Disinhibition of Primitive Reflexes in Attention Deficit and Hyperactivity Disorder: Insight Into Specific Mechanisms in Girls and Boys

Objective: Cognitive and motor disintegration and other functional disturbances in various neuropsychiatric disorders may be related to inhibitory deficits that may manifest as a persistence or re-expression of primitive reflexes and few recent data suggest that these deficits may occur in Attention Deficit and Hyperactivity Disorder (ADHD).Methods: We have tested a hypothesis to which extent ADHD symptoms and balance deficits are related to persisting primitive reflexes, such as Asymmetric Tonic Neck Reflex (ATNR) and Symmetric Tonic Neck Reflex (STNR) in 80 medication-naïve children with ADHD (40 boys and 40 girls) in the school age (8–11 years) and compared these data with a control group of 60 children (30 boys and 30 girls).Results: These data show new finding that ADHD symptoms and balance deficits are strongly and specifically associated with persistent ATNR in girls and STNR in boys.Conclusions: These results provide first evidence in medical literature that ADHD in girls and boys is specifically related to distinguished neurological developmental mechanisms related to disinhibition of primitive reflexes.

Impact of umbilical cord arterial pH, gestational age, and birth weight on neurodevelopmental outcomes for preterm neonates

Background The aim of this study was to determine the impact of umbilical cord arterial pH, gestational age, and birth weight on neurodevelopmental outcomes for preterm neonates. Methods We examined 112 neonates. Inclusion criteria were: Saturations greater than 88%, and heart rates between 100–205 beats per minute. Measurements We assessed several neurodevelopmental factors as part of the Brazelton Neonatal Behavioral Assessment Scale (NBAS), 4th edition, such as asymmetric tonic neck reflex (ATNR), motor maturity, response to sensory stimuli, habituation, and state regulation. Initial assessment parameters such as APGAR score and umbilical cord arterial pH were used to assess neonates. Results We found a strong correlation between the presence of the sucking reflex and umbilical cord arterial pH (r = 0.32; p = 0.018981). Umbilical cord arterial pH was also correlated with the presence of asymmetric tonic neck reflex (r = 0.27; p = 0.047124), cost of attention (r = 0.31; p = 0.025381) and general motor maturity (r = 0.34; p = 0.011741). Conclusions We found that the sucking reflex may be affected in infants with low umbilical cord arterial pH values. Practitioners and parents can use the NBAS to help determine neurodevelopmental factors and outcomes in preterm infants, possibly leading to safer and more effective feeding practices and interventions.

Primitive Reflex Activity in Relation to Motor Skills in Healthy Preschool Children

Psychomotor development in the first year of life is possible due to activity and then integration of primitive (neonatal) reflexes. The presence of active primitive reflexes (APRs) in preschool and school-aged children indicates neuromotor immaturity. Studies show dependencies between the preserved activity of primary reflexes and developmental problems such as learning difficulties (problems with reading, writing, reduced mathematics skills, and dyslexia), difficulties with coordination, and attention deficit. The primary purpose of this study is to present the activity of three tonic reflexes in a sample of 112 Polish children aged 4–6 in relation to their motor skills. The children were examined for the presence of the asymmetric tonic neck reflex (ATNR), symmetric tonic neck reflex (STNR), and tonic labyrinthine reflex (TLR). Motor performance was examined with the MOT 4–6. Statistical analysis shows an inverse correlation between the score in the test of reflexes and motor efficiency (MOT 4–6) at p < 0.05 (−0.33). Children with increased reflex activity presented a lower level of motor efficiency. The multiple regression model showed that with the older age of the child and the decrease in the level of reflex activity, the motor skills of children improve. Thus, there is a need for early screening of primitive reflexes in children. Properly selected exercises and therapeutic activities aimed at integrating APRs in children with developmental difficulties can improve their motor skills, perceptual abilities, and emotional behavior.

Developmental Language Disorder and Uninhibited Primitive Reflexes in Young Children

Purpose Developmental language disorder (DLD) is a developmental disorder where children fail to acquire language in the absence of a clear cause. Many studies have reported general motor deficits in children with DLD, but no studies have uncovered a cure. The purpose of our study is to better understand the underlying motor deficits in DLD, starting from uninhibited primary reflexes—which are the most basic stage of motor development. Knowledge of this motor–language relationship should lead to earlier and more targeted interventions in young children with DLD. Method Children with DLD ( n = 75, age range: 4–10 years) and 99 age-matched typically developing (TD) children completed a nonword repetition test to assess DLD and six other tests to assess primitive reflexes. Results Children with DLD demonstrated higher levels of persistent primitive reflexes compared to TD children. As the scores for neuromotor immaturity increased, nonword repetition test scores decreased ( r = −.44, p < .01). Results indicated that TD children exhibited lower neuromotor immaturity ( M = 7.63, SD = 3.75) compared to children with DLD ( M = 13.51, SD = 4.47). All primitive reflexes (the Moro reflex, the symmetrical tonic neck reflex in flexion and in extension, the asymmetrical tonic neck reflex, the tonic labyrinthine reflex, and the Galant reflex) turned out to be statistically significantly different for the TD and DLD groups ( p < .001). We also observed some differences between sexes. Conclusions Children with impaired language development underwent slower neuromotor development. However, further research is needed to determine whether motor intervention programs that inhibit primitive reflexes are helpful for children with DLD.

Pelvic Symmetry Is Influenced by Asymmetrical Tonic Neck Reflex during Young Children’s Gait

Gait is one of the examined functions in child development. It should be economical and symmetrical. One test increasingly used by physiotherapists and pediatricians is asymmetrical tonic neck reflex (ATNR). Physiologically, it is observed from in utero up to six postnatal months. This reaction is inhibited with the growing maturation of the central nervous system (CNS). In some children, when the natural process of development is incorrect, ATNR manifests later in life, when it is observed as an automatic response of muscle tension to head rotation. Analysis of pelvis symmetry in the gait of children with active ATNR is important for better understanding their specific movements. In the gait of children with persistent ATNR, some variations are observed. The aim of the study was to investigate the gait symmetry of preschool children and the influence of persistent ATNR. Fifty preschool children with a trace form of ATNR were examined. The distribution of the gait parameters was determined using a BTS G-SENSOR measurement instrument. ATNR negatively influences pelvic obliquity and pelvic rotation (p < 0.01). Younger children have a statistically higher symmetry index of pelvis obliquity in the examined group (p = 0.015). Boys obtain a higher result of symmetry in pelvic tilt than girls in the group (p = 0.027). ATNR affects walking symmetry in preschool children, thus evaluation of the reflex activity and then proper therapy is required to support proper development.

CASE STUDY OF PRIMITIVE REFLEXES IMPACT ON SWIMMING SKILL ACQUISITION BY HEALTHY CHILDREN

Primitive reflexes is an automatic muscle reactions which are only present in the first few months, but can remain active in healthy children, thus, impacting on motor proficiency. There is little evidence how primitive reflexes influence on swimming skills acquisition by healthy children. The aim of the study is to examine how primitive reflexes influence swimming skills acquisition by healthy children. Subjects: two 7-year-old girls. Methods: Checklists by Oh et al., (2011) were used to evaluate swimming skill proficiency at swimming lesson 8 and 16. The results were represented as a percentage of the possible maximal score. The testing of the asymmetrical tonic neck reflex, the symmetrical tonic neck reflex, and the tonic labyrinthine reflex was done using Blythe’s, 5-point rating scale. The analysis was carried out using descriptive method. The first girl showed two reflexes at level 1, while the second girl demonstrated all tested reflexes at level 1, 2 and 3. The girl with less total score of reflexes (8%) achieved a better level of swimming proficiency (from 73% to 77%) than the girl with higher (25%) severity of these reflex (from 21% to 33%.). The obteined data evidence about influence of primitive reflexes on swimming skill acquisition by healthy children.

Detecting neurodevelopmental problems in children aged 1-5 years using the simple parent-reported screening tool in combination with primitive reflex assessment

Background The Kuesioner Pra Skrining Perkembangan/DPsQ (Developmental Pre-screening Questionnaire/DPsQ) is a series of questions and instructions used as a developmental screening tool for children aged 3 months to 6 years. However, the DPsQ cannot fully detect the soft signs of future neurological disorders. However, the retained primitive reflex assessment as an adjunct to the DPsQ may be useful for such detection. Objective To determine whether assessing for retained primitive reflexes can add to the usefulness of DPsQ as a neurodevelopmental screen in children aged 1 to 5 years. Methods This cross-sectional study included children aged 1-5 years. Developmental screening was done using the DPsQ and retained primitive reflex assessment was performed using the Institute for Neuro-Physiological Psychology (INPP) screening and scoring guideline. Results Of 46 subjects, 56.8% of children with normal DPsQ scores had not retained primitive reflexes, while 88.9% of children with suspect DPsQ score had retained primitive reflexes. Hence, children with suspect DPsQ score had a 10.5 times higher chance of retaining primitive reflexes (OR 10.50; 95%CI 1.19 to 92.73; P=0.034). Furthermore, 66.7-77.8% of children with suspect DPsQ score had retained the Moro reflex, asymmetrical tonic neck reflex (ATNR), and symmetrical tonic neck reflex (STNR). Neither gender nor age were significantly associated with either suspect DPsQ score or the presence of retained primitive reflexes. Conclusion The DPsQ results correlate to integration of primitive reflexes, with 10.50 greater odds of children with ‘suspect’ DPsQ scores to have retained primitive reflexes. As such, retained primitive reflexes is not useful as a primary screen for future neurological problems. However, a high percentage of children (43.2%) with normal DPsQ scores also have retained primitive reflexes.

Disappearance of Biased Visual Attention in Infants: Remediated Tonic Neck Reflex or Maturating Visual Asymmetry?

Typically, infants younger than four months fail to attend to the left side of their spatial field, most likely due to an innate asymmetrical tonic neck reflex (ATNR). In a critical transition, by four months of age, infants begin to reach and develop depth perception; and, by five months, they tend to monitor the entire spatial field. However, this developmental transition can be delayed. Moreover, there is always a residual right-sided spatial bias under cognitive load, a phenomenon that may also occur among adult stroke patients. While causative factors of biased visual attention in both infants and brain-injured adults may vary, mechanisms of remediation may be similar. This literature review addresses whether the infant’s emergence of attention toward a full visual spatial field and the associated shift from monocular to binocular vision occurs because of (a) increased left side reaching, loosening the rarely mentioned high muscle tension ATNR or (b) maturational resolution of visual asymmetry in motion perception. More research is needed to investigate the origins of the infants’ visual control system and factors involved in its development, especially because Alzheimer and dementia patients may also show primitive two-dimensional vision and deficits in perceiving objects-in-motion that seem to mirror infant visual perception.