Primitive Reflex Integration Case Studies

OT helps client with ADHD and ASD improve his fine motor skills, coordination, and self-esteem

This young boy often refused to write due to fatigue, and had poor self-esteem. See how his therapist used rhythmic movements, reflex integration, and the 5-Step Balance Process to completely change his experience with handwriting, and establish a more positive outlook on life. He also showed improvements in coordination and sensory processing

Submitted by Nina Lechler, Occupational Therapy Assistant (OTA)

Benjamin is a 7-year-old student with a diagnosis of ADHD and Autism Spectrum Disorder. He has multiple unintegrated reflexes, including ATNR, STNR, Spinal Galant, Moro, and Babinski reflexes. He struggles with balance, handwriting, sequencing, and bilateral coordination. In class, he often has difficulty with sensory regulation and finds it hard to maintain a seated position. He frequently seeks out deep pressure and proprioceptive input. Handwriting fatigues him easily, and he often refuses to participate in handwriting activities. Another challenge is his muscle tone; he displays a constant underlying state of tension within the muscles, yet his tone appears low in his trunk and upper extremities.

I have worked with Benjamin over the past seven months as an Occupational Therapy Assistant. During this time, I began incorporating activities from the Brain and Sensory Foundation Program to support reflex integration during our sessions. I noticed that he had a strong reaction to touch and tactile input, especially when stimulating the Spinal Galant and Babinski reflexes. Therefore, in collaboration with the Occupational Therapist, we decided to prioritize the integration of these reflexes first. I introduced isometric activities from the program.

Over time, I observed significant changes. Initially, even approaching Benjamin to stimulate these reflexes was difficult; he would squirm and wiggle away. I introduced the activities gradually. Eventually, I began to notice improvements in his coordination and motor planning. Previously clumsy and uncoordinated, his movements became more fluid and intentional, even when walking or running.

As part of our school OT program, we ask students to set personal goals for the year. Benjamin stated his goals as: focusing, listening to the teacher, learning new things, balancing, writing faster and more neatly, and improving his handwriting overall. It was encouraging to see that he was aware of his difficulties and motivated to improve.

This is why I found the 5-Step Balance Process [from the Brain and Sensory Foundations course] so valuable and motivating. It was beautiful to witness Benjamin’s growth, especially in his ability to state things more positively and recognize his own progress. When I first learned the 5-Step Balance Process, I found it a bit abstract. I practiced it at home, working on my own intentions, before implementing it with students. I felt it was essential to understand it thoroughly, especially to be able to explain it clearly and imaginatively to young children. Fortunately, the OT I work with is also trained in this program, and she guided me through the process.

When I first introduced the 5-Step Balance Process to Benjamin, he found it silly. He often struggles to think positively about himself. If an activity is difficult, he tends to refuse it, saying it’s too hard or avoiding it altogether. I was concerned he might react the same way to the 5-Step Balance Process, but I felt it was important to help him practice self-affirmation and recognize positive changes in himself.

As Benjamin enjoys drawing, to identify a goal we began by having him draw something he found difficult. He drew himself trying to get onto a bolster swing and explained that it was hard because it was "high up and it moves." I wrote on the drawing: “I feel safe and happy when I swing”. After we completed the 5-Step Balance, I asked if he would like to try climbing the swing. While he was still hesitant, we lowered the swing to make it less intimidating, and he was willing to try. That was a great step forward.

The following week, we did another 5-Step Balance Process. This time, his goal was: “I enjoy writing and feel good writing one sentence.” Afterwards, Benjamin asked to write a sentence for his teacher, a remarkable shift.

Over the weeks, I’ve observed that Benjamin experiences less sensory discomfort and reduced tactile defensiveness, especially on his feet. Where he once squirmed away, he now even seems to enjoy reflex stimulation. He has left sessions where we used positive affirmations, feeling happy and relaxed, often saying that the session was fun and made him feel ready for his next class.

To my surprise, just before the summer break, Benjamin came to an OT session and proudly showed me some of his written work. This would have been unthinkable a few months ago, as he was previously very reluctant to share anything related to handwriting due to negative self-perception. Through introducing various reflex integration activities, Brain Tune-Up techniques, and the 5-Step Balance Process, I’ve seen significant improvements not only in Benjamin’s physical abilities but also in his positive self-talk and willingness to engage.

(Edited, emphasis added)