Primitive Reflex Integration Case Studies

OT sees improvements in attention, handwriting, balance, and social skills

This young boy with ADHD had poor letter formation and spacing, challenges with posture and stamina, general dysregulation, and anxiety around peers. See how reflex integration and rhythmic movements from the Brain and Sensory Foundations course helped with these as well as other issues.

Submitted by Caroline Szewc, Occupational Therapist

Liam is an 8-year-old second-grade student diagnosed with ADHD who attends a general education classroom. He presents with difficulties in postural control and core strength, handwriting, social anxiety, and attention. He fatigues quickly during tabletop tasks and often slouches or rests his head on the desk. His handwriting is inconsistent, with poor letter formation and spacing, and he frequently avoids writing tasks. He struggles to maintain focus in the classroom and requires frequent redirection from his teacher. Per teacher and parent report, Liam also demonstrates difficulty initiating peer interactions.

After screening for reflexes, Liam presented with retained Moro, Tonic Labyrinthine Reflex [TLR], and Asymmetrical Tonic Neck Reflex [ATNR]. I decided to focus on integrating these reflexes to improve postural stability, attention, social anxiety, bilateral coordination, and fine motor/visual motor participation in the classroom.

I chose to begin sessions with the Brain Tune-Up [from the Brain and Sensory Foundations course] as a warm-up. We focused on moving slowly in order to calm his nervous system, as Liam tends to move very quickly. After trialing all rhythmic movements [from the Brain and Sensory Foundations course], he appeared to prefer rhythmic movements 1A and 2A. I chose to focus on these movements to support nervous system regulation and prepare him for reflex integration.

Initially, Liam found both the Brain Tune-Up and rhythmic movements challenging. He struggled to cross midline during cross crawls, and during rhythmic movements he had difficulty engaging in rhythmic head movements. Music helped support his ability to nod his head along with the movements. After three sessions, he became more comfortable and began initiating the movements independently. After completing the rhythmic movements each session, Liam was noticeably calmer and more engaged during our sessions.

TLR and ATNR integration activities were gradually introduced through play and movement activities [from the Brain and Sensory Foundations course]. At first, Liam struggled to maintain positions and frequently attempted to rush through activities. I had to emphasize slowing down and breaking the movements into smaller steps so he could perform them successfully. Over time, his endurance improved, and he was able to maintain positions for longer periods. After about four weeks, I noticed improvements in his balance and overall body awareness. He was able to move more slowly and with greater control during the Brain Tune-Up.

Liam’s teacher reported increased attention during lessons and fewer requests for movement breaks. She also noted that he began sitting more upright at his desk and demonstrated improved tolerance for writing tasks. His handwriting was more legible, and he no longer seemed to mind writing, whereas previously he actively avoided it.

We also worked through the 5-Step Balance Process [from the Brain and Sensory Foundations course] together. Initially, Liam found it difficult to open up, but after a few sessions we were able to discuss goals. Liam’s stated goal was to feel calm around other kids.

Following the 5-Step Balance Process, Liam demonstrated improved posture, reduced fidgeting, and increased confidence. He became more willing to face peers and participate in small-group activities. His teacher reported that he was initiating more social interactions and appeared more comfortable around his peers. His parents shared that he was even able to invite a new friend over to his house, which was huge for him!

Sessions were approximately 20–30 minutes long and conducted once per week over a 10-week period. I also sent home exercises and rhythmic movements to support carryover at home.

Working with Liam taught me that physical and emotional regulation are very closely connected. I learned that the right movements can effectively regulate the nervous system, which in turn can significantly calm the mind. The 5-Step Balance Process showed me that acting out goals can build confidence and increase the likelihood of achieving them.

(Edited, emphasis added)