We designed Reflex Integration Through Play™️ around three themes of scientific research:

  • Biological understanding of primitive reflexes
  • Connections between primitive reflexes and functional outcomes
  • Interventions that address retained reflexes related to functional outcomes

For each of these themes, we present publications and some brief summaries of the findings, designed to facilitate further exploration by the reader.


We designed Reflex Integration Through Play™️ around three themes of scientific research:

  • Biological understanding of primitive reflexes
  • Connections between primitive reflexes and functional outcomes
  • Interventions that address retained reflexes related to functional outcomes

For each of these themes, we present publications and some brief summaries of the findings, designed to facilitate further exploration by the reader.

Biological Understanding of Primitive Reflexes

Primitive reflexes are well understood by the medical community and have been used in screenings of both children and adults for many years.

Amiel-Tison C, Grenier A. Neurological Assessment during first year of life. New York. Oxford University Press, 1986; 46-94.

Schott JM, Rossor MN. The grasp and other primitive reflexes. J Neurol Neurosurg Psychiatry. 2003 May;74(5):558-60. doi: 10.1136/jnnp.74.5.558. PMID: 12700289; PMCID: PMC1738455.

Futagi Y, Toribe Y, Suzuki Y. The grasp reflex and moro reflex in infants: Hierarchy of primitive reflex responses. International Journal of pediatrics. 2012; 2012:191562,

Connections Between Retained Primitive Reflexes and Developmental and Functional Challenges

Multiple studies over many years have demonstrated a strong correlative relationship between various developmental and functional challenges and the presence of retained primitive reflexes. We explore some of those relationships within the course.

Sigafoos, J., Roche, L., O’Reilly, M. F., & Lancioni, G. E. (2021). Persistence of primitive reflexes in developmental disordersCurrent Developmental Disorders Reports8(2), 98–105. 

  • A recent literature review of the correlation between RPR and developmental disorders.
  • “Several studies have shown persistence of primitive reflexes in children with cerebral palsy, attention-deficit/hyperactivity disorder, and autism spectrum disorder. Persistence of primitive reflexes varies in relation to the type and severity of symptoms in cases of cerebral palsy and attention-deficit/hyperactivity disorder and with the presence of comorbid intellectual disability in children with autism spectrum disorder. Primitive reflexes have also been shown to persist in adults with Down syndrome.”

Goddard Blythe, S. (2017). Attention, balance and coordination. The A.B.C. of learning success (2nd ed.). Wiley Blackwell.

  • A comprehensive overview of the relationship between neuromotor maturity and physical development on learning outcomes and behavior in childhood and later life.

Lorie Richards, Ryan Avery, Sarah Gray, Robin Price; Relationship of Retained Primitive Reflexes and Handwriting Difficulty in Elementary-Age Children. Am J Occup Ther July 2022, Vol. 76(Supplement_1), 7610505010p1. doi:

  • “We found that more children with handwriting difficulties had reflex retention, and reflex retention was associated with handwriting ability, after controlling for vision, implying a likely need to address reflex integration.”

Chinello, A., Di Gangi, V., & Valenza, E. (2018). Persistent primary reflexes affect motor acts: Potential implications for autism spectrum disorder. Research in Developmental Disabilities, 83, 287–295.

  • “Persistence of primitive reflexes might alter the developmental trajectory of future motor ability and therefore their evaluation might be an early indicator of atypical development.”

Gieysztor, E. Z., Choińska, A. M., & Paprocka-Borowicz, M. (2018). Persistence of primitive reflexes and associated motor problems in healthy preschool children. Archives of Medical Science, 14(1), 167–173.

  • Statistically significant correlation between uninhibited PR presence in children over 4 years old and poor physical skills, even in otherwise healthy children.

Diana Feldhacker, Reilly Cosgrove, Benjamin Feiten, Kayleigh Schmidt, Marissa Stewart; Relationship Between Retained Primitive Reflexes and Scholastic Performance. Am J Occup Ther August 2021, Vol. 75(Supplement_2), 7512505164p1. doi:

  • Results indicated statistically significant relationships between reflexes and areas of academic performance.

Matuszkiewicz, M., & Gałkowski, T. (2021). Developmental language disorder and uninhibited primitive reflexes in young children. Journal of Speech, Language, and Hearing Research, 64(3), 935–948. 

  • Developmental language delays associated with RPR.

Bob, P., Konicarova, J., & Raboch, J. (2021). Disinhibition of primitive reflexes in attention deficit and hyperactivity disorder: Insight into specific mechanisms in girls and boys. Frontiers in Psychiatry, 12. 

  • “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.”

Andrich, P., Shihada, M. B., Vinci, M. K., Wrenhaven, S. L., & Goodman, G. D. (2018). Statistical Relationships Between Visual Skill Deficits and Retained Primitive Reflexes in Children. Optometry & Visual Performance, 6(3), 106–111.

  • “Logistic Regression analysis suggested that the Tonic Labyrinthine Reflex is a potential predictor of VSD; the Motor Speed and Precision Test and Gardner Reversals Frequency Test can potentially be used to predict Neuro-Sensory Motor immaturity.”

Calvin, N., & Ramli, Y. (2020). Detecting neurodevelopmental problems using the simple parent-reported screening tool in combination with primitive reflex assessment. Paediatrica Indonesiana, 60(1), 31–6.

  • While not precise enough as a primary screening tool, RPR seen as highly correlated with suspect results on other developmental screening tools.

Melillo R, Leisman G, Machado C, Machado-Ferrer Y, Chinchilla-Acosta M, Kamgang S, Melillo T, Carmeli E. Retained Primitive Reflexes and Potential for Intervention in Autistic Spectrum Disorders. Front Neurol. 2022 Jul 7;13:922322. doi: 10.3389/fneur.2022.922322. PMID: 35873782; PMCID: PMC9301367.

  • “Evidence from large data sets indicates a significant relationship between RPRs, maturation, and cognitive function”

Interventions Related to Primitive Reflexes and Functional Outcomes

A number of studies in the last 20+ years have examined the effects of treating developmental challenges, often in the context of schools, using primitive reflex integration techniques.

McPhillips M, Hepper PG, Mulhern G. Effects of replicating primary-reflex movements on specific reading difficulties in children: a randomised, double-blind, controlled trial. Lancet. (2000) 355:537–41. PDF

  • Improvements in children’s reading ability seen specifically in addressing movement patterns to integrate the ATNR.
  • Utilizing movements that imitate the movements triggered by the Moro reflex, the tonic labyrinthine reflex, the ATNR, and the symmetrical tonic neck reflex, evaluates the impacts of those movements in a group of children, including two control groups for comparison.
    • As an example of the movements tested: “for the ATNR movement the child sat on a chair with eyes closed and turned the head slowly to one side followed by a slow extension of the arm on the same side. The arm was then flexed with the hand returning towards the shoulder while the head was turned back towards the mid-line. This procedure was then repeated for the opposite side,”

Melillo, R., Leisman, G., Mualem, R., Ornai, A., & Carmeli, E. (2020). Persistent childhood primitive reflex reduction effects on cognitive, sensorimotor, and academic performance in ADHD. Frontiers in Public Health, 8.

  • “After a 12-week program, RPR’s were significantly reduced, as well as performance on all motor and cognitive measures significantly increased. Listening comprehension demonstrated significant increases between pre- and post-testing of 7% (W = 1213000; df = 2094; p < 0.0001) and mathematical problem solving revealed a significant increase of 5% (W = 1331500; df = 2091; p < 0.0001) associated with a significant reduction in primitive reflexes. The study concluded that the incorporation of relatively simple hemispheric-based programming within the educational system worldwide could relatively inexpensively increase academic, cognitive, and motor performance.”

Grzywniak C. Integration exercise programme for children with learning difficulties who have preserved vestigial primitive reflexes. Acta Neuropsychol. (2017) 15:241–256. 10.5604/01.3001.0010.5491 [Google Scholar]

  • The program of exercises positively influenced the performance of the children from the experimental group during tests improving motor skills and learning abilities, relative to the control group.
  • “Studies the effectiveness of exercises aimed at supporting the development of children with learning difficulties and RPRs. Their symptoms included visual-motor coordination and attentional deficits, hyperactivity, and reduced visual and auditory analysis and synthesis.”

Jordan-Black JA. The effects of the Primary Movement programme on the academic performance of children attending ordinary primary school. J Res Spec Educ Needs. (2005) 5:101–11. PDF

  • A summary of a comparative study on the progress of 683 children over a two-year period. They completed the Primary Movement protocol.
  • “It was found that ATNR persistence was significantly associated with level of attainments in reading, spelling and mathematics and that boys were more at risk than girls for ATNR persistence. In both studies, it was found that the movement intervention programme had a very significant impact on reducing the levels of ATNR persistence in children and that this was associated with very significant improvements in reading and mathematics, in particular.”

Timothy Wahlberg, PhD, Dennis Ireland, OD, Med, Can Replicating Primary Reflex Movements Improve Reading Ability?, Optometry and Vision Development, vol. 36, no.2, 2005, p. 89-91. PDF

  • A relatively small sample size (22 students) were given activities mimicking PR movements over a one year period, found significant improvements in reading fluency along with RPR scores.

Bein-Wierzbinski, W. Persistent Primitive Reflexes in Elementary School Children. Presented at the 13th European Conference of Neuro-Developmental Delay in Children with Specific Learning Difficulties Chester, UK (2001).

  • Results that show improvement in oculo-motor functioning and reading skills as persistent reflexes were corrected. Functioning challenges continued to persist in the control group.

Bell, C. , Whitney, J. , Deiss, T., Tatarinova, Т. , Franckle, L. , Beaven, S. and Davis, J. (2019) The Effect of the MNRI Method on Neurotransmitter Biomarkers of Individuals with Neurodevelopmental Disorders. Neuroscience and Medicine, 10, 292-321. doi: 10.4236/nm.2019.103022.

  • Participants in an MNRI-focused study showed a tendency for regulation of neurotransmitters resulting in their calming down, decrease of hypervigilance, stress resilience increase, improvements in behavioral and emotional regulation, positive emotions, and cognitive processes control.

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