Primitive Reflex Integration Case Studies

Neurodevelopmental movements improve behavior and independence in girl with severe autism

This 14-year-old nonspeaking autistic girl exhibited frequent self-injurious behavior—school staff had resorted to putting boxing gloves on her hands to prevent her from ripping her hair out. After her OT applied movements from the Brain and Sensory Foundations course, her regulation greatly improved and the gloves were no longer needed. She also communicated more, and showed increased independence with routines and toileting.

by Christine Reeds, Occupational Therapist

Gia is a 14-year-old student who has a diagnosis of autism; she is non-speaking. She uses an augmentative communication device and is able to communicate one-word responses to simple questions. Gia may be described as prompt dependent as she does not initiate daily routines or communication and prefers to hold a familiar adults’ hand when walking to different classrooms. When she is upset, she will pull her hair out in chunks. Staff have used boxing gloves to reduce this behavior (it happens several times per day) and giving her things to hold in her hands. These interventions reduce her ability to use her hands for functional tasks because when she isn’t wearing gloves or holding things, she immediately goes for pulling her own hair. Gia cries often and enjoys food and the quiet room.

I chose to do passive Rhythmic Movement #2B [from the Brain and Sensory Foundations course] to start as this movement is easy to implement and comforting to receive passively (does not require motor planning). Gia tolerated this and would request “more” on her “talker." Then I trained staff to add the other rhythmic movements as tolerated. Passive rhythmic movements were chosen to help develop nerve networks in the brainstem, cerebellum, and basal ganglia. These networks help with filtering sensory input, improving focus, problem solving, and regulating emotions.

I initially had to start RM#2b then add 2a, 3, and 4 as I noticed that Gia was not relaxed with RM#1. After these RMs were embedded and tolerated well during her day, I added RM#1 slowly for 5-10 seconds. Gradually, we added more time with the RMs to where she does about 1 minute of each RM in the morning and 1 minute of each RM in the afternoon. During the RM’s Gia’s facial muscles looked more relaxed and she sometimes smiled and requested more on her device when asked if she was all done. She was not able to follow the directions stimulating the reflexes or for isometric activities, so I modified these to use passive stimulation and developmental movements for integration. Gia showed positive signs for TLR [Tonic Labyrinthine Reflex] and ATNR [Asymmetrical Tonic Neck Reflex]. We do a lot of modeling and assisting with the activities. We have also done the rhythmic movement for ATNR integration [from the Brain and Sensory Foundations course].

After implementing the RMs [rhythmic movements] into her daily routine, and doing the reflex integration activities, these are the changes that have been noticed by myself and familiar staff over the course of the school year:

• More relaxed at school, doesn't need to have things in both hands.
• Coming out of her shell, will giggle and seems to enjoy herself more.
• Using her talker more, for example, she will say “I'm thirsty” and is using her talker to follow along with morning meeting, getting better at asking for help.
• She is initiating conversations with familiar adults totally independently and she mastered the locker routine which includes taking her lock off and putting it back on.
• Gia usually “guzzles” the whole bottle of water when she gets it. We have been practicing counting to 3 and stopping. Gia is now drinking it independently, without guzzling and asking for more on her device.
• Communicating more and more: when asked where she was going and she said “bathroom,” sure enough she had gone to the bathroom and needed to be changed.
• She is also using the toilet more: Gia is completing the daily routine of getting off the bus, putting her things away, going into the bathroom and sitting on the toilet all by herself. She is also figuring out that after she washes her hands, she needs to grab her things and come out without prompting.
• Independently logging in to her computer, which is one of her goals.
• Gia no longer has to wear boxing gloves or have items in her hands; she rarely pulls her hair now (from several times per day to 1-2x per week).

I learned that these rhythmic movements are helpful in calming, regulating, improving independence with routines, and communication. Gia and other students in the classroom appeared to enjoy doing the RMs each day as evidenced by requesting for “more” and their facial expressions. I was skeptical about doing the reflex integration stimulation and isometric activities with this student. However, we found the developmental activities to be a more reasonable technique to do with this student. I also found the developmental activities were easier for me to train the paraprofessionals to do with Gia several times per week as I was not able to be at Gia’s particular school every day.

I spent 45 minutes per week with Gia, her special education teacher, and the paraprofessional that works with Gia each day. The paraprofessional did RMs with Gia for 5 minutes in the morning and afternoon at school. The paraprofessional also did the TLR and ATNR activities and stimulation 2-4x per week. I worked with Gia on these October 2024 through May 2025.

(Edited, emphasis added)