#414 - How to Write Primitive Reflex Goals That Actually Get Approved

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How to Write Primitive Reflex Goals That Actually Get Approved

If you're writing goals for primitive reflex integration, this episode is for you.

In this episode, we break down one of the biggest mistakes therapists make when writing goals for primitive reflex integration and explain how to connect reflex work to meaningful, functional outcomes that matter to families, IEP teams, and insurance providers.

We discuss why reflex integration itself should never be the goal, how retained reflexes can impact skills like handwriting, attention, coordination, regulation, and participation, and how to write goals that focus on the real-life challenges a child is experiencing. 

We also share practical examples of how to connect primitive reflex interventions to functional outcomes that support independence and participation. Whether you're an OT, COTA, PT, or therapist interested in reflex integration, this episode will help you think differently about goal writing, advocacy, and demonstrating the value of the services you provide.

Thanks for listening 🩷 If you work in pediatrics, we'd love to hear from you. What's one goal-writing tip that's helped you better advocate for the kids you support?

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Links

Primitive Reflex Digital Course 

All Things Sensory Podcast Instagram 

Harkla Website 

Harkla YouTube

Harkla Instagram

Harkla Digital Course

How To Write Primitive Reflex Goals That Actually Get Approved

If you've started using primitive reflex integration in your occupational therapy sessions, you've probably asked yourself this question: "How do I write goals that insurance will actually approve?" You're not alone.

This is one of the most common questions we hear from pediatric OTs and COTAs. Maybe you've seen great results using reflex integration activities, but you're worried about how to document them. 

Or maybe you've been told you shouldn't mention primitive reflexes at all because insurance won't cover them. The good news?

You don't have to stop using primitive reflex integration. You just need to shift how you write your goals.

Why "Child Will Integrate The ATNR" Isn't A Good Goal

Let's start with a common example. Imagine your goal says: Child will integrate the ATNR.

It sounds reasonable, right? After all, if the child has a retained ATNR, that's something you're working on during therapy.

But here's the problem. That goal doesn't tell anyone why therapy is needed.

• It doesn't explain what the child is struggling with.

• It doesn't describe how the child's daily life will improve.

• It isn't measuring a meaningful outcome.

Insurance companies, school teams, and parents all want to know the same thing: How is therapy helping this child become more independent? That's what your goals should answer.

Families Aren't Asking For Reflex Integration

Think about the conversations you have with parents. No parent walks into your clinic saying: "I'd really like my child's STNR to integrate."

Instead, they say things like:

• "My child hates handwriting."

• "They can't sit still during homework."

• "They're always falling out of their chair."

• "Getting dressed is a battle every morning."

• "They're anxious on the playground."

Those are the real concerns.

Primitive reflexes may help explain why those challenges are happening, but they're not the problem families are trying to solve. That's why our goals should always come back to function.

Primitive Reflex Integration Is Part Of Your Treatment Plan

Here's where many therapists get stuck. We accidentally write goals that describe our treatment instead of the child's outcome. 

Let's say you're working with a second grader whose handwriting is difficult to read. During your session, you might spend time:

• Crawling through an obstacle course.

• Doing Superman and Popcorn exercises.

• Climbing.

• Wall pushes.

• Crossing midline activities.

• Core strengthening games.

If someone walked into your session, they might wonder: "What does any of this have to do with handwriting?" As occupational therapists, we know those activities are building the underlying skills needed for better handwriting.

You're improving:

• Core strength.

• Postural control.

• Bilateral coordination.

• Visual motor integration.

• Motor planning.

Those activities are incredibly valuable. But they're still interventions, not goals.

Your goal is about what the child will be able to do because of those interventions.

Think Function First

Here's a simple question to ask yourself every time you write a goal: What is this retained reflex making difficult for this child? That question changes everything.

For example, a retained STNR might contribute to:

• Poor posture.

• W-sitting.

• Difficulty sitting at a desk.

• Trouble copying from the board.

• Fatigue during schoolwork.

Instead of writing:

Child will decrease STNR retention.

You could write:

Child will maintain an upright seated posture during a classroom activity for six minutes with no more than two verbal prompts.

See the difference? Now the goal clearly describes what success looks like in the child's everyday life.

And the best part? You can still use all of your favorite reflex integration activities during treatment.

Better Goal Examples

Let's look at a few more examples. Instead of...

Child will integrate the ATNR.

Try:

• Child will copy a five-word sentence from a near-point model using appropriate spacing and letter formation in 4 out of 5 opportunities.

• Child will cross midline during classroom activities without avoiding the task in 80% of opportunities.

Child will decrease STNR retention.

Try:

• Child will maintain an upright seated posture during tabletop work for eight minutes with no more than one verbal cue.

• Child will complete classroom writing activities without lying on the desk in 4 out of 5 opportunities.

Child will integrate the Moro reflex.

Try:

• Child will participate in a new movement activity with minimal signs of distress in 4 out of 5 opportunities.

• Child will independently use two calming strategies during moments of dysregulation.

Child will complete primitive reflex exercises daily.

Try:

• Child will independently put on a jacket using an age-appropriate sequence.

• Child will complete a three-step classroom routine with minimal adult support.

Notice something? 

None of these goals mention primitive reflexes. But every one of them allows you to use primitive reflex integration as part of your intervention plan.

Don't Stop Using What Works

We know documentation can feel frustrating. Sometimes it feels like you're spending almost as much time writing notes as you are treating your clients.

It can also be discouraging when you know an intervention is helping, but you're unsure how to explain its value to insurance. Don't let that stop you.

If reflex integration is helping your clients improve their participation and independence, keep using your clinical reasoning. Just make sure your documentation tells the full story.

Instead of focusing on the reflex itself, focus on:

• What the child struggles with.

• Why those challenges matter.

• How therapy is improving daily life.

• How you'll measure success.

That's what demonstrates medical or educational necessity.

Remember: The Goal Is Independence

At the end of the day, primitive reflexes are just one piece of the puzzle. Our goal has never been to integrate a reflex simply so we can say it happened.

Our goal is helping children participate more fully in their everyday lives.

• Helping them sit comfortably in class.

• Helping them write more easily.

• Helping them play confidently on the playground.

• Helping them get dressed with less frustration.

• Helping them feel successful.

That's why we do what we do.

So the next time you're writing a goal, remember this simple phrase:

The reflex is not the goal. Function is the goal.

When you focus on function, you're doing more than improving your documentation. You're advocating for your clients, communicating your clinical reasoning more clearly, and helping children continue to receive the services they need.

And that's something worth writing great goals for.

BORING, BUT NECESSARY LEGAL DISCLAIMERS

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 & art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views & opinions on how to address common sensory challenges, health related difficulties & 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.

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