouth sensitivity and a preference for certain textures, causing selective eating. Similarly, a persistent palmar grasp reflex shows tactile sensitivity in the hands, showing how reflexes affect sensory experiences. 

Due to their interconnected nature, determining whether reflexes or sensory integration take precedence is challenging. A holistic approach simultaneously addressing sensitivity and reflexes is likely the most effective strategy.

Which groups of people should not be considered for reflex integration?

From previous coursework, we've learned that individuals with cerebral palsy (CP) or neurological differences should avoid undergoing reflex integration. This is because their reflexes cannot integrate fully, relying instead on compensatory strategies for protection. 

Observing a child with cerebral palsy reveals that their reflexes act as a protective mechanism to prevent injury. Despite challenges, using customized techniques and activities for reflex integration offers significant benefits for unique needs.

We use our best clinical judgment to avoid harming the child. When dealing with high-need populations, continuing education to improve understanding is vital. 

Strategies For Building Tolerance To Deep Pressure With A Retained Spinal Galant Reflex?

Allow activities to be child-led

Deep pressure has benefits but actively engaging the child is highly recommended. Encourage dynamic movement by having people navigate a tunnel on their backs or roll a ball against a wall with their backs, promoting active engagement.

Look into other retained reflexes

A retained spinal galant reflex often goes hand in hand with a retained Symmetrical Tonic Neck Reflex (STNR), as both are connected to the hips. Thus, it's best to explore these first since tackling other reflexes might help integrate the spinal galant reflex, either at the same time or after. 

If a child exhibits strong reactions to tactile stimuli, such as a preference for deep pressure, it's essential to incorporate a comprehensive sensory strategy. This may include increased vibratory input, heavy lifting or pushing activities, and oral motor exercises. 

Examine behaviors from a sensory perspective

The Moro Reflex suggests behaviors like ticklishness, laughter, and squirming might be defense mechanisms against discomfort or anxiety in some positions or activities. The link between sensory integration and primitive reflex integration suggests that a holistic approach is vital for understanding and addressing these reactions. 

For A Child With Multiple Retained Reflexes, Should You Prioritize Certain Integration Exercises Or Work On Them Simultaneously?

Typically, we focus on integrating one primitive reflex at a time for several vital reasons. First, integrating a reflex involves creating new neural pathways in the brain, which is inherently challenging. 

This process can cause setbacks in emotional control, pushing the brain and body into unknown areas. The brain tends to resist change, preferring familiar routines to adapting to new tasks. 

For busy families, managing primitive reflex integration can be challenging. Concentrating on a single reflex at a time is more effective than performing one exercise twice daily for a minimum of 30 days rather than addressing multiple reflexes simultaneously.

From a developmental standpoint, addressing these elements in their natural sequence of integration is crucial. Nonetheless, focusing on the reflex that most profoundly impacts functionality can often yield more effective results.

What Does It Mean If A Child Hyperextends And Externally Rotates Their Elbows In A Crawling Position Before Moving Their Head?

Hyperextending means our elbow joints extend in the opposite direction, straightening instead of bending. Externally rotating the elbows means turning the hands outward, away from the body, usually to compensate and reduce the strength needed to maintain a quadruped head position. 

By doing this, we lock our joints, eliminating the need for strength to maintain the position. In the quadruped head position test for evaluating primitive reflexes, inaccurate responses can lead to false negatives. 

This phenomenon often occurs during assessments like the ATNR, where the child turns their head from side to side. If the child's arms are outwardly rotated or their elbows are overextended, they might not achieve elbow flexion, indicating that they may be compensating by locking their joints.

We must carefully guide children in positioning their hands, teaching them to maintain a slight elbow bend, mainly by rotating from the shoulder. This aims to align their elbows neutrally so their middle face each other instead of pointing forward. 

This minor modification helps preserve a natural posture, particularly while positioning a child on all fours for evaluation. Employ visual feedback and demonstrations to convey the appearance and sensation of the correct posture effectively.

How To Teach Children The Value Of Integration Activities?

Explaining the importance of these exercises is key to gaining their commitment. Making clear the reasons behind the exercises helps children understand what is happening, their body's needs, and their feelings. 

It can be characterized as a disconnect between your mind and body, a mismatch that complicates tasks. These exercises aim to fortify the link between your mind and body, enhancing coordination and functionality for smoother operation.

It's important to discuss your child's interests. Show how fun activities can improve strength and speed and how to share these skills with friends, connecting enjoyment with physical fitness.

For therapists, participating in exercises with clients instead of just watching and correcting improves the therapy experience. Turning these activities into fun challenges or games, mainly in morning and evening routines, can create a competitive and enjoyable atmosphere at home.

Explore how these activities boost our cognitive abilities and strengthen our muscles, preparing us for the day, especially for academic work. Physical movement and trying different motions improve the experience, turning it into fun, creative play that promotes better engagement and learning.






While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.

Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We try our best to keep things fair and balanced, in order to help you make the best choice for you.

This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.

Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC
Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC

Rachel Harrington, COTA/l, AC, CPRCS, and Jessica Hill, COTA/L, CPRCS are Harkla's in-house Certified Occupational Therapy Assistants (COTA) and Certified Primitive Reflex Clinical Specialists. They have been working with children for over 6 years in outpatient settings. They specialize in creating easy-to-digest, actionable content that families can use to help their child's progress at home. Jessica and Rachel are the in-house experts, content creators, and podcast hosts at Harkla! To learn more about Jessica and Rachel, visit the Harkla About Us Page. Make sure to listen to their weekly podcast, All Things Sensory by Harkla for actionable, fun advice on child development.

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