| What is NDD? (A Technical Explanation) by Anna R. Buck |
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Neuro-Developmental Delay is defined by the Institute in Neuro-Physiological Psychology
(INPP) "as the continued presence of a cluster of primitive reflexes above the age of one year
and the absence or underdevelopment of postural reflexes above the age of three and a half
years. The presence or absence of primitive and postural reflexes at key stages in development
provides reliable indicators of central nervous system maturity. Abnormal reflexes have also
been documented as playing a part in specific learning difficulties (Fiorentino 1970, Bobath &
Bobath 1975, Ayres 1972/3, Bender 1976, Blythe, McGlown 1979, Goddard 1994/96, Wilkinson
1994, Goddard Blythe 1998) and immature behavior."
Primitive reflexes are automatic movements that are not cortically controlled. They begin in the
womb and continue up through 6 months to one year of life. Pediatricians commonly test for these
reflexes when assessing a newborn’s neurological health. Postural reflexes are automatic
movements that begin after birth and should be in place by the age of three-and-a-half and
remain for life. When these reflexes do not inhibit or are not stimulated, as they should in
normal development, it can be an indication of problems with the vestibular system and/or
immature development of the central nervous system.
(INPP) "as the continued presence of a cluster of primitive reflexes above the age of one year
and the absence or underdevelopment of postural reflexes above the age of three and a half
years. The presence or absence of primitive and postural reflexes at key stages in development
provides reliable indicators of central nervous system maturity. Abnormal reflexes have also
been documented as playing a part in specific learning difficulties (Fiorentino 1970, Bobath &
Bobath 1975, Ayres 1972/3, Bender 1976, Blythe, McGlown 1979, Goddard 1994/96, Wilkinson
1994, Goddard Blythe 1998) and immature behavior."
Primitive reflexes are automatic movements that are not cortically controlled. They begin in the
womb and continue up through 6 months to one year of life. Pediatricians commonly test for these
reflexes when assessing a newborn’s neurological health. Postural reflexes are automatic
movements that begin after birth and should be in place by the age of three-and-a-half and
remain for life. When these reflexes do not inhibit or are not stimulated, as they should in
normal development, it can be an indication of problems with the vestibular system and/or
immature development of the central nervous system.
| Scroll down for information on specific reflexes |
Primitive and Postural Reflexes:
Their Functions and Their Affectations
By Anna R. Buck
As a child develops inside the womb, enters life, and
begins the growth process, the central nervous system
develops in a systematic and progressive manner. The
central nervous system consists of the spinal cord, brain
stem, and higher levels of the brain. Essentially, growth
takes place from the “bottom up,” as the child moves from
primitive, vital-for-life movements to more and more
advanced movements, thinking, and reasoning. Initially,
the spinal cord and brain stem control these very basic,
primitive movements. Later the cerebellum and basal
ganglia control movement; and then more advanced levels
of the brain take control, the cortex being the last to
fully develop (Eliot, p. 8).
liquid in a confined space and complete darkness. Now he
must adapt to the force of gravity, unprotected sounds, light
and vision, and greater movement. How the newborn adapts
to this new environment can be influenced by his ability to
integrate with a healthy central nervous system. “The developmental milestones of the normal child demonstrate the
integration of the central nervous system with the lower, primitive patterns to the higher, more selective behavior
necessary to the performance of everyday living” (Fiorentino, p. ix). All newborns experience similar developmental
progress. It is when these early movements are not observable or are retained beyond the normal time span so that later
movements cannot emerge that problems within the central nervous system can be detected. Fiorentino says that it is
important to know “the developmental motor milestones as they relate to the normal child so that recognition of the lack of
development as seen in the cerebral palsied child is noted at an early stage of development” (Fiorentino, p. 4). Lack of a
progressive and timely development can be an indication of central nervous system damage or dysfunction. If the nerves
in the central nervous system do not myelinate (insulate) well, the cortex will be unable to inhibit primitive reflexes.
Similar problems can occur in pathological conditions such as MS and AD when demyelination has a disinhibitory effect
releasing the reflexes in the absence of full cortical control.
It is similar with disturbances of the central nervous system. Even though the disturbance may be very limited and
specific, its effect on the overall pattern of functioning may be very great. It is not the lack of individual data that
creates the problem. It is, rather, the effect of this lack upon the integration of the body of data that disturbs behavior
and learning.
Such disturbances are particularly disruptive during the early years when patterns of generalization are being formed.
When a pattern is being developed but is not yet complete and a disturbance is encountered, the effect is to disrupt and
make largely impossible the establishment of the pattern from that point onward. It is something like the weaver who is
weaving a piece of cloth. If a thread breaks on the loom, the effect is not so much a hole in the cloth as it is the fact that
the pattern of the fabric does not appear from the point of the broken thread throughout the rest of the piece. If the
appeal of the weave is its overall pattern (as is true in the pattern underlying a generalization) the whole loom run is
ruined. When the developing pattern of functioning encounters a disturbance in the central nervous system, a similar
distruction of the pattern occurs….In most cases, the disturbance in the central nervous system suffered by the slow
learning child occurred at or near the time of birth (Kephart, p. 53).These early movements are called primitive reflexes
and they allow postural reflexes to later emerge. When primitive and postural reflexes do not inhibit or emerge as they
should, difficulties arise for the child. “…if any of the basic reflexes are aberrant the developing CNS will have a
structural weakness, and the inhibitory activities of the cortex will be lost or impaired” (Blythe, p. 44-45). It may
manifest in general immaturity, various learning difficulties and even problems with motor coordination, posture and
balance. “Primitive reflexes are automatic, stereotyped movements, directed from the brain stem and executed without
cortical involvement” (Goddard, p. 1). They emerge in utero, are present at birth, are essential for survival and should
inhibit within the first six to 12 months of life. “If these primitive reflexes remain active beyond 6-12 months of life,
they are said to be aberrant, and they are evidence of a structural weakness or immaturity within the central nervous
system” (Goddard, p. 4). Kephart emphasizes the importance of determining where the child has broken down in
development and starting therapy or teaching from that point so as to restore the normal course of development (Kephart,
p. 42). “One of his earliest learning tasks is to increase the scope and flexibility of his initial reflex responses (Kephart,
p. 4). Perhaps one or two reflexes need stimulated, or perhaps teaching strategies can remedy the problem for the slow
learner. However, if a group or “cluster of aberrant reflexes are present, neuro-developmental delay is said to exist”
(Goddard, p. 2). As these reflex movements are corrected, change can be measured, and the emotional, physical and
academic problems may disappear.
The first reflex to emerge in utero is one of withdrawal. The embryo will withdraw from any stimulus until tactile
awareness develops. As the central nervous system develops, this reflex will inhibit. Primitive reflexes emerge in utero,
are fully present at birth, and are inhibited by the developing brain usually within the first six months of life. The
postural reflexes emerge after birth, should be fully present by the age of three-and-a-half, and should remain through
life.
Moro Reflex
At about nine weeks in utero, the primitive Moro reflex emerges and
should continue through about the first two to four months of life.
It then should diminish so that the adult startle response emerges and
remains throughout the rest of the individual’s life. The Moro reflex
is a startle response – the first “fight or flight” response of an
individual.
Its role as a survival mechanism in the first months of life is to alert,
to arouse and to summon assistance. It is also thought to play a major
part in developing the baby’s breathing mechanism in utero, coinciding
with the earliest breathing-like movements observed in the womb. It facilitates the first “breath of life” at birth and
helps to open the windpipe if there is threat of suffocation” (Goddard, p. 5).
The Moro reflex can be triggered by sudden unexpected occurrences, sudden change in head position, noise, sudden
movement or change of light or tactile stimulation. It “is one of the most commonly tested early coordinative patterns, or
reflexes, in the evaluation of the neurological status of a newborn infant” (Crutchfield, p. 162). When the Moro reflex
does not inhibit as it should and remains with the child beyond the first four months of life, various difficulties arise for
the child. “Late persistence of the Moro reflex may suggest a sensorimotor dysfunction” (Crutchfield, p. 165). Overall,
the emotional contour of the child is most affected. He may demonstrate numerous difficulties such as a hypersensitivity
to stimuli, light, noise and tactile responses. He may be described as being easily over-stimulated and unable to cope with
multiple sensory stimulation. Instead of demonstrating the adult startle response – a shrugging movement or turn of the
head to determine the source of the disturbance, and then continuation of what one was doing – the child is unable to
respond appropriately. Long-term effects of the retained Moro reflex may include one or more of the following:
significant vestibular related problems (balance, coordination, motion sickness), immature behavior, physical timidity,
oculomotor and visual-perceptual problems, photosensitivity, auditory confusion, allergies and lowered immune system,
adverse reactions to drugs, poor stamina, poor adaptability to changes or surprises, poorly developed CO² reflex
(appropriate and automatic stimulation of deep breathing), reactive hypoglycemia, anxiety, excessive reaction to stimuli
(mood swings, tense muscle tone, difficulty accepting criticism, hyperactivity, weak ego, low self-esteem, insecurity or
dependency, need to “control” or “manipulate” events (Goddard, p. 7). This reflex is connected to all of the other senses,
and the effects of its retention are significant.
Palmar Reflex
The Palmar, or grasp, reflex also emerges in utero and should be replaced
by the pincer grasp by about two to three months of life. The newborn will
grasp objects with his first three fingers and the thumb is virtually inactive.
As the pincer grasp begins to dominate, the thumb and forefinger are able
to grasp in opposition. Thisallows finger manipulation and finger pressure.
A continued Palmar reflex can have a “lasting adverse effect upon fine muscle
coordination, speech and articulation” (Goddard, p. 8) It will also hinder manual
dexterity, tactile sensitivity, manipulatory activities, handwriting, and pencil grip. Children
with a retained Palmar reflex often “talk with their hands” and “write with
their mouths”. “Hand skills need to be developed at an early age and contribute indirectly to speech and language
development” (Davis, p. 53).
Along with the grasp reflexes are the rooting and sucking reflexes. They develop in utero and should be fully present at
birth. Usually these reflexes are inhibited by three-to-four months of life. Rooting initiates the suck and swallow
reflexes and is stimulated by touch. It allows the infant to transfer from tactile to visual responses and may help in
developing muscle groups involved in smiling. Newborns who do not have these reflexes at birth will not feed well.
However, if these reflexes are retained beyond their normal time-span, the child may be hypersensitive in the oral region,
have a continued desire for oral stimulation (chewing or sucking needs), immature chewing and swallowing movements,
speech and articulation difficulties and manual dexterity problems.
Plantar Reflex
Similar to the grasp Plantar reflex in the hands, is the Plantar reflex in the feet. This reflex emerges in utero and is
usually inhibited at seven to nine months of age. It is a spontaneous movement of the toes, stimulated by touch, and
precedes many of the larger movements made by the infant, so that it should disappear when the child begins to stand up
and walk. If this reflex is retained beyond the first year of life, the child may sense gravitational insecurity. It can be
observed when trying to put shoes on a child: the toes curl under and it becomes impossible to push the foot into the shoe.
“The late persistence of the response may suggest sensorimotor dysfunction or deficit” (Crutchfield, p. 173).
Spinal Galant
The Spinal Galant reflex also emerges in utero and should inhibit between
three and nine months of age. This reflex facilitates movement in the womb
and allows hip flexibility. “…it may take an active role in the birth process.
Contractions of the vaginal wall stimulate the lumbar region and cause small
rotational movements of the hip on one side…. In this way, the baby can help
to work its way down the birth canal” (Goddard, p. 16). It is believed that
this reflex also works to help get the elimination system up and going.
Connections have been found between children with a retained Spinal Galant
reflex and auditory difficulties as well as urinary and digestive disorders such as irritable bowel syndrome (Goddard, p.
16). If this reflex is retained the following behaviors are usually observed: constant fidgetiness, inability to sit still,
difficulty with concentration, poor bladder control and bedwetting past the age of five, tactile hypersensitivity, auditory
processing difficulties, scoliosis of the spine, short term memory, dislike for clothes to be fitted at the waist, posture and
gait problems (hip rotation to one side when walking on the side which retains the reflex). It may also interfere with the
full development of the later amphibian and segmental rolling reflexes, affecting fluency and mobility in physical
activities or sports” (Goddard, p. 17).
Tonic Labyrinthine Reflex
The Tonic Labyrinthine reflex in the forward (flexed) position emerges
in utero and inhibits at at about the age of four months. Its counterpart,
the Tonic Labyrinthine reflex in the backward position (extension)
emerges at birth and gradually diminishes between six months and three
years of age, as the postural and bridging reflexes are emerging. This
reflex is closely linked with the Moro reflex.
Both are vestibular in origin, and both are activated by stimulation of
the labyrinths, movement of the head and alteration of position in space…
The tonic labyrinthine reflexes exert a tonic influence upon the
distribution of muscle tone throughout the body, literally helping the
neonate to “straighten out” from the flexed position of the fetus and the
newborn (Goddard, p. 17-18).
If these reflexes do not inhibit as they should, the child will have
difficulty with balance and gravitational security. Thus he may have
difficulty in judging space, distance, depth and velocity. Muscle tone
is affected, as is controlled eye movement. Later reflexes will not
emerge as they should, which can affect creeping, crawling and sensory
integration. “Head control and good balance are essential to the
automatic functioning of all other systems – a residual tonic labyrinthine
reflex (TLR) will prevent the complete establishment of both head
control and of balance” (Goddard, p. 20). Indicators of a retained
forward TLR are: poor balance, postural problems, poor muscle tone, eye movement difficulties, visual-perceptual
problems, vertigo, motion sickness beyond the age of puberty, orientation difficulties, headaches, auditory confusion, and
under-developed head righting reflexes. A retained backward TLR can be exhibited through poor posture, poor balance
and coordination, stiff, jerky movements through poor muscle tone, vestibular problems, visual-perceptual and spatial
perception problems, poor sequencing skills, and poor organization skills.
Asymmetric Tonic Neck Reflex
The Asymmetric Tonic Neck reflex (ATNR) also emerges in utero.
It should inhibit at about six months of age. This reflex facilitates
movement in the womb, assists in balance control, and increases
neural control. It may even be activated during the birth process.
It helps the fetus and newborn develop muscle tone, homolateral
movements such as in early creeping, and early hand-eye
coordination. The ATNR also ensures free airway when lying on
the tummy (the head will turn toward the extended arm rather than
face down). Continued presence of the ATNR can interfere with
the development of laterality. However, “[i]n the persistent
influence of the ATNR on movement, almost every important motor skill will fail to develop” (Crutchfield, p. 202). A
retained ATNR reflex affects many areas: balance is affected when the head is rotated, cross pattern movements might
be impaired as midline cannot be crossed (vertical midline barrier), mixed laterality occurs, hand-eye coordination is
affected in reading and writing, horizontal eye tracking is impaired, difficulties are observed with bilateral integration,
written expression is poor, and reading comprehension may be compromised. “[W]riting never becomes automatic and
therefore they may have difficulty with multi-tasking” (Goddard, p. 12). The hand will want to extend when writing,
rather than bending at the elbow and assuming a normal hand-writing position.
Symmetric Tonic Neck Reflex
The Symmetrical Tonic Neck reflex (STNR) is considered a “bridge”
reflex as it emerges after birth and should inhibit soon thereafter. It
emerges between six and nine months of age and should be inhibited
between nine and eleven months. It assists in inhibiting the TLR and
bridges into creeping on hands and knees. It further helps the baby
to defy gravity because now he is attempting to lift more than just the
head or a limb at one time. Rather, the infant attempts to lift his body
off of the floor into a quadruped position, which assists in alignment
of the spinal cord for a later standing position. The child learns to
operate the upper and lower body independently of each other, and
training of reestablishment of binocular vision begins (accommodating
the eyes as they look at objects in the distance and then at his hands as they creep forward). “Creeping is one of the most
important movement patterns in the prolonged process of teaching the eyes to cross the midline. In addition to looking
ahead, babies also learn eye-hand coordination from the movement of the hands…. It is through creeping that the
vestibular, proprioceptive and visual systems connect to operate together for the first time. Without this integration
there can be a poorly developed sense of balance and poor space and depth perception” (Goddard, p. 23). Signs of a
retained STNR might include: poor posture, tendency to slump when sitting, “w” leg position when sitting on the floor, poor
hand-eye coordination, difficulty copying from a blackboard to desk, slowness at copying, difficulty with vertical
tracking (necessary for aligning columns in math calculations), difficulty with activities such as swimming, forward rolls
(activities that involve a coordinated upper and lower body) and difficulty with attention. “At the Bender Institute, O’
Dell and Cook (1996) found a retained STNR to be a significant factor in children with…ADD and…ADHD. Both groups
improved markedly when the STNR was inhibited as a result of a specific movement program” (Goddard, p. 24).
Landau Reflex
The Landau reflex is another “bridge” reflex, as it emerges between three and ten weeks of age and should not remain
throughout life. As with the STNR, the Landau reflex has an inhibitory effect on the TLR. It also helps strengthen
muscle tone and develop vestibulo-ocular motor skills. “Muscle control must be available in order for righting reactions to
work” (Crutchfield, p. 213). A retained Landau reflex may signify causal primitive reflexes. It might be observed as “a
child may run with stiff awkward movement in the lower half of the body and find hopping, skipping and jumping difficult
as he cannot flex the leg muscles at will” (Goddard, p. 34).
Head Righting Reflexes
Head Righting Reflexes are postural reflexes. They emerge between two and four months of age and should remain for
life. While the Labyrinthine Head Righting reflexes operate from the midbrain, the Oculo Head Righting reflexes are
dependent on the functioning of the cerebral cortex (higher brain activity).
These [reflexes] are reactions to gravity which result from somatosensory, visual and proprioceptive influences acting
together when the three inputs are available and functioning appropriately…. The oculo-headrighting reflexes operate as a
result of visual cues, while the labyrinthine headrighting reflexes are dependent upon vestibular information. The two
should synchronize to supply accurate data upon which head position is adjusted. If they fail to develop fully, or only one
develops adequately, balance, controlled eye movements and visual perception will all be impaired (Goddard, p. 31).
Head righting reflexes allow the head to automatically respond to the pull of gravity on the body so that balance is
maintained. They also allow the Vestibular-Ocular Reflex Arc to function effectively, which maintains visual stability
during head movement. If these reflexes are underdeveloped, several areas may be affected. Posture and postural
control are affected, as are muscle groups that support posture. Oculo-motor functioning might be impaired, affecting
visual fixation and visual pursuit. This will then affect reading ability, comprehension, spelling, and copying. Simple skills
like catching a ball may be difficult or impossible. Underdeveloped horizontal headrighting reflexes may also be an
indication of a retained ATNR, whereas underdeveloped forward and backward headrighting reflexes may indicate a
retained TLR.
Amphibian Reflex
Another postural reflex is the Amphibian reflex. It emerges between four and six months of age and should remain for
life. This reflex, when fully developed, indicates an inhibited ATNR. It allows freedom for independent movement of the
arms and legs, which is “essential for crawling, creeping, and gross muscle coordination later on and enables the child to
move one quadrant of the body independently of the other three” (Goddard, p. 34). This naturally allows greater
flexibility and adaptability in movement. If the reflex is underdeveloped the following observations might be noted: poor
muscle tone, poor crawling and creeping skills, difficulty with activities that depend on gross muscle coordination,
bilaterality problems and a lack of trunk mobility. “Total lack of an amphibian reflex suggests uninhibited primitive
reflexes, particularly the…ATNR and the…TLR” (Goddard, p. 34).
Segmental Rolling Reflex
The Segmental Rolling reflexes are postural reflexes that emerge from six months when rolling from the back to tummy
and eight to ten months when rolling from tummy to back. These should remain throughout life. Movement starts at the
head and follows in a wave format through the shoulders, trunk and pelvis. Or, the movement may start at the pelvis and
move upward through a reverse pattern. It allows for easy flow of movement from lying to sitting, kneeling and eventually
standing. Later on, simple fluid movement from lying to standing is achieved. The reflex remains “to facilitate changing
positions and to give fluidity to movements such as running, jumping, skiing, etc.” (Goddard, p. 35). When these reflexes
are underdeveloped the following observations might be made: lack of body integration (especially with the trunk),
differentiated movement through the upper/lower and left/right sections of the body during certain movements, stiff gait
from a lack of hip movement.
While it would appear that retained primitive reflexes greatly affect development and learning, it might be mistakenly
assumed that underdeveloped postural reflexes do not affect learning as much as involvement in physical education and
sports activities, when gross muscle coordination is in high demand.
Whereas there is documented evidence that retained primitive reflexes underlie difficulties in the learning of basic skills
such as reading, writing and copying, less attention has been paid to the role of postural reflexes in providing a functional
link between postural control, cognitive functioning and academic performance (Goddard, p. 37).
Academic performance seems to be most affected by underdeveloped postural reflexes when the child reaches higher
education. Such problems are manifested in these areas: adaptation, problem solving, multi-processing, sequencing, and
information overload.
The effect on a child of having underdeveloped postural reflexes is the environmental and social equivalent of having an
underdeveloped vocabulary. Often an individual can cope as long as the rules remain the same and it is possible to use
previously learned skills. If the rules required by a situation changes, such children are forced to “learn and practice”
the new rules because they are not able to adapt and change to meet the altered circumstances. This can result in
“awkwardness,” feelings of personal and social inadequacy and increased propensity to suffer from anxiety (Goddard, p.
37).
Primitive and postural reflexes play an important role in the development of the child. Not only do they reveal the
healthy development of the central nervous system, but they also lead to more advanced development for muscle
coordination, balance, and academic learning. These early reflexes are what make higher activities possible. “There are
two points to emphasize: (1) Development is variable even with the normal child; (2) each new activity is built upon
previous patterns which are integrated and elaborated on to make possible the varied, complex, and refined movements of
function” (Fiorentino, p. 9). When learning problems develop for a child, it is essential that it be determined where the
problem began developmentally. Dr. Dorinne Davis says, “Muscular balance is an outward sign that our body is
functioning properly” (Davis, p. 31).
After birth, “[g]ravity presents a new challenge to balance and muscle power. Some of the once preferred patterns that
were expressed as far back as fetal life may be simpler and more readily available than complex patterns. The ability to
generate novel movements is impaired because at least one system – the nervous system – is not functioning normally. The
requirements of the activity or skill may be too difficult … so postures and movements that require less strength and
balance are used” (Crutchfield, p. 203).
If a cluster of aberrant primitive reflexes are detected, it is essential that a reflex inhibition and stimulation program
be initiated. “[T]he innate mechanistic processes involved in the inhibition, modification and transformation of the basic
reflexes are observable and replicable at any age to assist in overcoming neurological impairment” (Blythe, p. 46). As the
child begins to correct the early movement patterns, the reflexes can become inhibited, later postural reflexes can
develop appropriately, and then higher cognitive abilities can begin to come together for the child as maximum integration
is facilitated.
“Children who can discriminate between the directions begin to understand what the teachers are talking about – but those
who can’t discriminate, don’t understand what teachers are talking about. A child who is still in the laterality stage (does
not know right and left) or lacks directionality (has not gained a sense of up and down, before and behind) will continue to
get…letters [p, q, b, d] confused” (Cheatum, p. 117).
Through reflex inhibition and stimulation, laterality, directionality, spatial, and orientation problems should be alleviated,
allowing for better comprehension and application of reading, writing, and math skills. It is logical to assume that all
behavior is basically motor, that the prerequisites of any kind of behavior are muscular and motor responses. Behavior
develops out of muscular activity, and so-called higher forms of behavior are dependent upon lower forms of behavior,
thus making even these higher activities dependent upon the basic structure of the muscular activity upon which they are
built (Kephart, p. 79).
Resources
Blythe, Peter and David J. McGlown. An Organic Basis for Neuroses and Educational
Difficulties. Great Britain: Insight Publications, 1979.
Cheatum, Billye Ann and Allison A. Hammond. Physical Activities for Improving
Children’s Learning and Behavior. Illinois: Human Kinetics, 2000.
Crutchfield, Carolyn A. and Marylou R. Barnes. Motor Control and Motor Learning in
Rehabilitation. Atlanta, Georgia: Stokesville Publishing Company, 1993.
Davis, Dorinne S. Sound Bodies Through Sound Therapy. New Jersey: Kalco
Publishing, L.L.C., 2004.
Eliot, Lise. What’s Going On In There? How the Brain and Mind Develop in the
First Five Years of Life. New York: Bantam Books, 1999.
Fiorentino, Mary R. Normal and Abnormal Development: The Influence of Primitive
Reflexes on Motor Develoment. Illinois: Charles C. Thomas, 1972.
Goddard, Sally. Reflexes, Learning and Behavior: A Window into the Child’s Mind.
Eugene, Oregon: Fern Ridge Press, 2002.
Kephart, Newell C. The Slow Learner in the Classroom. Columbus, Ohio: Charles E.
Merrell Publishing Company, 1971.
Their Functions and Their Affectations
By Anna R. Buck
As a child develops inside the womb, enters life, and
begins the growth process, the central nervous system
develops in a systematic and progressive manner. The
central nervous system consists of the spinal cord, brain
stem, and higher levels of the brain. Essentially, growth
takes place from the “bottom up,” as the child moves from
primitive, vital-for-life movements to more and more
advanced movements, thinking, and reasoning. Initially,
the spinal cord and brain stem control these very basic,
primitive movements. Later the cerebellum and basal
ganglia control movement; and then more advanced levels
of the brain take control, the cortex being the last to
fully develop (Eliot, p. 8).
liquid in a confined space and complete darkness. Now he
must adapt to the force of gravity, unprotected sounds, light
and vision, and greater movement. How the newborn adapts
to this new environment can be influenced by his ability to
integrate with a healthy central nervous system. “The developmental milestones of the normal child demonstrate the
integration of the central nervous system with the lower, primitive patterns to the higher, more selective behavior
necessary to the performance of everyday living” (Fiorentino, p. ix). All newborns experience similar developmental
progress. It is when these early movements are not observable or are retained beyond the normal time span so that later
movements cannot emerge that problems within the central nervous system can be detected. Fiorentino says that it is
important to know “the developmental motor milestones as they relate to the normal child so that recognition of the lack of
development as seen in the cerebral palsied child is noted at an early stage of development” (Fiorentino, p. 4). Lack of a
progressive and timely development can be an indication of central nervous system damage or dysfunction. If the nerves
in the central nervous system do not myelinate (insulate) well, the cortex will be unable to inhibit primitive reflexes.
Similar problems can occur in pathological conditions such as MS and AD when demyelination has a disinhibitory effect
releasing the reflexes in the absence of full cortical control.
It is similar with disturbances of the central nervous system. Even though the disturbance may be very limited and
specific, its effect on the overall pattern of functioning may be very great. It is not the lack of individual data that
creates the problem. It is, rather, the effect of this lack upon the integration of the body of data that disturbs behavior
and learning.
Such disturbances are particularly disruptive during the early years when patterns of generalization are being formed.
When a pattern is being developed but is not yet complete and a disturbance is encountered, the effect is to disrupt and
make largely impossible the establishment of the pattern from that point onward. It is something like the weaver who is
weaving a piece of cloth. If a thread breaks on the loom, the effect is not so much a hole in the cloth as it is the fact that
the pattern of the fabric does not appear from the point of the broken thread throughout the rest of the piece. If the
appeal of the weave is its overall pattern (as is true in the pattern underlying a generalization) the whole loom run is
ruined. When the developing pattern of functioning encounters a disturbance in the central nervous system, a similar
distruction of the pattern occurs….In most cases, the disturbance in the central nervous system suffered by the slow
learning child occurred at or near the time of birth (Kephart, p. 53).These early movements are called primitive reflexes
and they allow postural reflexes to later emerge. When primitive and postural reflexes do not inhibit or emerge as they
should, difficulties arise for the child. “…if any of the basic reflexes are aberrant the developing CNS will have a
structural weakness, and the inhibitory activities of the cortex will be lost or impaired” (Blythe, p. 44-45). It may
manifest in general immaturity, various learning difficulties and even problems with motor coordination, posture and
balance. “Primitive reflexes are automatic, stereotyped movements, directed from the brain stem and executed without
cortical involvement” (Goddard, p. 1). They emerge in utero, are present at birth, are essential for survival and should
inhibit within the first six to 12 months of life. “If these primitive reflexes remain active beyond 6-12 months of life,
they are said to be aberrant, and they are evidence of a structural weakness or immaturity within the central nervous
system” (Goddard, p. 4). Kephart emphasizes the importance of determining where the child has broken down in
development and starting therapy or teaching from that point so as to restore the normal course of development (Kephart,
p. 42). “One of his earliest learning tasks is to increase the scope and flexibility of his initial reflex responses (Kephart,
p. 4). Perhaps one or two reflexes need stimulated, or perhaps teaching strategies can remedy the problem for the slow
learner. However, if a group or “cluster of aberrant reflexes are present, neuro-developmental delay is said to exist”
(Goddard, p. 2). As these reflex movements are corrected, change can be measured, and the emotional, physical and
academic problems may disappear.
The first reflex to emerge in utero is one of withdrawal. The embryo will withdraw from any stimulus until tactile
awareness develops. As the central nervous system develops, this reflex will inhibit. Primitive reflexes emerge in utero,
are fully present at birth, and are inhibited by the developing brain usually within the first six months of life. The
postural reflexes emerge after birth, should be fully present by the age of three-and-a-half, and should remain through
life.
Moro Reflex
At about nine weeks in utero, the primitive Moro reflex emerges and
should continue through about the first two to four months of life.
It then should diminish so that the adult startle response emerges and
remains throughout the rest of the individual’s life. The Moro reflex
is a startle response – the first “fight or flight” response of an
individual.
Its role as a survival mechanism in the first months of life is to alert,
to arouse and to summon assistance. It is also thought to play a major
part in developing the baby’s breathing mechanism in utero, coinciding
with the earliest breathing-like movements observed in the womb. It facilitates the first “breath of life” at birth and
helps to open the windpipe if there is threat of suffocation” (Goddard, p. 5).
The Moro reflex can be triggered by sudden unexpected occurrences, sudden change in head position, noise, sudden
movement or change of light or tactile stimulation. It “is one of the most commonly tested early coordinative patterns, or
reflexes, in the evaluation of the neurological status of a newborn infant” (Crutchfield, p. 162). When the Moro reflex
does not inhibit as it should and remains with the child beyond the first four months of life, various difficulties arise for
the child. “Late persistence of the Moro reflex may suggest a sensorimotor dysfunction” (Crutchfield, p. 165). Overall,
the emotional contour of the child is most affected. He may demonstrate numerous difficulties such as a hypersensitivity
to stimuli, light, noise and tactile responses. He may be described as being easily over-stimulated and unable to cope with
multiple sensory stimulation. Instead of demonstrating the adult startle response – a shrugging movement or turn of the
head to determine the source of the disturbance, and then continuation of what one was doing – the child is unable to
respond appropriately. Long-term effects of the retained Moro reflex may include one or more of the following:
significant vestibular related problems (balance, coordination, motion sickness), immature behavior, physical timidity,
oculomotor and visual-perceptual problems, photosensitivity, auditory confusion, allergies and lowered immune system,
adverse reactions to drugs, poor stamina, poor adaptability to changes or surprises, poorly developed CO² reflex
(appropriate and automatic stimulation of deep breathing), reactive hypoglycemia, anxiety, excessive reaction to stimuli
(mood swings, tense muscle tone, difficulty accepting criticism, hyperactivity, weak ego, low self-esteem, insecurity or
dependency, need to “control” or “manipulate” events (Goddard, p. 7). This reflex is connected to all of the other senses,
and the effects of its retention are significant.
Palmar Reflex
The Palmar, or grasp, reflex also emerges in utero and should be replaced
by the pincer grasp by about two to three months of life. The newborn will
grasp objects with his first three fingers and the thumb is virtually inactive.
As the pincer grasp begins to dominate, the thumb and forefinger are able
to grasp in opposition. Thisallows finger manipulation and finger pressure.
A continued Palmar reflex can have a “lasting adverse effect upon fine muscle
coordination, speech and articulation” (Goddard, p. 8) It will also hinder manual
dexterity, tactile sensitivity, manipulatory activities, handwriting, and pencil grip. Children
with a retained Palmar reflex often “talk with their hands” and “write with
their mouths”. “Hand skills need to be developed at an early age and contribute indirectly to speech and language
development” (Davis, p. 53).
Along with the grasp reflexes are the rooting and sucking reflexes. They develop in utero and should be fully present at
birth. Usually these reflexes are inhibited by three-to-four months of life. Rooting initiates the suck and swallow
reflexes and is stimulated by touch. It allows the infant to transfer from tactile to visual responses and may help in
developing muscle groups involved in smiling. Newborns who do not have these reflexes at birth will not feed well.
However, if these reflexes are retained beyond their normal time-span, the child may be hypersensitive in the oral region,
have a continued desire for oral stimulation (chewing or sucking needs), immature chewing and swallowing movements,
speech and articulation difficulties and manual dexterity problems.
Plantar Reflex
Similar to the grasp Plantar reflex in the hands, is the Plantar reflex in the feet. This reflex emerges in utero and is
usually inhibited at seven to nine months of age. It is a spontaneous movement of the toes, stimulated by touch, and
precedes many of the larger movements made by the infant, so that it should disappear when the child begins to stand up
and walk. If this reflex is retained beyond the first year of life, the child may sense gravitational insecurity. It can be
observed when trying to put shoes on a child: the toes curl under and it becomes impossible to push the foot into the shoe.
“The late persistence of the response may suggest sensorimotor dysfunction or deficit” (Crutchfield, p. 173).
Spinal Galant
The Spinal Galant reflex also emerges in utero and should inhibit between
three and nine months of age. This reflex facilitates movement in the womb
and allows hip flexibility. “…it may take an active role in the birth process.
Contractions of the vaginal wall stimulate the lumbar region and cause small
rotational movements of the hip on one side…. In this way, the baby can help
to work its way down the birth canal” (Goddard, p. 16). It is believed that
this reflex also works to help get the elimination system up and going.
Connections have been found between children with a retained Spinal Galant
reflex and auditory difficulties as well as urinary and digestive disorders such as irritable bowel syndrome (Goddard, p.
16). If this reflex is retained the following behaviors are usually observed: constant fidgetiness, inability to sit still,
difficulty with concentration, poor bladder control and bedwetting past the age of five, tactile hypersensitivity, auditory
processing difficulties, scoliosis of the spine, short term memory, dislike for clothes to be fitted at the waist, posture and
gait problems (hip rotation to one side when walking on the side which retains the reflex). It may also interfere with the
full development of the later amphibian and segmental rolling reflexes, affecting fluency and mobility in physical
activities or sports” (Goddard, p. 17).
Tonic Labyrinthine Reflex
The Tonic Labyrinthine reflex in the forward (flexed) position emerges
in utero and inhibits at at about the age of four months. Its counterpart,
the Tonic Labyrinthine reflex in the backward position (extension)
emerges at birth and gradually diminishes between six months and three
years of age, as the postural and bridging reflexes are emerging. This
reflex is closely linked with the Moro reflex.
Both are vestibular in origin, and both are activated by stimulation of
the labyrinths, movement of the head and alteration of position in space…
The tonic labyrinthine reflexes exert a tonic influence upon the
distribution of muscle tone throughout the body, literally helping the
neonate to “straighten out” from the flexed position of the fetus and the
newborn (Goddard, p. 17-18).
If these reflexes do not inhibit as they should, the child will have
difficulty with balance and gravitational security. Thus he may have
difficulty in judging space, distance, depth and velocity. Muscle tone
is affected, as is controlled eye movement. Later reflexes will not
emerge as they should, which can affect creeping, crawling and sensory
integration. “Head control and good balance are essential to the
automatic functioning of all other systems – a residual tonic labyrinthine
reflex (TLR) will prevent the complete establishment of both head
control and of balance” (Goddard, p. 20). Indicators of a retained
forward TLR are: poor balance, postural problems, poor muscle tone, eye movement difficulties, visual-perceptual
problems, vertigo, motion sickness beyond the age of puberty, orientation difficulties, headaches, auditory confusion, and
under-developed head righting reflexes. A retained backward TLR can be exhibited through poor posture, poor balance
and coordination, stiff, jerky movements through poor muscle tone, vestibular problems, visual-perceptual and spatial
perception problems, poor sequencing skills, and poor organization skills.
Asymmetric Tonic Neck Reflex
The Asymmetric Tonic Neck reflex (ATNR) also emerges in utero.
It should inhibit at about six months of age. This reflex facilitates
movement in the womb, assists in balance control, and increases
neural control. It may even be activated during the birth process.
It helps the fetus and newborn develop muscle tone, homolateral
movements such as in early creeping, and early hand-eye
coordination. The ATNR also ensures free airway when lying on
the tummy (the head will turn toward the extended arm rather than
face down). Continued presence of the ATNR can interfere with
the development of laterality. However, “[i]n the persistent
influence of the ATNR on movement, almost every important motor skill will fail to develop” (Crutchfield, p. 202). A
retained ATNR reflex affects many areas: balance is affected when the head is rotated, cross pattern movements might
be impaired as midline cannot be crossed (vertical midline barrier), mixed laterality occurs, hand-eye coordination is
affected in reading and writing, horizontal eye tracking is impaired, difficulties are observed with bilateral integration,
written expression is poor, and reading comprehension may be compromised. “[W]riting never becomes automatic and
therefore they may have difficulty with multi-tasking” (Goddard, p. 12). The hand will want to extend when writing,
rather than bending at the elbow and assuming a normal hand-writing position.
Symmetric Tonic Neck Reflex
The Symmetrical Tonic Neck reflex (STNR) is considered a “bridge”
reflex as it emerges after birth and should inhibit soon thereafter. It
emerges between six and nine months of age and should be inhibited
between nine and eleven months. It assists in inhibiting the TLR and
bridges into creeping on hands and knees. It further helps the baby
to defy gravity because now he is attempting to lift more than just the
head or a limb at one time. Rather, the infant attempts to lift his body
off of the floor into a quadruped position, which assists in alignment
of the spinal cord for a later standing position. The child learns to
operate the upper and lower body independently of each other, and
training of reestablishment of binocular vision begins (accommodating
the eyes as they look at objects in the distance and then at his hands as they creep forward). “Creeping is one of the most
important movement patterns in the prolonged process of teaching the eyes to cross the midline. In addition to looking
ahead, babies also learn eye-hand coordination from the movement of the hands…. It is through creeping that the
vestibular, proprioceptive and visual systems connect to operate together for the first time. Without this integration
there can be a poorly developed sense of balance and poor space and depth perception” (Goddard, p. 23). Signs of a
retained STNR might include: poor posture, tendency to slump when sitting, “w” leg position when sitting on the floor, poor
hand-eye coordination, difficulty copying from a blackboard to desk, slowness at copying, difficulty with vertical
tracking (necessary for aligning columns in math calculations), difficulty with activities such as swimming, forward rolls
(activities that involve a coordinated upper and lower body) and difficulty with attention. “At the Bender Institute, O’
Dell and Cook (1996) found a retained STNR to be a significant factor in children with…ADD and…ADHD. Both groups
improved markedly when the STNR was inhibited as a result of a specific movement program” (Goddard, p. 24).
Landau Reflex
The Landau reflex is another “bridge” reflex, as it emerges between three and ten weeks of age and should not remain
throughout life. As with the STNR, the Landau reflex has an inhibitory effect on the TLR. It also helps strengthen
muscle tone and develop vestibulo-ocular motor skills. “Muscle control must be available in order for righting reactions to
work” (Crutchfield, p. 213). A retained Landau reflex may signify causal primitive reflexes. It might be observed as “a
child may run with stiff awkward movement in the lower half of the body and find hopping, skipping and jumping difficult
as he cannot flex the leg muscles at will” (Goddard, p. 34).
Head Righting Reflexes
Head Righting Reflexes are postural reflexes. They emerge between two and four months of age and should remain for
life. While the Labyrinthine Head Righting reflexes operate from the midbrain, the Oculo Head Righting reflexes are
dependent on the functioning of the cerebral cortex (higher brain activity).
These [reflexes] are reactions to gravity which result from somatosensory, visual and proprioceptive influences acting
together when the three inputs are available and functioning appropriately…. The oculo-headrighting reflexes operate as a
result of visual cues, while the labyrinthine headrighting reflexes are dependent upon vestibular information. The two
should synchronize to supply accurate data upon which head position is adjusted. If they fail to develop fully, or only one
develops adequately, balance, controlled eye movements and visual perception will all be impaired (Goddard, p. 31).
Head righting reflexes allow the head to automatically respond to the pull of gravity on the body so that balance is
maintained. They also allow the Vestibular-Ocular Reflex Arc to function effectively, which maintains visual stability
during head movement. If these reflexes are underdeveloped, several areas may be affected. Posture and postural
control are affected, as are muscle groups that support posture. Oculo-motor functioning might be impaired, affecting
visual fixation and visual pursuit. This will then affect reading ability, comprehension, spelling, and copying. Simple skills
like catching a ball may be difficult or impossible. Underdeveloped horizontal headrighting reflexes may also be an
indication of a retained ATNR, whereas underdeveloped forward and backward headrighting reflexes may indicate a
retained TLR.
Amphibian Reflex
Another postural reflex is the Amphibian reflex. It emerges between four and six months of age and should remain for
life. This reflex, when fully developed, indicates an inhibited ATNR. It allows freedom for independent movement of the
arms and legs, which is “essential for crawling, creeping, and gross muscle coordination later on and enables the child to
move one quadrant of the body independently of the other three” (Goddard, p. 34). This naturally allows greater
flexibility and adaptability in movement. If the reflex is underdeveloped the following observations might be noted: poor
muscle tone, poor crawling and creeping skills, difficulty with activities that depend on gross muscle coordination,
bilaterality problems and a lack of trunk mobility. “Total lack of an amphibian reflex suggests uninhibited primitive
reflexes, particularly the…ATNR and the…TLR” (Goddard, p. 34).
Segmental Rolling Reflex
The Segmental Rolling reflexes are postural reflexes that emerge from six months when rolling from the back to tummy
and eight to ten months when rolling from tummy to back. These should remain throughout life. Movement starts at the
head and follows in a wave format through the shoulders, trunk and pelvis. Or, the movement may start at the pelvis and
move upward through a reverse pattern. It allows for easy flow of movement from lying to sitting, kneeling and eventually
standing. Later on, simple fluid movement from lying to standing is achieved. The reflex remains “to facilitate changing
positions and to give fluidity to movements such as running, jumping, skiing, etc.” (Goddard, p. 35). When these reflexes
are underdeveloped the following observations might be made: lack of body integration (especially with the trunk),
differentiated movement through the upper/lower and left/right sections of the body during certain movements, stiff gait
from a lack of hip movement.
While it would appear that retained primitive reflexes greatly affect development and learning, it might be mistakenly
assumed that underdeveloped postural reflexes do not affect learning as much as involvement in physical education and
sports activities, when gross muscle coordination is in high demand.
Whereas there is documented evidence that retained primitive reflexes underlie difficulties in the learning of basic skills
such as reading, writing and copying, less attention has been paid to the role of postural reflexes in providing a functional
link between postural control, cognitive functioning and academic performance (Goddard, p. 37).
Academic performance seems to be most affected by underdeveloped postural reflexes when the child reaches higher
education. Such problems are manifested in these areas: adaptation, problem solving, multi-processing, sequencing, and
information overload.
The effect on a child of having underdeveloped postural reflexes is the environmental and social equivalent of having an
underdeveloped vocabulary. Often an individual can cope as long as the rules remain the same and it is possible to use
previously learned skills. If the rules required by a situation changes, such children are forced to “learn and practice”
the new rules because they are not able to adapt and change to meet the altered circumstances. This can result in
“awkwardness,” feelings of personal and social inadequacy and increased propensity to suffer from anxiety (Goddard, p.
37).
Primitive and postural reflexes play an important role in the development of the child. Not only do they reveal the
healthy development of the central nervous system, but they also lead to more advanced development for muscle
coordination, balance, and academic learning. These early reflexes are what make higher activities possible. “There are
two points to emphasize: (1) Development is variable even with the normal child; (2) each new activity is built upon
previous patterns which are integrated and elaborated on to make possible the varied, complex, and refined movements of
function” (Fiorentino, p. 9). When learning problems develop for a child, it is essential that it be determined where the
problem began developmentally. Dr. Dorinne Davis says, “Muscular balance is an outward sign that our body is
functioning properly” (Davis, p. 31).
After birth, “[g]ravity presents a new challenge to balance and muscle power. Some of the once preferred patterns that
were expressed as far back as fetal life may be simpler and more readily available than complex patterns. The ability to
generate novel movements is impaired because at least one system – the nervous system – is not functioning normally. The
requirements of the activity or skill may be too difficult … so postures and movements that require less strength and
balance are used” (Crutchfield, p. 203).
If a cluster of aberrant primitive reflexes are detected, it is essential that a reflex inhibition and stimulation program
be initiated. “[T]he innate mechanistic processes involved in the inhibition, modification and transformation of the basic
reflexes are observable and replicable at any age to assist in overcoming neurological impairment” (Blythe, p. 46). As the
child begins to correct the early movement patterns, the reflexes can become inhibited, later postural reflexes can
develop appropriately, and then higher cognitive abilities can begin to come together for the child as maximum integration
is facilitated.
“Children who can discriminate between the directions begin to understand what the teachers are talking about – but those
who can’t discriminate, don’t understand what teachers are talking about. A child who is still in the laterality stage (does
not know right and left) or lacks directionality (has not gained a sense of up and down, before and behind) will continue to
get…letters [p, q, b, d] confused” (Cheatum, p. 117).
Through reflex inhibition and stimulation, laterality, directionality, spatial, and orientation problems should be alleviated,
allowing for better comprehension and application of reading, writing, and math skills. It is logical to assume that all
behavior is basically motor, that the prerequisites of any kind of behavior are muscular and motor responses. Behavior
develops out of muscular activity, and so-called higher forms of behavior are dependent upon lower forms of behavior,
thus making even these higher activities dependent upon the basic structure of the muscular activity upon which they are
built (Kephart, p. 79).
Resources
Blythe, Peter and David J. McGlown. An Organic Basis for Neuroses and Educational
Difficulties. Great Britain: Insight Publications, 1979.
Cheatum, Billye Ann and Allison A. Hammond. Physical Activities for Improving
Children’s Learning and Behavior. Illinois: Human Kinetics, 2000.
Crutchfield, Carolyn A. and Marylou R. Barnes. Motor Control and Motor Learning in
Rehabilitation. Atlanta, Georgia: Stokesville Publishing Company, 1993.
Davis, Dorinne S. Sound Bodies Through Sound Therapy. New Jersey: Kalco
Publishing, L.L.C., 2004.
Eliot, Lise. What’s Going On In There? How the Brain and Mind Develop in the
First Five Years of Life. New York: Bantam Books, 1999.
Fiorentino, Mary R. Normal and Abnormal Development: The Influence of Primitive
Reflexes on Motor Develoment. Illinois: Charles C. Thomas, 1972.
Goddard, Sally. Reflexes, Learning and Behavior: A Window into the Child’s Mind.
Eugene, Oregon: Fern Ridge Press, 2002.
Kephart, Newell C. The Slow Learner in the Classroom. Columbus, Ohio: Charles E.
Merrell Publishing Company, 1971.
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