PRIMITIVE MOTOR REFLEXES

& THEIR IMPACT ON A CHILD’S FUNCTION ©www.ToolsToGrowOT.com

The inhibition by higher

centers of neurological
A stereotyped control which modify the
What is a response to a What is reflex in such a way that the
reflex?
sensory stimulus.
in t e g rat io n ? pattern of response is no
longer stereotypical.

1 asymmetrical tonic neck reflex (ATNR)

onset integration Importance Significance if
Persists
0-2 4-6
months months  Assists with early  May impair ability to roll,
eye-hand regard. use hands smoothly together
 Provides vestibular at midline
stimulation. Poor visual regard for
stimulus Changes the

object(s) being held.
distribution of  Poor balance.
Rotation of the head. muscle tone.  May impair creeping or
crawling.
Influence of Retained aTNR
response HOW THESE MAY PRESENT In EARLY CHILDHOOD & SCHOOL AGE CHILDREN
 Poor Isolation of Individual  Impaired Scissor Use
 Arm and leg on the “jaw” Body Movements  Impaired Pre-Writing and
side extends.  Poor Sitting Posture Writing
 Arm and leg on the “skull”  Impairments in Gait  Impairments in Reading
side flex.
Attention and Focus
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2 Symmetrical Tonic Neck Reflex (STNR)

onset integration Importance Significance if
Persists
4-6 8 - 12
months months Assists in the
  Interferes with reciprocal
development of creeping.
bilateral patterns of
stimulus body movement.  Impairs dissociation between
the two lower extremities
 Allows child to move up and transitioning between
Flexion and extension of against gravity and quadruped to sitting to
the head (neck) assume quadruped. kneeling to standing and vice
versa.

response Influence of Retained STNR

HOW THESE MAY PRESENT In EARLY CHILDHOOD & SCHOOL AGE CHILDREN
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 With neck flexion the upper extremities will  Decreased Strength and Walking: May predispose


flex and the lower extremities will extend. Balance children to walk up on their
Difficulty Sitting in Chair/Desk toes rather than flat feet
 With neck extension the upper extremities 
Impairs Writing
will extend and the lower extremities will  Floor Sitting: More likely 

flex. to W-Sit Immature Ball Handling Skills



3 tonic labyrinthine-prone & supine (tlr)

onset integration Importance Significance if
Persists
Birth 6 months
 Allows baby’s posture to  Interferes with movement
adapt to that of the head. that requires smooth grading
of flexor and extensor
stimulus 
muscles.
Affects anti-gravity control
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for developing mobility.
Change of
orientation of the
head in space
Influence of Retained tlR
response HOW THESE MAY PRESENT In EARLY CHILDHOOD & SCHOOL AGE CHILDREN
 Walking: May present as extra cautious Writing: Leans down over 

 In prone flexor tone will predominate with  Lacks strong arms necessary to protect the page when writing.
arms flexed by the child’s chest. from trips and falls. Balance: Difficulty with 

 In supine extensor tone will predominate.  Sitting: Slouches while sitting in a chair. stairs, curbs, steps.

4 EXAMPLES OF INTERVENTION POSITIONS

prone Prone Supine Side lying Side sit Long leg sitting
extension flexion

4-point 2-point quadruped squat Tall kneel One-half kneel standing

quadruped

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