Sensory processing

Retained Primitive Reflexes: What They Are and What the Evidence Shows

Name: Retained Primitive Reflexes: Real or Debunked? The Evidence
Creator: Dr. Eva Lassey, PT, DPT
Published: 2026-08-06

What the reflex-integration claim rests on, what it does not, and what to ask a provider who offers it.

Expert Reviewed
Evidence Based
Patient Focused

A mother crouching behind her baby, supporting the baby’s chest as the baby takes steps

Written and reviewed by Dr. Eva Lassey, PT, DPT · Last updated October 8, 2026

Primitive reflexes are automatic movement patterns present in infancy that typically fade during the first year or so as the nervous system matures. When they remain active beyond the expected window, they are described as retained or non-integrated. Research does link active primitive reflexes to weaker motor, attention, and academic performance in preschool and school-age children — but that is an association, not an established cause. The American Occupational Therapy Association's Choosing Wisely recommendations advise against using reflex integration programs without clear links to occupational outcomes, noting that a retained reflex does not automatically mean a child has a functional impairment. Screening for reflexes is a reasonable part of a broader assessment; treating their integration as the goal is what the guidance cautions against.

Primitive reflexes are automatic infant movement patterns that normally fade during the first year. When one stays active past that window it is called retained or non-integrated. Research does link persisting reflexes to weaker motor, attention and academic performance — but as an association, not an established cause, and the most defensible reading is that they are a marker of slower neuromotor maturation rather than its mechanism. The American Occupational Therapy Association advises against reflex integration programs without clear links to occupational outcomes, and states that a retained reflex does not by itself mean a child is impaired.⁠¹ Screening reflexes as part of a broader assessment is reasonable; treating their integration as the goal is what the guidance cautions against.

Key takeaways

Primitive reflexes are automatic infant movement patterns that typically fade during the first year as voluntary control develops.
A reflex still readily observable past that window is described as retained or non-integrated.
Research links persisting reflexes to weaker motor, reading and mathematics performance at group level — an association, not a demonstrated cause.⁠⁷
The most defensible reading is that persisting reflexes are a marker of slower neuromotor maturation, not the mechanism producing a child's difficulty.
Intervention evidence is limited and heterogeneous: some studies report improvement, most are small, and several come from researchers with commercial ties to specific programs.⁠⁷
AOTA's Choosing Wisely guidance advises against reflex integration programs without clear links to occupational outcomes.⁠¹
A retained reflex on its own does not mean a child has a functional impairment.⁠¹
The question to ask a provider is what daily-life difficulty is being targeted and how improvement will be measured — not whether the reflex is still present.
Retained primitive reflexes are not debunked: the reflexes are real and can be tested. What has only limited evidence behind it is the claim that integrating them improves reading, attention or behavior.⁠⁷

What are primitive reflexes?

Babies are born with a set of automatic movement patterns that don't require conscious control. They support survival and early development — feeding, grasping, orienting to sound, responding to a sudden change in position. As the nervous system matures and higher brain centers take over voluntary movement, these reflexes typically become less prominent during the first year or so. That process is usually described as integration.

The seven reflexes most often discussed, and when each typically integrates
Reflex	What it is	Typically integrates by⁠⁶
Moro	The startle response — arms fling out and then draw in.	4–6 months
ATNR	The “fencing” posture: when the head turns, the arm on that side extends and the opposite arm bends.	3–4 months
STNR	Head position affects arm and leg flexion or extension.	Not given in this reference
TLR	Head position relative to the body affects muscle tone throughout.	Not given in this reference
Spinal Galant	Touch along one side of the spine produces a hip movement toward that side.	4–6 months
Palmar grasp	Pressure on the palm produces a closing of the fingers.	4–6 months
Rooting and sucking	Turning toward touch near the mouth, and sucking.	Rooting, 4–6 months

That reference gives an integration window for five of these seven. STNR and TLR are named in it but not assigned one.

When one of these remains readily observable well past the expected window, it's described as retained or non-integrated.

Are retained primitive reflexes real?

Yes, and the more useful finding is how ordinary they are.

A study of 35 healthy preschool children aged 4 to 6 found that 65% had primitive reflexes still present at a residual level — and that only 11% had none at all.⁠²

These were typically developing children with no diagnosis. So a screening that finds a persisting reflex in your child has found something real, and something most children of that age also have. That is the single most useful thing to know before deciding what it means.

Two honest caveats about that study. It is small — 35 children — so treat the percentages as an indication rather than a national estimate. And its authors conclude that reflex integration therapy should be introduced for children with low psychomotor skills, which is a conclusion this page does not follow; we cite it for what it measured, not for what it recommends.

The clinical view. Primitive reflexes are a genuine part of a neurological examination. They are testable, their persistence is measurable, and the same study found that the more pronounced the reflex, the lower the child's motor efficiency.⁠² Clinicians who screen them as one component of a broader assessment are doing something defensible.

The skeptical view. What is not supported is the leap from that to a specific retained reflex causing a specific difficulty — the bedwetting, the handwriting, the attention. Those claims are made most confidently by the people selling programs to fix them, and the AOTA guidance further down this page is a direct response to exactly that.⁠¹

Both of those can be true at once, and the disagreement online mostly comes from treating them as if they cannot be.

Is “retained primitive reflexes” debunked?

No — not the reflexes themselves. Primitive reflexes are real, examining them is one of the simplest and most frequently used ways child neurologists assess an infant's nervous system,⁠¹⁷ and faint traces of them are common in children who are developing typically.⁠² What has not held up is the larger claim built on top of them: that a retained reflex is the cause of a child's reading, attention or behavior difficulties, and that exercises to integrate it are the way to fix them. That claim is what the American Occupational Therapy Association's Choosing Wisely recommendation addresses, and it is usually what people mean when they say the idea has been debunked.⁠¹

So the honest answer depends on which claim is meant. Taken one at a time:

Which parts of the retained-reflex idea hold up
The claim	What the evidence shows
Primitive reflexes exist and fade in infancy	Established. They are a standard part of examining a baby's nervous system.⁠¹⁷
Traces of them persist past infancy	Supported, and common in typical development: in one study of healthy 4- to 6-year-olds, only 11% showed none.⁠²
Persisting reflexes go with weaker motor and school skills	Supported as a group-level association, including in children with no diagnosis.⁠⁷
A retained reflex causes a child's reading or attention difficulty	Not established. The researchers behind much of the work linking the ATNR to reading state that reflex persistence cannot be treated as a cause of reading difficulties.⁠¹³
Integration exercises improve reading, attention or schoolwork	Not established. A 2026 review found five intervention studies, most reporting improvement, and judged the evidence as a whole “limited and heterogeneous”.⁠⁷
Every child with a retained reflex needs treatment	Contradicted by AOTA: “the presence of retained reflexes does not necessarily equate to functional impairment”.⁠¹

Calling the whole idea debunked overreaches in the other direction. A reflex examination is a legitimate part of assessing a baby, and an ATNR that a baby cannot move out of is a sign doctors take seriously, as the section on the ATNR below explains.⁠¹⁵ What AOTA advises against is using reflex integration programs without a clear link to what the child needs to be able to do, not noticing a reflex during an assessment.⁠¹

Is primitive reflex integration evidence-based?

Not by the usual standard, which asks for well-controlled studies, more than one of them, showing that an intervention improves what a child can do. A randomized, double-blind trial published in The Lancet in 2000 enrolled 60 children aged 8 to 11 who had reading difficulties and a persisting ATNR, and assigned them to a movement sequence designed to replicate early reflex movements, to non-specific movements, or to no movements. The group given the specific sequence showed a significant fall in its ATNR level; the other two groups did not.⁠⁴ AOTA lists that same trial among the sources for its 2021 recommendation against reflex integration programs that lack clear links to occupational outcomes.⁠¹

For contrast, Ayres Sensory Integration, a different therapy that is often discussed alongside reflex integration, was assessed against the Council for Exceptional Children's standards in a 2019 systematic review and found to qualify as an evidence-based practice for autistic children aged 4 to 12.⁠⁵ A 2026 review of persisting reflexes was more tentative about reflex integration, calling movement-based interventions possibly promising while judging the evidence limited.⁠⁷

What does research link retained reflexes to?

The association is reasonably documented. Several studies report links between active primitive reflexes and weaker motor or attention performance in preschool and school-age children. Research has found persisting reflexes in typically developing children affect psychomotor performance, with more strongly retained reflexes associated with lower motor efficiency. Correlations have been reported with handwriting difficulty and with scholastic performance. Children with ADHD, autism, and dyslexia show clinically higher levels of persisting primitive reflexes than peers. This is real, and it's why therapists screen. A 2026 systematic review of 14 studies in children aged 3 to 11 without neurodevelopmental diagnoses found the same pattern: all six studies of motor development reported negative associations, particularly for locomotion, balance and manual dexterity, and six more linked persisting reflexes to lower performance in reading, spelling and mathematics.⁠⁷ A meta-analysis puts numbers on the ADHD association specifically — a moderate correlation, r = 0.48 for the ATNR and r = 0.39 for the STNR — from four studies and 229 participants, which is a small evidence base to carry a strong claim.⁠⁸

What the association doesn't establish. Correlation isn't causation, and there are at least three explanations that fit the same data:

Retained reflexes cause the difficulties
Both are downstream of the same underlying neurological difference
Retained reflexes are a marker of slower neuromotor maturation rather than its mechanism

The third is the reading most current guidance favors — retained reflexes as a window into neuromotor status rather than as the thing causing the problem. That distinction determines whether integrating a reflex should be expected to fix anything.

Where the evidence is genuinely weak: intervention. Studies of reflex integration programs exist, and some report improvements. The 2026 review found five such studies, most reporting improved outcomes with effect sizes from small to large, and concluded in the same breath that the available evidence “remains limited and heterogeneous”.⁠⁷ The literature is heterogeneous, studies are typically small, and methodological limitations are common — control conditions, blinding, and outcome measures are frequent weak points. Several of the more enthusiastic studies come from researchers with commercial ties to specific programs, which is worth knowing when reading them. An older randomized trial published in The Lancet examined replicating primary-reflex movements for children with specific reading difficulties; it's frequently cited by program providers, but it's from 2000, and the field has not built the body of replication that would normally follow a promising early result.

What happens if the ATNR is not integrated?

Often nothing that needs treating in its own right. The asymmetrical tonic neck reflex, or ATNR, is the “fencing” reflex: when the head turns, the arm and leg on the side the face points toward straighten and the arm and leg on the other side bend. It is present before birth and is normally observed up to about six months of age.⁠¹⁴ A faint version of it on testing is common well into the early school years in children who are developing typically.⁠¹⁶ Where a stronger one persists, research links it at group level to reading, attention and coordination difficulties,⁠^7,8,13 but a link is not a cause, and a persisting ATNR on its own does not mean a child is impaired.⁠¹ The reflex itself is covered in more depth in the full guide to the ATNR.

What is a persisting ATNR linked to?

Reading. Among 409 children aged 9 and 10 in ordinary schools, the poorest 10% of readers had a significantly higher average ATNR score than average or strong readers: 1.56 on a 0-to-4 scale, against 0.56 and 0.59.⁠¹³ In a sample of 739 children aged 7 to 9, the level of ATNR persistence predicted reading and spelling scores.⁠¹⁸
Attention. The ADHD meta-analysis described above found the ATNR's correlation with ADHD symptoms the stronger of the two reflexes it examined, and its authors call for longitudinal or experimental studies to show whether either causes the other.⁠⁸ The ADHD guide covers how ADHD itself is diagnosed.
Movement. In 50 preschool children, more ATNR activity went with less symmetrical pelvic movement when walking.⁠¹⁴ The ATNR is also one of the three reflexes most often observed in the 2026 review's studies of children without a diagnosis, where persisting reflexes went with weaker locomotion, balance and manual dexterity.⁠⁷

The same reading study shows why none of this works as a diagnosis. A quarter of the poorest readers showed no ATNR at all, while a third of the average and strong readers showed some. Its lead author, who also led the 2000 Lancet trial, concluded that reflex persistence “cannot be used as a causal model for reading difficulties, including dyslexia”.⁠¹³ If reading is the worry, the dyslexia guide covers how reading difficulties are assessed and which intervention has the evidence behind it.

How do clinicians check for a persisting ATNR?

In a baby, it shows when the head is turned to one side. In an older child, two tests are used. On hands and knees, the examiner turns the child's head to each side and watches whether the elbow on the side of the back of the head bends; standing with the arms held out in front, the examiner turns the head slowly and watches whether the arms follow it. The response is graded on a five-point scale, from 0 for none to 4 for the strongest.⁠¹⁴ Some response on the hands-and-knees test is normal: in a study of 80 typically developing first and third graders, every child showed some elbow bending or change in muscle tone, the younger group more than the older.⁠¹⁶ The ATNR guide walks through the tests, and the section on measurement explains why a score from them is a clinical judgment rather than a fixed number.

When is the ATNR a reason to see a doctor?

In a baby: an obligatory ATNR, one the baby cannot move out of. A newborn ATNR is easy to elicit and normal, and one that shows only when the head turns to one side is not uncommon; a 1983 paper on the newborn ATNR advises that it should not be considered pathological unless it is obligatory.⁠¹⁵ Persistence or slow fading of primitive reflexes, the ATNR among them, is also one of the signs child neurologists use to identify infants at risk of cerebral palsy early.⁠¹⁷ If you see an obligatory ATNR, or reflexes that seem slow to fade alongside late motor milestones, raise it with your pediatrician.

In a school-age child: a specific task that is hard. The useful question is not whether the reflex is present but which everyday task is difficult and how improvement would be measured, which is the standard AOTA sets.⁠¹ An occupational therapist can assess that task directly.

Do retained primitive reflexes go away on their own?

Probably the most common follow-up question, and the honest answer has two halves.

Finding one is not inherently abnormal. The 2026 systematic review that found the associations described above studied children aged 3 to 11 without neurodevelopmental disorders — that was its inclusion criterion.⁠⁷ Persisting reflexes turn up in ordinary children who are developing typically, which is worth knowing if a screening has just found one in yours.

Nobody has tracked what happens next. That means nobody can tell you the odds that it resolves on its own, how long that takes, or whether it matters if it does not — and anyone who does tell you is going beyond what has been measured. This page will not guess a trajectory it cannot source.

What that leaves you with is more useful than it sounds: judge the child, not the reflex. If a specific difficulty is affecting daily life, that difficulty is what to assess and address, whether or not a reflex is part of the picture.

Who tests for retained reflexes, and is there a diagnosis code?

Occupational and physical therapists screen primitive reflexes, normally as one component of a broader assessment rather than as an examination in its own right. A developmental pediatrician or a pediatric neurologist may also examine them where there is a neurological question.

There is no diagnosis code for retained primitive reflexes. It is not a diagnosis in ICD-10-CM, and it is not a diagnosis in any classification system in use. The nearest code is R29.2, “Abnormal reflex” — and that sits in the chapter for symptoms and signs, not the chapters for diseases. A sign code records something a clinician observed. It is not a condition a child has.

That distinction is worth carrying into any conversation where a program presents retained reflexes as a diagnosis, or offers to diagnose them.

If you want an assessment, an occupational therapist or a physical therapist is where to start — and the useful request is not “test my child's reflexes” but “here is what my child is finding hard; please work out why”.

Do MNRI, INPP and other reflex integration programs work?

Several commercial programs train practitioners and sell courses of treatment built around integrating reflexes. The two named most often are MNRI — Masgutova Neurosensorimotor Reflex Integration — and INPP, the Institute for Neuro-Physiological Psychology program.

The standard this page applies to them is the same one it applies to everything else: is there independent evidence that this program produces functional change in the children it is marketed to?

MNRI. Two studies are indexed in PubMed, and both were in children with cerebral palsy rather than in the broader population these programs are marketed to. The larger randomized 40 children with spastic diplegic cerebral palsy to MNRI or to a sensory integration program alongside standard physiotherapy; both groups improved, and there was no statistically significant difference between them. Its own conclusion is that the two “can equally be used”.⁠⁹ The other followed 17 children with cerebral palsy using auditory evoked potentials, with 15 completing.⁠¹⁰

INPP. No peer-reviewed evaluation of the INPP program is indexed in PubMed. That is not a finding that it does not work — it is an absence of published evidence either way, and it is what you are choosing under if you are offered it.

None of that makes a practitioner using these methods a bad clinician. It means the questions in the next section matter more than the brand name does.

What does AOTA say about reflex integration programs?

The American Occupational Therapy Association's Choosing Wisely recommendations are a list of services occupational therapists should generally not provide. The relevant recommendation:

Don't use reflex integration programs for individuals with delayed primary motor reflexes without clear links to occupational outcomes.

Three points in AOTA's explanation matter more than the headline:

Integrating a reflex is not itself a functional outcome. Interventions designed only to integrate retained reflexes do not, in themselves, promote participation in daily activities.

A retained reflex does not automatically mean impairment. A child can show a retained reflex and function without difficulty. Finding one does not create a problem to treat.

Assessment should connect any finding to daily function. If reflex patterns are observed, standardized tools should be used to link them to actual occupational performance — and intervention should target that performance, not the reflex.

Read this correctly. It is not "reflex screening is invalid" and not "never address reflex patterns." It is: the reflex is not the goal — the child's ability to do things is. A therapist who notices an ATNR pattern disrupting a child's handwriting and then works on legibility, endurance, and positioning is working within this guidance. A program selling a course of exercises to integrate reflexes, with integration itself as the outcome, is what the recommendation addresses.

How should reflex screening be used? An OT example

A reasonable use of reflex screening: A child struggles to copy from the board. During assessment the therapist notices that when the child turns their head toward the board, their writing arm extends — an ATNR pattern. That observation explains something: the difficulty isn't inattention or effort, it's that head-turning is disrupting arm control. The therapist then targets the actual problem — legibility, speed, endurance — using task-specific practice, changes to how material is presented, and positioning adjustments. The reflex observation informed the plan. It wasn't the plan.

What the guidance cautions against: A program identifies several retained reflexes and prescribes a course of exercises to integrate them, with progress measured by whether the reflexes are still present. Daily function is assumed to follow. It may or may not.

How is a retained reflex tested and measured?

This question sits underneath every other one on the page, and it has an uncomfortable answer.

A 2025 paper developing a measurement scale for reflex integration opens by stating that “measurement methods for PR integration remain unestablished”.⁠¹²

Children have been screened for retained reflexes, told they have them, and sold courses of treatment for them for decades. That sentence is from the people building the instrument, in 2025.

In practice, assessment has meant a clinician placing a child in a position, applying a stimulus, and judging whether a response is present and how strong it is. That can be done carefully and informatively — it is part of a standard neurological examination — but it is a judgment, and without an established instrument there is no agreed threshold for where “present” becomes “retained”, nor a published measure of how well two clinicians assessing the same child would agree.

That matters in a specific way. If a finding cannot be measured consistently, then a program that reports integrating a reflex is reporting a change in the same judgment that identified it, made by the person providing the treatment. It does not mean nothing happened. It does mean the claim is softer than it sounds.

The instrument now being built. CPRIMS — the Children's Primitive Reflex Integration Measurement Scale — was developed with 555 primary-school children in Shenyang, China, across a pilot and a formal testing round. It covers seven reflexes in 17 items and reports good model fit and strong internal consistency.⁠¹² It is one scale, validated in one population, and it is a real step forward.

What to do with that as a parent: ask how the finding was measured, and what would count as it having changed. A practitioner who can answer both is doing something you can follow. It is the same question as the one in the next section, asked earlier.

Questions to ask before reflex integration therapy

If reflex integration has been recommended for your child:

Ask the practitioner

What functional difficulty are we actually trying to change? There should be an answer in daily-life terms — handwriting, dressing, sitting through a lesson.
How will we measure whether that's improved? Not "is the reflex still present," but whether the child can do the thing.
What's your relationship to the program being recommended? Reasonable to ask, and a good practitioner won't mind.
Is this part of a broader assessment, or the whole plan?
What would make you change or stop this approach?
What standardized tools were used?

Which signals deserve extra attention?

Progress measured only by reflex testing rather than by function
Claims to improve reading, attention, or academic performance directly
Long packages sold before any functional assessment
Framing retained reflexes as an overlooked root cause that mainstream practice misses
Marketing that names a proprietary method more prominently than any goal for your child

This isn't a reason to distrust your therapist. Many excellent OTs screen reflexes as part of a comprehensive assessment, and that's appropriate. The questions above distinguish that from a program where the reflex has become the point.

Four common claims about retained reflexes, and the evidence

These four turn up constantly, including in Google's own AI-generated summaries of this topic, usually traced back to a business selling the program or the product.

Does a cesarean birth cause retained reflexes? There is no evidence base for this. The claim is that a baby born by cesarean misses the pressure of the birth canal and so does not "switch off" its primitive reflexes. There is a real and separate literature on cesarean delivery and infant motor development, running to about a hundred papers; it is not this claim.

Does bedwetting mean a retained Galant reflex? No study links the two.

What that literature does say is more useful to a parent. Monosymptomatic nocturnal enuresis is common in early childhood and usually resolves on its own, and current thinking treats it as a developmental variation: nocturnal urine production, bladder capacity and the ability to wake all mature at different rates, and wetting happens when the waking part lags behind the others.⁠¹¹ That is a described mechanism with a known trajectory. A reflex at the base of the spine is not part of it.

Does vision therapy treat retained reflexes? We could find no peer-reviewed evaluation of it for this purpose. A search for vision therapy and primitive reflex integration returns nothing; broadening it to primitive reflex integration and vision returns five papers, which are about robotics, balance disorders, the evolutionary origins of consciousness, retinal cell types and smooth-pursuit eye movements. None concerns treating reflexes. Vision therapy has its own evidence base for its own indications; this is not one of them.

Do car seats, bouncers and carriers cause retained reflexes? No study makes that link. There is a genuine, separate question about how much time in equipment affects gross motor development, with a couple of dozen papers behind it — worth knowing about, and not the same claim.

What the pattern tells you. All four claims are confidently stated, all four are attached to something being sold, and none has published work behind it. That does not prove any of them false — absence of evidence is not evidence of absence, and this page has said as much about other claims. It does mean that anyone stating them as fact is going well beyond what has been measured, and it is a reasonable thing to say out loud when one of them is offered as a reason to buy a program.

What retained reflex research does not support

Stated plainly, because these claims circulate:

That integrating reflexes improves reading or academic performance directly — not established.
That retained reflexes are a primary cause of ADHD, autism, or dyslexia — the association exists; causation does not follow, and no professional body describes them this way.
That every child with retained reflexes needs intervention — AOTA states explicitly that a retained reflex does not automatically mean impairment.
That reflex integration is a treatment for any diagnosed condition — it isn't described that way in any clinical guideline.

And a note on adults, because programs are marketed to them too. Primitive reflexes that reappear in an adult are a different phenomenon entirely, not a childhood reflex that was never integrated: they are frontal release signs, and they point to frontal lobe or diffuse cerebral dysfunction. People with dementia are reported at roughly 14 to 16 times the odds of exhibiting them compared with age-matched controls.⁠⁶ An adult reflex finding is a reason to see a neurologist, not a reason to buy a course of exercises.

Retained reflexes and sensory processing: how do they relate?

Retained reflexes and sensory processing are frequently discussed together, and they do overlap: both concern how the nervous system organizes input and produces movement, and both are commonly raised in the same OT assessment. But they have different evidence bases and shouldn't be merged. Sensory processing has a substantially larger literature, and sensory features appear in both current autism manuals — the DSM-5 since 2013 and ICD-11 since 2022. Retained reflex integration has nothing comparable. If your child has been assessed for one and not the other, both are reasonable to ask about — as separate questions.

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Frequently Asked Questions

What are retained primitive reflexes?

Automatic infant movement patterns — such as the Moro startle response or the asymmetrical tonic neck reflex — that remain readily observable beyond the age at which they typically fade. They're also called non-integrated reflexes.

Does reflex integration therapy work?

The evidence is weak. Studies exist and some report improvements, but they are typically small and methodologically limited. AOTA's Choosing Wisely guidance advises against reflex integration programs without clear links to occupational outcomes.

What does AOTA say about reflex integration?

AOTA's Choosing Wisely recommendation states: don't use reflex integration programs for individuals with delayed primary motor reflexes without clear links to occupational outcomes. AOTA notes that integrating a reflex does not in itself promote participation, and that a retained reflex does not automatically mean functional impairment.

Can retained reflexes be integrated at any age?

Programs claiming this exist. The evidence for reflex integration at any age is limited, and stronger claims about older children and adults have less support than claims about young children.

Should my child be tested for retained reflexes?

Reflex screening is a reasonable part of a broader occupational therapy assessment. It shouldn't be the whole assessment, and a finding on its own doesn't establish that intervention is needed.

What is ATNR and what happens if it isn't integrated?

The asymmetrical tonic neck reflex causes the arm on the side the head turns toward to extend, and the opposite arm to bend. When it remains active, it can disrupt tasks requiring the head to turn while the hands stay steady — copying from a board, for example. Whether it needs addressing depends on whether it's actually affecting daily function.

Do retained primitive reflexes cause learning problems?

Research links active primitive reflexes to weaker motor, attention, and academic performance, but that's an association rather than an established cause. Retained reflexes may be a marker of slower neuromotor maturation rather than the mechanism producing the difficulty.

Is reflex integration the same as sensory integration therapy?

No. They're distinct approaches with different evidence bases, though both appear in occupational therapy practice and are often discussed together. Ayres Sensory Integration has considerably more research behind it.

Can adults have retained primitive reflexes?

Programs are marketed to adults on that basis, but the evidence in adults is thinner than in children, and the claim is not the same one. A primitive reflex that never integrated in childhood is a different thing from one that reappears later in life.

What does it mean if a primitive reflex reappears in an adult?

Something quite different, and it is worth knowing. Reflexes that reappear in adulthood are called frontal release signs and point to frontal lobe or diffuse cerebral dysfunction; people with dementia are reported at roughly 14 to 16 times the odds of showing them. That is a reason to see a neurologist, not to buy a course of exercises.

Does a C-section cause retained primitive reflexes?

There is no evidence base for this.

Does bedwetting mean my child has a retained Galant reflex?

No study links the two, against more than a thousand papers on the causes of nocturnal enuresis. Current thinking treats bedwetting as a developmental variation: urine production, bladder capacity and the ability to wake mature at different rates, and wetting happens when waking lags behind.

Does vision therapy help retained primitive reflexes?

We could find no peer-reviewed evaluation of vision therapy for this purpose. Vision therapy has its own evidence base for its own indications; treating retained reflexes is not among them, though it is offered for that by some clinics.

Do car seats, bouncers and baby carriers cause retained reflexes?

No study makes that link. There is a separate and genuine question about how much time in infant equipment affects gross motor development, with a couple of dozen papers behind it, but that is a different claim from reflex retention.

How are retained primitive reflexes tested?

A clinician places the child in a position, applies a stimulus, and judges whether a response appears and how strong it is. A 2025 paper developing the first validated scale for this states that measurement methods had remained unestablished, so ask how a finding was measured and what would count as it changing.

When does the ATNR normally integrate?

It is present before birth and is normally observed up to about six months of age, fading as the nervous system matures.⁠¹⁴ What a later finding means depends on how strong it is and whether the child is struggling with anything, not on age alone.⁠^1,16

Is some ATNR normal in a school-age child?

Yes. In a study of 80 typically developing first and third graders tested on hands and knees, every child showed some elbow bending or change in muscle tone when the head was turned, and the author concluded that frequent, visible changes of this kind could be considered normal through third grade.⁠¹⁶

Can a persisting ATNR affect how a child walks?

One 2020 study of 50 preschool children found that more ATNR activity went with less symmetrical pelvic movement when walking. It measured the symmetry of the walking pattern, not any difficulty the children had, so it shows an association rather than a problem that needs treating.⁠¹⁴

Does a retained ATNR cause ADHD?

That has not been shown. A 2023 meta-analysis found a moderate correlation between ADHD symptoms and the ATNR, from four studies and 229 participants, and its authors say longitudinal or experimental studies are still needed to show whether either causes the other. A retained ATNR cannot diagnose ADHD on its own.⁠⁸

Are there ATNR exercises I can do at home?

Programs sell them, but the evidence that reflex exercises improve reading, writing or attention is limited, and AOTA advises that therapy target the task a child finds hard rather than the reflex. If copying from the board, handwriting or sitting through a lesson is the problem, an occupational therapist can work on that task directly and agree with you how progress is measured.⁠^1,7

Sources

American Occupational Therapy Association. Don't use reflex integration programs for individuals with delayed primary motor reflexes without clear links to occupational outcomes. Recommendation AOTA8, Choosing Wisely clinician list, released July 27, 2021. AOTA's rationale in full: “Interventions designed solely to integrate retained reflexes do not promote participation in occupation, and while they may be observed in clients with difficulties in occupational performance, the presence of retained reflexes does not necessarily equate to functional impairment. If reflex integration techniques … are being considered for intervention, standardized tools and assessment approaches are necessary to connect impairment to occupational performance. Intervention should focus on improving occupational participation and performance rather than solely on reflex integration.” AOTA cites Stallings-Sahler et al. (2019) and McPhillips et al. (2000) in support. Choosing Wisely has since retired its clinician lists and the original URL now redirects to the campaign homepage, so this links to the Internet Archive capture, which shows AOTA's wording as published: archived recommendation. AOTA's own Choosing Wisely page: aota.org/about/choosing-wisely. Checked September 13, 2026.
Gieysztor EZ, Choińska AM, Paprocka-Borowicz M. Persistence of primitive reflexes and associated motor problems in healthy preschool children. Archives of Medical Science. 2018;14(1):167–173. doi:10.5114/aoms.2016.60503 (PMID 29379547) 35 healthy preschool children aged 4–6. 65% had primitive reflexes surviving at a residual level and only 11% had none; greater reflex severity went with lower motor efficiency (p < 0.05).
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Its authors conclude in favor of reflex integration therapy for children with low psychomotor skills — a conclusion this page cites the study's measurements without adopting.
Feldhacker DR, Cosgrove R, Feiten B, Schmidt K. The correlation between retained primitive reflexes and scholastic performance among early elementary students. Journal of Occupational Therapy, Schools & Early Intervention. 2022;15(3):288–301. doi:10.1080/19411243.2021.1959482
McPhillips M, Hepper PG, Mulhern G. Effects of replicating primary-reflex movements on specific reading difficulties in children: a randomised, double-blind, controlled trial. The Lancet. 2000;355(9203):537–541. doi:10.1016/S0140-6736(99)02179-0 (PMID 10683004)
Schoen SA, Lane SJ, Mailloux Z, May-Benson T, Parham LD, Smith Roley S, Schaaf RC. A systematic review of Ayres Sensory Integration intervention for children with autism. Autism Research. 2019;12(1):6–19. doi:10.1002/aur.2046 (PMID 30548827)
Chamarthi VS, Gunasekaran V, Daley SF. Primitive Reflexes: Comprehensive Neurological Assessment Across the Lifespan. In: StatPearls. StatPearls Publishing; updated 2026. ncbi.nlm.nih.gov/books/NBK554606 (PMID 32119493). Checked August 25, 2026.
Provazník A, Musálek M, Bob P, Větrovský T, Malambo C, Silva AF, Anderson D. Persisting primitive reflexes and motor and cognitive development in children: a systematic review. Acta Psychologica. 2026;266:106915. doi:10.1016/j.actpsy.2026.106915 (PMID 42061063).
Wang M, Yu J, Kim HD, Cruz AB. Attention deficit hyperactivity disorder is associated with (a)symmetric tonic neck primitive reflexes: a systematic review and meta-analysis. Frontiers in Psychiatry. 2023;14:1175974. doi:10.3389/fpsyt.2023.1175974 (PMID 37484683).
Mohamed MA, El-Dein MS, El-Deen SMN, El Fakharany MS. Sensory integration versus Masgutova neuro-sensorimotor reflex integration program on controlling primitive reflexes and gross motor function in children with spastic diplegic cerebral palsy. Physiotherapy Research International. 2023.
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40 children with spastic diplegic cerebral palsy, aged 3–6, randomized to MNRI or to a sensory integration program, both alongside a standardized physiotherapy regimen, three sessions a week for three months. Both groups improved on GMFM and on reflex control; there was no statistically significant difference between the two groups after treatment. Concludes that the two approaches “can equally be used”. (PMID 37381746)
Sobieszczańska M, Koleda P, Pilecka A, Kałka D. The impact of rehabilitation carried out using the Masgutova Neurosensorimotor Reflex Integration method in children with cerebral palsy on the results of brain stem auditory potential examinations. Advances in Clinical and Experimental Medicine. 2012.
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17 children with cerebral palsy aged 1.3 to 5.9 years, of whom 15 completed the analysis; no control group. (PMID 23214200)
Uemura O. Rethinking monosymptomatic nocturnal enuresis as a developmental variation. European Journal of Pediatrics. 2026.
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Reviews the position that monosymptomatic nocturnal enuresis is common in early childhood, typically resolves spontaneously, and is better understood as a developmental variation than a structural disorder — nocturnal urine production, bladder storage capacity and sleep-arousal mechanisms mature at different rates, and wetting occurs when arousal maturation lags behind. (PMID 42183884)
Wang M, Yu J, Li H, Zhao C, Li Y, Yang X. Development of the children's primitive reflex integration assessment scale. Frontiers in Psychology. 2025. States that “measurement methods for PR integration remain unestablished” and describes the development of CPRIMS to address that. 555 participants from three primary schools in Shenyang, China — 234 in pilot testing and 321 in formal testing, mean age about 7.6 years. Seven dimensions and 17 items covering the Moro, ATNR, STNR, TLR, spinal Galant and further reflexes; confirmatory factor analysis showed good model fit (χ²/df = 1.631, RMSEA = 0.044, CFI = 0.980) and Cronbach's α from 0.730 to 0.945. PMID 39911996
McPhillips M, Sheehy N. Prevalence of persistent primary reflexes and motor problems in children with reading difficulties. Dyslexia. 2004;10(4):316–338. doi:10.1002/dys.282 (PMID 15573963) 409 children aged 9–10 from 11 ordinary primary schools in Northern Ireland; ATNR persistence rated 0 to 4 in the bottom, middle and top 10% of readers, 41 children each.
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Mean ATNR 1.56 in the poorest readers against 0.56 and 0.59; 24% of the poorest readers showed no ATNR, against 66% of the middle and top groups. The authors stress that reflex persistence “cannot be used as a causal model for reading difficulties, including dyslexia”.
Gieysztor E, Pecuch A, Kowal M, Borowicz W, Paprocka-Borowicz M. Pelvic symmetry is influenced by asymmetrical tonic neck reflex during young children’s gait. International Journal of Environmental Research and Public Health. 2020;17(13):4759. doi:10.3390/ijerph17134759 (PMID 32630679) Describes the ATNR as physiological from before birth to six months after it, and the two clinical tests for it in children: on hands and knees (the Ayres test, graded 0 to 4) and standing with the arms raised (the Schilder test).
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50 preschool children, mean age 5.5; more ATNR activity went with less symmetrical pelvic obliquity and rotation when walking (p < 0.01). Its authors conclude in favor of therapy; this page cites its descriptions and measurements without adopting that conclusion.
Marinelli PV. The asymmetric tonic neck reflex: its presence and significance in the newborn. Clinical Pediatrics. 1983;22(8):544–546. doi:10.1177/000992288302200804 (PMID 6861422) The newborn ATNR is easily elicited and “should not be considered pathologic unless it is obligatory”; responses to one side only are not uncommon.
Parmenter CL. The asymmetrical tonic neck reflex in normal first and third grade children. American Journal of Occupational Therapy. 1975;29(8):463–468. 80 typically developing children, 44 in first grade and 36 in third, tested on hands and knees with the head turned each way: every child showed some elbow bending or change in muscle tone, first graders significantly more. The author concludes that frequent, visible changes of this kind could be considered normal through third grade. PMID 1163609
Zafeiriou DI. Primitive reflexes and postural reactions in the neurodevelopmental examination. Pediatric Neurology. 2004;31(1):1–8. doi:10.1016/j.pediatrneurol.2004.01.012 (PMID 15246484) Primitive reflexes and postural reactions are among the simplest and most frequently used tools child neurologists have for assessing an infant’s nervous system; persistence or delayed disappearance of primitive reflexes, the ATNR among them, contributes to the early identification of infants at risk of cerebral palsy.
McPhillips M, Jordan-Black JA. Primary reflex persistence in children with reading difficulties (dyslexia): a cross-sectional study. Neuropsychologia. 2007;45(4):748–754. doi:10.1016/j.neuropsychologia.2006.08.005 (PMID 17030045) 739 children aged 7–9 in mainstream schools in Northern Ireland: ATNR persistence was significantly predictive of reading, spelling and non-word reading scores. A cross-sectional design, so it cannot show which way any influence runs.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It does not provide exercise instructions. Always consult a qualified healthcare provider about your child.