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Sarah Marshall
M.A. Hons (Psych)
Neuro Developmental Therapist (INPP)
Sound Therapist (JIAS)



  Primitive Reflexes in detail...

Some of the reflexes that might be involved in specific learning difficulties and behavioural problems are noted. More than two reflexes must be present before a diagnosis of Neuro-Developmental Delay is considered.

Asymmetrical Tonic Neck Reflex

The ATNR is activated as a result of turning the head to one side. As the head is turned, the arm and leg on the same side will extend while the opposite limbs bend. The reflex should be inhibited by 6 months of age in the waking state.

If the ATNR remains active in a child at a later age, it can affect:

  • Hand-eye co-ordination - difficulties such as ability to control the arm and hand when writing resulting in an awkward pencil grip or turning of the page
  • What the child writes will generally be of a lesser standard than that which he can produce orally
  • Ability to cross the vertical midline. For example, a right-handed child may find it difficult to write on the left side of the page. Writing may slope one way then the other
  • Visual tracking will be more difficult i.e. the ability of the eyes to move over and back smoothly along a line of print when reading and writing. The child may have to use his finger when reading, or continually lose his place on the page
  • Bilateral integration (differentiated and integrated use of the two sides of the body) will be more difficult
  • Mixed-handedness above 8 years of age


Symmetrical Tonic Neck Reflex ( STNR )

The STNR is present in normal development from circa 8 to 11 months of post-natal life and is a precursor to crawling on the hands and knees.

STNR in extension

STNR in flexion

If it remains present in an older child, it can affect:

  • Integration of upper and lower portions of the body
  • Sitting posture (tendency to slump when sitting at a desk or a table). A conventional learning position is very uncomfortable for this child
  • Poorly developed muscle tone This child is more likely to slump when sitting at a desk or a table, sit on his legs or generally twist and turn resulting in inattention and possibly hyperactivity.
  • Poor hand-eye co-ordination. He will be quite slow at copying tasks


Tonic Labyrinthine Reflex (TLR)

Inhibition of the TLR is a gradual process involving the maturation of other systems. It should be completed by three and a half years of age.

If it persists beyond this time, it is often associated with:

  • A greater tendency to reverse letters or mix them up with similar letters (bd / pq)
  • Sequencing difficulties which can affect the ability to learn off the days of the week, months of the year, maths tables, or remember a sequence of instructions
  • Postural problems resulting in the child with floppy or tight muscles who may have a tendency to walk on his toes
  • History of motion sickness
  • Orientation and spatial difficulties with a direct impact on our concept of time, understanding and giving directions, or maths ability
  • Dislike of Physical Education (PE)
  • Poor balance


The Moro Reflex

The Moro reflex acts as a baby's primitive fight/flight reaction. It should be inhibited by circa 4 months of post-natal life to be replaced by an adult "startle" reflex.

If it persists in the older child, it can be associated with:

  • Hypersensitivity
  • Stimulus bound effect (cannot ignore peripheral stimuli to focus attention on one thing - has to pay attention to everything, very distractible)
  • Sensory overload which could result in child switching off or daydreaming
  • Anxiety
  • Emotional and social immaturity
  • Need to control and manipulate events
  • Physical timidity
  • Allergies and lowered immunity
  • Dislike of change or surprise - poor adaptability


Spinal Galant Reflex

This reflex is present at birth and should be inhibited between 3 and 9 months of post-natal life

If it persists it can affect:

  • Ability to sit still
  • Attention
  • Co-ordination
  • Posture
  • Sometimes associated with bedwetting

What causes NDD? It is unlikely that any single factor can be identified as the cause. It is more likely to be a combination of factors which have led to the persistence of primitive reflexes beyond the normal age of inhibition. Hereditary factors do play a part in abnormal reflexes, as do factors influencing pregnancy , the birth process and infancy.

Reference: Reflexes, Learning and Behaviour, Sally Goddard-Blythe.