July 8, 2022 - ADHD
It all starts with the primitive reflexes, movements that originate in utero or in the weeks after birth and are initiated by the brainstem. The primitive reflexes act as a foundation for more complex eye-body movements and help newborns adjust to the new stimuli they receive in their first weeks and months. Sometimes these primitive reflexes are retained past the time when they would normally be left behind, and this can interfere with a child’s development. In the rest of this book we will learn about treatment strategies, but first, it is important to know about the reflexes and their role in the development of the nervous system.
The primitive reflexes have a protective function, stimulating the newborn to move in response to input from the senses. They help the infant to navigate in a world with gravity, to develop muscle tone, and to build a sense of self in relation to the world. As the reflexes become more integrated and more complex, the baby starts to be able to move intentionally. The reflexes are also key in early brain and visual development, allowing infants to coordinate their eyes with each other,
focus and perceive depth, and begin to identify what they see.
Outgrowing our Primitive Reflexes
Our higher brain centers typically integrate the primitive reflexes by the time the child is 6-12 months old, replacing them with more advanced postural reflexes which control balance, coordination, and sensory-motor development. If the primitive reflexes continue beyond that age, normal development can be impeded, contributing to ASD and other developmental delays. The child may also have problems in other areas, including coordination, balance, energy levels, and the ability to concentrate, socialize, and learn.
Why do some children’s primitive reflexes remain intact, instead of being integrated during the first year after birth? Sometimes the reflex may lose its association with the sensory stimulus that originally triggered it, perhaps because of restraint or fear. A difficulty pregnancy or birth illness, emo- tional trauma, chronic stress, and other problems can cause the reflexes to overreact, creating an environment for muscle tension, hyperactivity, and impulsiveness. And situations that require children to limit their behavior, if they occur frequently, may cause their reflexes to be inhibited. For example, sitting in a car seat for too long can result in motor deprivation. If a parent commands, “Hold still and pay attention!” the baby may manage to inhibit its normal reflexive response.
If these over- reactions and inhibitions become habitual, muscle tension from the uncompleted movements remains in the body, and there can be consequences for the child’s development. A non-integrated grasp reflex results in poor pencil grip. A non-integrated righting reflex causes confusion with right-left body orientation. A non- integrated palmar reflex interferes with oral motor control.
When the primitive reflexes are unintegrated, our bodies store accumulated tension in the nervous, visual and vestibular systems. This stored tension puts us on continual hyper-alert, in an ongoing fight-flight-freeze reaction. The survival patterning becomes imbedded and habitual and, ultimately, can interfere with our functioning in arenas ranging from movement to information processing to relationships to others.
Our primitive reflexes are fundamental building blocks for both motor and cognitive development. When the reflexes have been integrated properly, a child’s movements reveal physical and emotional intelligence. When the primitive reflexes are retained, however, the child’s motor skill development may be delayed or faulty. For a child with retained primitive reflexes, every task is like trying to walk down the street with a 40-pound backpack – everything is harder, from balance to concentrating
Retained reflexes can even result in vision problems: our eyes are one of the major ways we connect to the world, and they often store tension created by an imbedded fight-flight-freeze response. In my opinion, this is at least a partial cause of almost all eye problems.
Each primitive reflex is a specific movement with a specific purpose. Each emerges at a particular point in the fetus or infant’s development and is normally integrated at another time, either prenatally or during the year after birth. Some are the earliest survival responses, providing early protection from threat. Some help the fetus to adapt to gravity and motion. Still others are movements that prepare the muscles that will be used during birth, or those that are used for creeping. Later the primitive reflexes prepare the child to track visually copy from the board and play sports.
When these reflexes are retained past the normal time, the child’s development is likely to suffer in predictable ways. Depending on the reflex in question, the problems that result may affect the child’s muscle tone, balance, coordination, sensory-motor processing, biochemistry, energy level, immunity, interpersonal abilities, or ability to tolerate stress.
The child may feel overwhelmed by life, lack the coordination to enjoy physical activities, get sick too easily, have mood swings or panic attacks, or find it hard to concentrate. These problems often result in behavior and learning issues that create difficulties in every aspect of the lives of the children and their families.
Six Primitive Reflexes That Most Affect Vision and Sensory Processing:
The Moro Reflex emerges at 9 weeks in utero, the earliest of the primitive reflexes, and should be integrated by 2-4 months after birth. It is a survival response and can be triggered by noise, light, touch, or a change in position. It turns on the adrenals and stimulates the sympathetic nervous system and appears as a series of rapid movements of the arms upward away from the body. A retained Moro Reflex can cause:
Poor balance and coordination
Visual-motor processing problems
Biochemical and nutritional imbalances. Allergies and decreased immunity, especially ear and throat infection
Low energy, fatigue, mood swings
Terry is a 5-year-old who experiences the world as overwhelming. Social situations are hard for her, and she usually withdraws or manipulates events so that she can feel that she is in control. Terry gets motion sickness very easily, has poor balance, and suffers from asthma, eczema, and frequent ear infections. Her muscles are always tense. She tends to fix her gaze on a single object, blinks excessively, and avoids eye contact.
The Fear Paralysis Reflex also begins to function prenatally, around 35 weeks, and is normally integrated before birth. It says: “I need to withdraw to feel safe,” and appears in utero as movement of the head, neck and body in response to threat. It is thought that this reflex is the first step in learning to cope with stress. A retained Fear Paralysis Reflex can cause:
Fear, anxiety and panic disorders, phobias, insecurity, depression
Low tolerance of stress
Withdrawal, often accompanied by screaming
Elective mutism
Hypersensitivity to sensory information
Aggressive or controlling behavior
John is a ten-year-old who shows underlying anxiety and shallow breathing when sitting in the classroom. He always has difficulty leaving his mom and dad when he goes to school. When they try to comfort him with touch, he pulls away. He seems to be afraid of everything and does not talk very much. He craves attention and sometimes acts out very aggressively.
The Tonic Labyrinthine Reflex first appears at 16 weeks in utero and is gradually inhibited from 4 months, as the infant begins to use the neck muscles to lift its head up and down, up to 3 years after birth. A retained Tonic Labyrinthine Reflex can cause:
Poor balance
Weak muscle tone
Visual motor processing problems
Eddie is a 6-year-old who has many develop- mental delays. His posture is stooped due to poor muscle tone, and he tends to walk on his toes. Eddie hates most physical activities. He gets car sick almost every time he’s in a moving vehicle. He is disorganized and his room is always messy. Eddie is a very poor reader and when he writes, he leans on one hand to hold his head up.
The Spinal Galant Reflex first occurs at 20 weeks in utero and is integrated by 9 months after birth.
It is one of the reflexes that helps the baby to work its way down the birth canal; it also enables the fetus to hear and feel the sound vibrations in the aquatic environment in the womb. A retained Tonic Labyrinthine Reflex can cause:
Bedwetting beyond the age of 5
Irritable bowel syndrome in adults
In school-age children, difficulty sitting still
Need to be in constant motion
Josh is an eight-year-old who is always fidgeting in class and still wets the bed. He has a hip rotation to one side and was diagnosed with an abnormal curvature of the spine. Josh suffers from memory problems, especially with short-term memory, and has hard time concentrating.
The Asymmetrical Tonic Neck Reflex occurs at 18 weeks in utero and is inhibited at 6 months after birth. This reflex moves the fetus’s head from side to side while swinging the arms and the legs, a pattern the fetus eventually uses to “unscrew” itself out of the birth canal. This twisting movement helps develop muscle tone, the vestibular system, and co- ordination of the two sides of the body. A retained Asymmetrical Tonic Neck Reflex can cause:
Problems with balance
Confusion with mid-line and mixed laterality
At 9 years old, Jason still confuses right and left. He tries to do everything with his right side, and when he runs or skips, he moves the arm and leg of the same side together. He loses his balance easily and bumps into objects when he walks or runs. When reading, Jason skips words and letters, so he usually must-read things more than once. He has a hard time expressing his ideas in writing and has terrible handwriting.
The Symmetric Tonic Neck Reflex occurs at 6-9 months after birth and should be integrated at 9-11 months. This reflex helps the infant to rise on hands and knees in preparation for creeping. It is important for visual development: When a child begins to move from one hand to another while creeping, the eyes learn to focus from one side to the other, a skill necessary for reading. A retained The Symmetric Tonic Neck Reflex can cause:
Inability to learn to creep and crawl
Problems with visual development
Reading and learning problems
Marge is a 7-year-old who has been described as “a very clumsy child.”
Despite lessons, she can barely swim. She has difficulty copying from the board and cannot shift her focus from near to far and back very easily.
Marge is a messy eater and has poor posture. She tends to lose her place when reading and confuses right and left. She makes many reversals with her letters.
Final Thoughts…
In 1906, Sir Charles Sherrington, a British neurophysiologist, bacteriologist, and pathologist published The Integrative Action of the Nervous System, describing his theories about reflexes and the autonomic nervous system. Sixty years later, rehabilitation therapists began to make use of Sherrington’s ideas in their therapy practices. The Sherrington model still gives us an important foundation and much-needed insights, but one of its assumptions is that anyone who has not integrated their reflex patterns, including the primitive reflexes, is doomed to be forever tethered to the survival response. Most rehabilitation specialists still use this model.
In the past thirty years, I have worked with thousands of children with developmental and learning delays of many kinds. As I learned more about the survival response, I could see that those who store tension in their nervous, visual, and vestibular systems are likely to have retained their primitive reflexes and, as a result, be caught in an ongoing fight-flight-freeze pattern.
With this new understanding, I realized that I would have to look beyond Sherrington for answers. Stay tuned for what my discovery has been!