Primitive Reflex Integration Case Studies

Submitted by Madison Williams, Occupational Therapist

Chris is a 4-year-old boy who lives with his mother, father and 7-year-old older brother.

"Chris has had a lot of difficulties interacting with others around his age. He has a lot of energy and at times is too rough when playing with other children. He has been “kicked out” of two day cares per his mother’s report. Chris had difficulties with his brother, punching and hitting him often."

He has delays in fine motor and visual motor skills and has difficulties attending to multi-step activities. He is very happy and engaging, however has a hard time focusing on any activity longer than one minute. He had difficulties with all transitions during his day, crying and screaming or refusing to transition between activities and areas with his mother. He also demonstrates delays in speech.

For our first four sessions, I began each session with an obstacle course as he was just too busy to focus. I would have to guide him through the activity every time and I wanted him to get the deep pressure input to help calm him for increased focus later so we could work on fine motor.

At the fourth week I had just learned about the rhythmic movement [from the Brain and Sensory Foundations course] and attempted position 1 with him. He loved the rhythmic movement. Chris asked for me to continue well past the one song. 

We sang four rounds of twinkle twinkle little star and immediately after he took a big breath and looked at me with full attention. He then completed a puzzle prone on the ground. After the first time using rhythmic movements, he would request doing them.

His mother reported that the rest of the day he seemed happier. We continued rhythmic movement and used it at the beginning of the session. Around his sixth week I learned about the FPR [Fear Paralysis Reflex] and Moro reflex 5-step balance process from the Brain and Sensory Foundations course] and began to integrate it into his session because I learned it helped with social issues which he was having difficulties with.

We discussed using soft hands with our friends and brother and he agreed to that goal. We acted out playing with friends/brother, sharing and asking children to play together.

We then did the Fear Paralysis reflex and Moro reflex activities, which he loved. We completed an obstacle course that incorporated a fine motor skills and sharing/taking turns. After that I attempted the re patterning sequence.

He acted out the sharing with friends and using soft hands so much more calmly and seemed to have remembered how to share and use his words to asks to toys. For the next four sessions we continued this work.

At the end of our ten-week series of sessions he was able to calmly walk into our room, he continued to be a happy and excitable boy but was able to stop, look, and listen when prompted by me. He had more resources and tools to assist him with sharing and using soft hands and his mother reported she could now let her older son and Chris play alone together as he was not hitting her elder son as much.

With verbal prompts and reminders he was able to transition between activities and out of the OT room. He also improved with his head nodding with the song during rhythmic movement one which really impressed me!

I learned a lot about the fear response with this child. I believe not being able to speak as well and understand verbal directions might have put him in a very anxious state which led him to become upset with transitions and physical with others. Giving him the rhythmic movement and Fear Paralysis and Moro exercises helped to calm him. The 5 step activity then helped him in a calm state fully process how to interact with others and not to fear the unknown and transitioning.

[Edited for length and clarity; emphasis added]