Primitive Reflex Integration Case Studies

Young man gets help for anxiety, sensory issues, handwriting challenges, and attention deficits

This college student with chronic anxiety had been biting his nails for years. He experienced a variety of emotional regulation, sensory-motor, and academic issues, with traditional interventions providing little relief. Once his occupational therapist implemented reflex integration, rhythmic movements, and the 5-Step Balance Process from the Brain and Sensory Foundations program, he quickly made tremendous gains—including completely stopping all nail biting!

Submitted by Jenna Duvall, OTR/L, ACN

Alex is a 20-year-old college student with a diagnosis of Anxiety/Depression. Alex has struggled with attention, emotional regulation, and a broad range of motor, behavioral, and sensory challenges since childhood. Previous interventions included occupational therapy and counseling, with limited improvement in self-regulation, fine motor skills, stress management, and adaptability.

Challenges

Learning: Alex has experienced academic difficulties, poor focus, messy handwriting and an awkward pencil grasp.

Social Emotional: He has a history of anxiety and depression with OCD tendencies, a low tolerance for stress, difficulty with change in his routine, and feelings of overwhelm. He has bouts of aggressive behavior, emotional outbursts, and poor eye contact.

Sensory Sensitivities: Alex frequently bites his nails and has a history of vaping. He has a fear of heights and is claustrophobic. He is bothered by tags in his clothing and has always worn shoes that are too large for the purpose of comfort. Alex frequently jiggles his leg when sitting and often fidgets.

Gross Motor Skills: Alex exhibits weak upper extremity strength and an inability to flatten his hands when in a quadruped position, complaining of pain in his hands and wrists. He has difficulty separating hand and mouth movements, for example when writing. Alex has slumped posture in both sitting and standing and often rests his head on his hand when sitting at a desk. During testing for the ATNR, Alex exhibited compensations and reported pain.

Developmental: Alex reports he had difficulty with bladder control well into his teenage years.

A comprehensive neurodevelopmental assessment revealed positive signs for retained primitive reflexes, specifically:

• Moro Reflex
• Fear Paralysis Reflex
• Palmar/Babkin Reflex
• Asymmetrical Tonic Neck Reflex (ATNR)
• Symmetrical Tonic Neck Reflex (STNR)
• Tonic Labyrinthine Reflex (TLR)
• Spinal Galant

Retained reflexes were contributing to Alex’s difficulties with fine motor tasks, upper extremity strength, posture, handwriting, stress response, concentration, emotional regulation, adaptability to change, sensory processing, and behavioral responses.

Integration

1. Reflex Integration Exercises:  Daily movement-based exercises targeting Moro, Fear Paralysis, Palmar/Babkin, ATNR, STNR, and TLR reflexes. Activities included rhythmic movements, and exercises to specifically integrate each reflex [from the Brain and Sensory Foundations course].
2. Implementation of the 5-Step Balance Process [from the Brain and Sensory Foundations course], with the goal to stop biting nails.
3. Sensory Regulation Strategies: Calming techniques such as deep breathing and proprioceptive input were incorporated into Alex’s treatment plan.
4. Academic and Behavioral Accommodations: He was educated in the use of fidget tools, frequent breaks, and visual supports during study sessions
5. Supportive Counseling: Regular check-ins to address anxiety, OCD tendencies, and track progress was also provided.

Progress and Outcomes
After a month of Alex consistently engaging in reflex integration exercises with guidance from an occupational therapist, notable improvements included:

• Improved handwriting, upper extremity strength, and posture
• Reduced startle response, nail biting, and anxiety
• Better attention span and ability to manage stress
• Increased adaptability to changes in routine
• Enhanced emotional regulation and decrease in aggressive outbursts

Conclusion
Alex’s treatment is ongoing, however over the past month, Alex has been performing the Rhythmic movement exercises and reflex integration exercises daily for approximately 20-30 minutes each day. Therapist has reviewed his progress and technique at his weekly sessions over 4 sessions. He will continue with this treatment plan implementing the tools from this course until his reflexes are integrated.

Alex’s use of and results from the 5-Step Balance Process were astonishing. The impact of going through this process improved his ability to reach his goal in a very short period of time. Alex has struggled with nail biting for years, so reducing the urge and actually stopping the behavior after 21 days is remarkable!

(Edited, emphasis added)