Primitive Reflex Integration Case Studies

Rhythmic Movements and Reflex Integration Help with Speech, Learning, Social Skills, and Coordination

This child with ASD symptoms and echolalia struggled with gross and fine motor skills, attention, fear of failure, and self-regulation. He also exhibited low muscle tone and W-sitting. See how integrating his reflexes resulted in global improvements.

Submitted by Alejandra Miranda, Occupational Therapist

Johnny is a 5-year-old boy whom I began working with in September 2022. He presented with many classic traits of ASD and his main form of communication when I met him was echolalia. The only times Johnny was not echolalic was when he objected to something he did not agree with or want. In those cases, he would simply yell out “No!” Johnny presented with significant delays in self-regulation. He had difficulty listening, understanding and following simple directions and required repetition, extra time and modeling to follow simple instructions. He would get distracted very easily by internal and external stimuli and required constant redirection to stay on task. Johnny also presented with motor planning delays and poor coordination. He had difficulty executing novel, yet very simple physical activities and executed these with poor fluency, poor quality of movement and poor accuracy. His movements were frequently clumsy and awkward and very deliberate. He also presented with a very weak core and weak upper extremities. His preferred way of sitting on the floor was W-sitting.

Johnny used immature grasps to manipulate writing utensils and could not trace or imitate simple shapes without assistance. He used a very weak and loose grasp when using crayons/markers and had very poor control when trying to trace/imitate shapes and/or color. In September, Johnny could not hold a pair of scissors for longer than a few seconds secondary to weak hand muscle strength, weak upper extremity strength, a weak trunk control and poor motor planning skills.

He also had difficulty interacting with peers and initiating these interactions, most likely due to his limited language skills. He rarely sought out peers, preferring to play independently. He gravitated towards the adults more as we were more attuned to his needs and wants.

I saw Johnny three times a week for 30-minute sessions at his school. I started incorporating the P.A.C.E. exercises along with the Rhythmic Movement Program [from the Brain and Sensory Foundations, First Level course] in early October. I had to modify some of the P.A.C.E. exercises and do hand-over-hand assistance at first for the first few sessions because of Johnny’s difficulty executing new activities and because of overall decreased strength and poor coordination. Johnny also could not tolerate the Hook-Ups. I tried re-introducing these several times throughout the year as he made gains but he always expressed discomfort when doing these so I did away with them altogether.

After about the 4th week of doing the P.A.C.E. exercises and Rhythmic Movement Program, Johnny was more organized and focused during the sessions. He was able to follow simple directions independently without the supports initially required. The most noticeable and incredible thing to me was his echolalia had disappeared completely!! He does get speech therapy, as well. However, I have been working with children with ASD for 10 years now and have seen my share of students with echolalia who also receive speech therapy and NONE of my previous students had stopped being echolalic in such a short period of time. This was astounding to me!!

Based on the checklist for long-term effects of retained reflexes, I tested Johnny for TLR [Tonic Labyrinthine Reflex], the hand reflexes, the foot reflexes, STNR [Symmetrical Tonic Neck Reflex], ATNR [Asymmetrical Tonic Neck Reflex], and Spinal Galant Reflex. He tested positive for TLR, Palmar and Babinski Reflexes, STNR, ATNR, and Spinal Galant Reflex. Also based on his extreme self-consciousness and extreme fear of failure (he would frequently initially refuse to try something new) and his poor balance and coordination, poor stamina, being easily distracted and poor core strength, I surmised that his FPR [Fear Paralysis Reflex] and More Reflex were also present.

I began working on integrating Johnny’s TLR, FPR and Moro Reflex first. I used a lot of variations of the Playful Developmental Movements [from the Brain and Sensory Foundations, First Level course]. One of the first things I noticed was he was no longer W-sitting on the floor after the 5th or 6th session. Doing the integration exercises for FPR I feel boosted Johnny’s confidence, and although he was still reluctant, at times, to try new things, he was definitely more frequently willing to explore new activities. Also, working on integrating his Moro Reflex definitely improved Johnny’s coordination and motor planning skills. Although he can still struggle to execute novel tasks to this day, this has significantly improved since the beginning of the year and he is doing things he could not do at all in the beginning, such as jumping jacks or frog jumping.

After working on integrating the above reflexes for about 4 weeks, I introduced integrating the remainder of the reflexes. Because I saw him three times a week for 30-minute sessions, I would try to work on 2-3 reflexes during each session so that I would be addressing each reflex at least once a week.

After about 1 month of doing reflex integration, Johnny was consistently initiating age-appropriate grasps with writing utensils and tweezers. He was using better hand control when tracing and imitating simple shapes and was imitating vertical and horizontal lines, circles and crosses independently with fair accuracy, something he was unable to do when we first started. Johnny was also cutting straight lines across with minimal physical assistance. He also was executing core and upper extremity strengthening activities with better graded control and increased endurance.

Although Johnny’s progress has been slow and steady, if you look at where he was at the beginning of the year until now, it is night and day. He consistently engages in reciprocal conversations; he makes observations or tells me something that happened or that he did at home and he is very vocal about his needs and wants. He initiates interactions with his peers and engages in associative play with them. He is still learning how to share and engage in cooperative play. He can now trace his name with better accuracy. He is cutting simple shapes with minimal to no assistance. He navigates his environment with more confidence and his movements are more fluid. Johnny is also more willing to try something new, something that was challenging for him at the beginning of the year. I feel like, although, he still has a long way to go, he has grown and developed so much over the last 9 months! I no longer see the ASD traits I saw in the beginning of the year and that, to me, is beyond astounding! His mom and teacher have also seen how much Johnny has improved from September until now. His mom relayed she has seen “how much Johnny has developed” this school year.

Since Johnny was so involved in the beginning, I did not expect him to be where he is now. And, although, the rate of progress was much faster in the beginning and then it slowed down, he continues to make progress. Taking into consideration where he started and all the deficits with which he presented, I feel he is definitely the student that made the most progress this year. I feel this is because I incorporated the Rhythmic Movement Program and Reflex Integration [from the Brain and Sensory Foundations, First Level course]. I also really like the fact that I waited to do the Reflex Integration because it allowed me to see how powerful and life-changing the Rhythmic Movement Program is on its own. I feel like this is what helped Johnny’s echolalia, which is something that I know is very hard to treat. I now know what game changers these strategies are and how they can expedite progress and literally change someone’s life. I am a firm believer in this program and will be using it with my students from now on. Thank you for this invaluable course. I have taken so many courses throughout my professional career because I love to learn and love to learn new ways to help my students and I have to say this is the absolutely best course I have ever taken.

(Edited, emphasis added)