Primitive Reflex Integration Case Studies

Autistic boy improves spelling, letter formation, midline crossing, and ability to stay seated

This child with ASD was able to function better in school after receiving neurodevelopmental movements from the Brain and Sensory Foundations course. See how his occupational therapist used rhythmic movements and reflex integration to promote changes in his regulation, attention, writing, coordination, communication, and more.

Submitted by Nina Lechler, Occupational Therapy Assistant

Howard (a pseudonym) is a twelve-year-old boy attending 6th grade in a private school. He was diagnosed with Autism Spectrum Disorder at a young age, after his parents noticed delays in developmental milestones, language, and difficulties with transitions.

Howard’s primary challenges include coping with change, vocal communication, focus, emotional regulation, and sleeping difficulties. Routine disruptions cause him significant anxiety, which leads to repeated questions, stimming, or avoiding situations. Howard’s needs have been highlighted in routines, rigidity, vocal communication, social cognition and executive functioning, emotional regulation, attention, and focus. 

Howard struggles with different sensory needs. His muscle tone is often very high. This results in lots of tension in his muscles and stiffness in his movements. When he walks, he straightens his legs, and he walks on his toes. He finds it difficult to physically relax, which causes difficulty in sitting and performing certain daily tasks. He has an un-integrated Asymmetrical Tonic Neck Reflex (ATNR).

This has further implications for Howard’s posture and postural strength, as sitting for some time can become tiring to him, and he fatigues easily during handwriting activities. This can disengage him during tasks. Howard has auditory sensitivity and dislikes loud noises or unexpected noises, causing him to be dysregulated in environments where noise levels are higher. Howard’s fine motor skills are delayed; he writes with a dynamic 4-finger grasp, and writing is performed cognitively. The movement comes from a fixed arm position rather than an isolated finger, or wrist movement, which amounts to fluctuating pencil pressure and tiredness and loss of concentration. Howard receives twice weekly OT within the school setting to work on his sensory, gross and fine motor skills.

Within his OT setting, we have introduced Howard to the Brain Tune Up [from the Brain and Sensory Foundations course] as a warm-up activity. He does this activity every time he comes into the OT room so as to activate his brain and be calm and peaceful before starting his session, as sometimes he comes to OT highly dysregulated and energetic. Having introduced the Brain Tune-Up as a starting point of the session, I have seen a reduction in his energetic behaviour, being more regulated and able to focus on the activities we start to introduce during his sessions.

For Howard, the rhythmic movements [from the Brain and Sensory Foundations course] were initially very tricky. He struggled to maintain a rhythm or became silly. To help support him with the rhythmic movement, I felt it was important to introduce a rhyme/song, as indicated in the course video. It helped him to focus on the rhythm and feel calmer. I also felt that the movements were quite intense for a while at the start; therefore, we did not practice the movements for very long, only a few minutes. Furthermore, the movement was done passively for the first three weeks, while slowly reducing my help to facilitate the movement. Each week, Howard would come to OT and ask for rhythmic movements. Especially when he felt very dysregulated, he would want me to help him rock him during the movement and do the rhyme with him. I noticed a calmer presence and improvement in self-regulation. Him being able to vocalise that he feels the need to do the movements to calm his body was a big step. It was amazing to see his engagement and progress after a few weeks. When adding isometric activities for Howard’s unintegrated ATNR, he wanted to quickly move through one of the activities, in the prone position. I noticed that the prone position was maybe too difficult, as mentioned in the course session video, and so changed to the supine position. After trying to follow the exact explanations in the video with Howard in his session, he seemed to be able to stay in the position longer.

In discussion with teachers over the few weeks of integrating activities such as the Brain Tune Up, rhythmic movement and ATNR activities, they have noticed a great change in his overall appearance. He can maintain a longer seating position in class without consistently standing up or taking movement breaks. His coordination has improved, as well as his ability to follow midline crossing activities. He has displayed improvement in letter formation and spacing, as well as spelling.

I have worked with Howard for over 7 months in the sensory room, where I have introduced the above-mentioned techniques from the course within each session. Teachers and parents alike have seen Howard progress and see a better focus and stamina in his work. Howard has also started to be proud of his work, especially when doing balancing tasks which were tricky for him and slowing his movements down.

(Edited, emphasis added)