Primitive Reflex Integration Case Studies

Neurodevelopmental movements transform social anxiety and selective mutism

This child with ASD and severe anxiety would freeze up during social encounters. He could not initiate conversations, and he often was unable to respond to prompts or questions. His occupational therapist provided neurodevelopmental movements—including innate rhythmic movements and reflex integration—from the Brain and Sensory Foundations course, and saw huge changes in just five sessions: he easily communicated, played, and laughed with others; made eye-contact; and did more tasks independently.

Submitted by S.P., Occupational Therapist

This student, E.E., age 10, has autism and was petrified of talking to peers or staff [selective mutism]. He would freeze if he was requested to initiate a conversation or respond to someone. If greeted by an adult or another student in the hall, he would not respond. He also had difficulty with task initiation. In the general education classroom he would not initiate directives from the teacher. He had a para in class with him but they sat right next to him and ended up being his frontal lobe by telling him everything he needed to do. He had no opportunity for independence. I had them sit further away so he had to at least try to initiate a task but that was so hard for him. Each time I was with him in class there was a topic of the day and each student was to share their idea from the topic with their elbow partner. He never initiated this and would not respond if I or another adult would cue him to talk to his peer.

He was in an OT group with another student and had difficulty staying on topic. He had difficulty responding in a socially appropriate way to the other student. If the other student asked him a question he would not respond. He never initiated a ‘good morning’ or ‘how are you’. He and the other student did not really connect with each other nor were they comfortable with each other. They were polite but the heart connection was not there. They would say, “how are you” and one would answer “I’m fine how are you” and that was about it.

I saw him with the speech therapist as she had social goals and I had the task initiation goal and it worked very well to address both in the same session. It was also good that there was another student with the same goals as it is hard to address social goals when a student is seen independently.

I used the Brain Tune Up each time I saw him to get him ready for reflex integration and rhythmical rocking. After 2 sessions of just doing the Brain Tune Up and rhythmic movements, I did the stimulation and integration for Fear Paralysis Reflex (FPR) as well as the 5-Step Balance process [from the Brain and Sensory Foundations course]. I chose the FPR due to his freeze responses to the many social situations described above. I also chose the 5-Step Balance process to help him with a specific social situation that was set up in the OT/speech session to address the social skill and task initiation goals he had.

Initially he did not like rhythmic rocking. He has long hair which is braided and he did not want his braid messed up. He would stiffen up if he thought it was being affected by the movements but he agreed reluctantly to movement 1A. We tried the others and he did not like any of them initially. After a couple of sessions he relaxed and enjoyed movement 1A and let go of the worry over his braid. He eventually was able to try all of the rhythmical movements and was able to relax with each one. He always responded positively to the Brain Tune Up and had no difficulty with any of the movements.

Both students had a task assigned to them by the speech therapist and me to choose and then talk to a familiar adult and ask them 3 prescribed questions. We had been addressing task initiation since November with not much change. We had practiced many times how to hold a conversation, discussed what frightened them the most about holding conversations and used a written system to help them for several months, prior to using the tools provided in this course. We did the Brain Tune Up and rhythmical movements beforehand, but the conversation did not go well. He froze again and was not able to respond to the adult.

However, the next OT/speech session was absolutely stunning. The speech therapist and I had planned for the two boys to do a conversation with a different familiar adult within the next couple of weeks. I had him do the Brain Tune Up and innate rhythmical rocking 1b. Then we did the 5-Step balance process with the goal statement of: “I am talking back and forth with Ms. H., responding appropriately to her statements and questions.” We incorporated the Fear Paralysis Reflex for the reflex portion of the 5-Step balance. After I did the integrative movements for FPR he asked me to “do it again”. This stunned me as he had not been receptive to positive physical contact from me before. He loved it and wasn’t worried about his braid at all. So, the immediate result was him asking for more, which he had never done before. The more consequential result is discussed below. I then facilitated a 5-Step balance with the same goal for the other student when he came in (who also has ASD and fear with relationships).

After the Brain Tune Up, 5-Step balance and FPR stimulation and integration, these two boys came out of their shells with each other. It was amazing. I have a lot of fun OT stuff in my room and they were doing imaginative play with the kitchen, with cars, interacting back and forth with no “stuffiness/awkwardness”, laughing and talking away. The speech therapist and I had never seen them act like this with each other, or with any other person in the building. We had never seen imaginative, creative play, and it was boisterous. We were absolutely thrilled with their behavior. She and I had to see another group so they were sitting together at the back table talking away, laughing, looking at each other’s computer and I got an actual picture of this student looking directly at the other student with the sweetest smile on his face, completely calm, looking directly at him, which I had never seen him do. It was the most incredible thing I have witnessed.

During the next session I did the 5-Step Balance with him. At the end of the FPR integration he said “you forgot something” so I did one of the activities that we did in the prior session.” He again said, “you forgot something else” and it was the next activity we had done previously. Then he said, “you forgot to look at your book.” He would have never confronted me like that prior to this process.

Unfortunately, we were never able to do the second round of speaking with an adult due to all of the schedule changes and end of the year activities. However, during transitions in the hall and in the general education classroom he started initiating greetings with staff and would look at staff or peers if they initiated contact in some way. In the hall in the mornings, he would initiate a question such as “how are you doing?” and used eye contact during these interactions. He responded to others greeting him, needing no cues to do so, which he had always needed in the past. Other adults in the building made comments on how nice it was to have him respond in a pro social way and be the one to initiate contact. Staying on topic was improved. He also was less fearful of partaking in the morning meetings with the general education class. He would answer a question and use eye contact with a peer, which he had not done all year long. He did more tasks independently and improved with understanding what the teacher was asking the class to do. He also was able to independently problem solve a task that was difficult for him. I was working with him on this problem solving task. He had tried 3 other responses which did not work. I said, is there anything else you can do by using your vision and he was able to be flexible, use the cue and solve the problem.

I never thought in my wildest dreams that EE could initiate a conversation, that he could do reciprocal and creative play with another child and build rapport and a relationship with that student. I also learned that these methods, the reflex stimulation and integration [from the Brain and Sensory Foundations course] can work to help children with many types of concerns, issues and goals.
We did a total of 5 hours over the course of 5 sessions.

(Edited, emphasis added)