Primitive Reflex Integration Case Studies

Help for fine-motor skills, daily headaches, behavior issues, and anxiety

Daily headaches after preschool had this 4-year-old's mother worried. After using tools from the Brain and Sensory Foundations course, his mother assessed his retain reflexes, and worked with him to resolve his headaches—in addition to addressing his social-emotional regulation, sleep issues, anxiety, and fine-motor skills.

Submitted by Kendra Browder, OTR/L

I am an OT, but K is my son who I recently discovered has retained reflexes, so I have been lucky enough to treat him myself after taking this course! K is a typically developing 4-year-old boy who was delivered via c-section after going into distress while I was pushing (he was discovered to be positioned face-up when he was delivered). K is a very smart and sweet boy, but had several struggles that I thought should be resolved by age 4. He had extreme meltdowns (hitting, kicking, screaming, hysteria) and was easily triggered by the least little thing not going his way or being asked to do something. Daily routines, such as getting ready for preschool and bed, were a struggle. He had meltdowns on the way to school because he was scared and didn’t want to leave me. He had 45 minute episodes of hysteria when arriving home from preschool on days there had been a fire alarm.

He always held it together at school and was described as “so serious” by his teachers, but let it all out at home to me. K is a tornado – always running, jumping, climbing, crashing, and pushing toys around. He fell frequently and ran into walls/doorways as if they weren’t there. He could sit to eat or play a game if I asked him to, but shook his head or kicked his legs constantly while sitting. He always knocked his cup over at dinner and could not keep his body on a scooter board in prone. When drawing, he used a gross/fisted grasp and used his right hand on the right side of the page and his left hand on the left side of the page. I was also concerned he wasn’t learning in a group setting because at age 2 before starting preschool, he could count to 10; but after 2 years of preschool, at age 4, he could only count to 12. At one point (after a fall where he hit his head), I noticed one of his eyes turning inward intermittently and when testing tracking, found he was unable to track smoothly through midline. K was also waking up during the night and seemed exhausted in the mornings, even if he stayed in his room all night. He had headaches every day after preschool once he turned 4. I was getting really worried!

Looking back, as a baby he didn’t army crawl, did quadruped crawl, but walked with a push toy at 7 months old and started walking independently at 10 months. He was extremely clingy and would bury his face in my leg if anyone looked at him.

When I assessed him for retained reflexes [from the Brain and Sensory Foundations course], he exhibited Moro [reflex] (and I think FPR [Fear Paralysis Reflex]as well based on his presentation) ATNR [Asymmetrical Tonic Neck Reflex] TLR [Tonic Labyrinthine Reflex], STNR [Symmetrical Tonic Neck Reflex], palmar, plantar, and spinal galant [reflexes]. He did not have head-righting reactions and had decreased protective responses.

Being an OT mom, I had previously tried visual schedules and timers to help with managing expectations to help get through our daily routines of getting ready for school and bedtime, used visuals for choosing calming strategies, and of course all of K’s play was vestibular and proprioceptive input that would have been recommended for a sensory diet. When K was calm, he could tell me a variety of calming strategies (deep breathing, punching pillow, tent with beanbag, etc.), but nothing helped when he was triggered. He was out of control and could not calm himself.

The more I tried to intervene (even showing pictures of calming choices and not otherwise talking to him), the more he escalated. I had to put him in his room so he couldn’t hurt me or his baby brother in his fits of rage. Once I learned about reflex integration treatment through this [Brain and Sensory Foundations] course, I started daily play in prone and then moved to quadruped, daily obstacle courses filled with neurodevelopmental movement activities daily [activities] for Moro, and rhythmic movements for 10 minutes as part of his bedtime routine.

K was resistant initially, as he is to any change in routine, but I persevered. I had him do the [Moro reflex activity] before school every day, the obstacle course after dinner, and rhythmic movements [from the Brain and Sensory Foundations course] before bed. I initially put an “OT” picture on his visual schedule to get him to do the obstacle course, and eventually this became his new routine and he no longer resisted.

I notice that when he is tired, he is extremely dysregulated and cranky. After doing an obstacle course of neurodevelopmental movements, he is happy and more calm/agreeable, and I point this out to him.

K started making notable progress after just 1-2 months, and is a totally different child after 6 months of reflex integration! After the first couple of months, I noticed he was more calm, sitting and building with Legos (instead of only active play), not resistive to daily routines, dressed himself, and didn’t run into walls/door frames anymore.

After the next couple of months he had completely stopped having his “rage episodes” as I called them (no more hitting or kicking!), didn’t knock over his cup anymore, could maintain his body in prone on a scooter board, could track smoothly through midline, and had no more eye deviations or headaches! After six months, he was sleeping through the night, less fatigued, improved frustration tolerance and impulse control, can catch a ball and hit a tossed ball with a bat, can count to 100, and can float on his back in the pool and flip backwards off the bar at gymnastics!

He also has head-righting reactions and protective responses now! K is now known to be right-hand dominant and crosses midline fluently when drawing using a quadruped grasp. Perhaps the most visually impressive progress was his drawing ability. He was unable to perceive anything besides a single shape (e.g., square) when asked to copy a simple drawing (e.g.. a house) – he attempted several times, then just scribbled in frustration, despite the fact that he could easily copy a single square. After 3 months of reflex integration treatment (no copying practice), he copied a recognizable house! [See Before and After drawings above.]

K still gets triggered with sudden transitions or changes, but rather than escalating into hysteria or rage, he can use his words to tell me what is wrong and be redirected to a calming strategy, solving the problem, or allowing me to do [reflex integration activities] if he is scared. In fact, the last time there was a fire alarm at his school, he was just slightly emotional for 10 minutes when we got home (as opposed to 45 minutes of hysteria).

K is now described by his teachers as “a chatterbox” and “so funny”! He is a different child after 6 months of reflex integration treatment, and I am so proud of him for working so hard!

Our whole family is more relaxed due to K becoming more calm and not struggling so much with daily routine activities. K also likes to give me advice for my patients, such as “You should do rhythmic movements and [reflex movements] with your therapy kids, Mommy!”

[Edited for length and clarity; emphasis added]