Retained Primitive Reflexes and ADHD: Another Piece of the Puzzle (And Free Exercises to Help)

wolfelin
3 days ago
8 min read

Going Granola Without Going Nuts · Neurodiversity · Sensory · 7 min read

When someone first said the words "retained primitive reflexes" to me, my brain immediately went to tiny little monkeys doing some kind of ancient ancestral survival dance.

Which is not exactly what it means. But honestly? Not entirely wrong in spirit either.

Once I understood that primitive reflexes are movements literally built into every human baby for survival, and that most of us graduate out of them naturally in the first year of life while some kids do not quite make it all the way through graduation, it made complete sense. We all start with these reflexes. Most of us just do not remember having them.

What I also did not know was that when these reflexes stick around longer than they should, they can quietly contribute to things that look a lot like ADHD, sensory challenges, learning difficulties, and coordination struggles. And what I really did not know was that there are exercises you can do at home, for free, that can actually help.

So let us talk about it. Because this is one of those pieces of the neurodiversity puzzle that almost nobody mentions, and I genuinely think more parents should know it exists.

What is a primitive reflex and why does it matter?

Primitive reflexes are automatic movements that babies are born with, controlled by the brainstem, that help them survive the birthing process and the first months of life. You have probably seen them. The way a newborn startles at a loud noise and throws out their arms. The way they turn their head when their cheek is touched. The way their tiny fingers grip around yours with surprising strength.

In typical development, these reflexes are active early and then gradually integrate, meaning they get absorbed into the central nervous system and replaced by more voluntary, controlled movements. By the time a child is walking and talking and starting school, most primitive reflexes should be fully integrated.

But sometimes they do not integrate fully. And when they stick around, they are called retained primitive reflexes. And that retention can interfere with things like reading, writing, coordination, focus, sensory processing, and emotional regulation in ways that are genuinely hard to see unless you know to look for them.

What the research says

A 2025 peer-reviewed study found that children with ADHD and autism show higher rates of retained primitive reflexes, particularly the ATNR, compared to typically developing peers. A twelve-week structured exercise program reduced ATNR retention and led to significant behavioral improvements in the ADHD group, including better focus and coordination.

Research published in Frontiers in Psychiatry found that ADHD is associated with retained tonic neck reflexes, and that these retained reflexes may contribute to the hyperactivity, impulsivity, and attention challenges we see in ADHD. The authors suggest that movement-based interventions targeting reflex integration may support behavioral development alongside other ADHD treatments.

The brain is remarkably plastic. It can build new pathways at almost any age. Which means that even if your child has retained reflexes, there is real reason for hope.

What causes a reflex to be retained?

This is one of the most interesting and least talked about parts of the whole topic. Retained reflexes can be linked to birth complications including cord around the neck, cesarean section, or a very fast or very difficult labor. They can also be connected to limited tummy time or floor time in early infancy, a short crawling phase, early walking, chronic ear infections, head injuries, or illness in early childhood.

In our son's case, the occupational therapist suspected his two retained reflexes were connected to the fact that he was born with the umbilical cord around his neck. Even mild birth experiences that seem to resolve quickly can sometimes leave an imprint on how the nervous system wires itself in those early months. His body did the best it could. Some of those early reflexes just did not fully let go on the usual timeline.

Knowing that did not change anything about who he is. But it gave us a map. And a map is always better than wandering.

The most common retained reflexes, what they look like, and what you can do at home.

Here is the part I want every parent to sit with, because this genuinely surprised me: you do not need a program or a therapist to start working on reflex integration. The exercises are simple, they take just a few minutes a day, and they cost nothing. Consistency over time is the key. Most resources recommend doing them once or twice daily for several months to support the brain in building new pathways.

Always check with your child's pediatrician or occupational therapist before starting, especially if you have any concerns. But the exercises themselves are gentle, movement-based, and completely accessible.

ATNR: Asymmetrical Tonic Neck Reflex

The fencing reflex. Typically integrates by four to six months.

If retained may look like: poor handwriting, difficulty tracking words across a page, losing their place while reading, poor eye-hand coordination, and trouble crossing the midline of the body. This was one of our son's two retained reflexes and it showed up most clearly in his handwriting and his ability to copy shapes.

At-home exercise

Cross-crawl movements where the opposite arm and leg move together. Have your child crawl on hands and knees, moving right hand and left knee forward at the same time, then left hand and right knee. Slow and deliberate is better than fast. Also try slow neck turns paired with arm stretches: turn the head to the right while the right arm extends out, then return to center and repeat on the other side. Do this six to eight times on each side, once or twice daily.

STNR: Symmetrical Tonic Neck Reflex

Supports the transition to crawling. Typically integrates by nine to eleven months.

If retained may look like: slumping when sitting, difficulty copying from a board, poor posture, W-sitting on the floor, slow with written work, and trouble shifting visual focus from near to far. Also one of our son's retained reflexes.

At-home exercise

Rocking on hands and knees: start on all fours, then slowly rock forward so the elbows bend and the head drops down, then rock back so the arms straighten and the head lifts up. Slow and rhythmic. Do this ten times, once or twice daily. Cat-cow yoga stretches do exactly this and children often enjoy them. Make it silly. Add animal sounds. The movement is what matters.

Moro Reflex

The startle reflex. Typically integrates by two to four months.

If retained may look like: a nervous system in a constant state of high alert. Emotional reactivity, sensory overload, poor stress tolerance, hypersensitivity to sound, light, or touch, anxiety, and difficulty recovering after being startled or surprised. This one in particular can look a lot like anxiety or sensory processing disorder.

At-home exercise

Starfish breathing: have your child lie flat on their back, arms and legs relaxed. Ask them to slowly stretch all four limbs out wide like a starfish, opening their hands and tilting their head back gently, then slowly bring everything back in like they are curling into a ball. Hold each position for five to seven seconds. Do this six times, once or twice daily. It looks like nothing. It does something.

Spinal Galant Reflex

The hip rotation reflex. Typically integrates by three to nine months.

If retained may look like: constant fidgeting especially when sitting, hypersensitivity around the waist and lower back, bedwetting beyond the typical age, difficulty concentrating, and poor short-term memory. Children with this retained reflex often cannot stand having waistbands touching their skin.

At-home exercise Snow angels on the floor: have your child lie on their back and slowly move their arms and legs out and back in like a snow angel, making sure all four limbs move at the same rate. Slow and deliberate, counting to ten or fifteen on the way out and the same count coming back in. Do this five times, twice daily. Also try gentle rocking in a hammock or on a therapy ball if you have access to one.

TLR: Tonic Labyrinthine Reflex

Supports head control and postural development. Integrates over the first three years.

If retained may look like: low muscle tone, toe walking, poor balance, motion sickness, difficulty with spatial awareness, and trouble knowing where their body is in space. Common in kids with ADHD.

At-home exercise Balance and vestibular activities: walking heel to toe along a line, standing on one foot, rocking on a balance board or wobble cushion, rolling on the floor, spinning gently in an office chair. These activities stimulate the vestibular system which helps integrate this reflex. Even ten minutes of this kind of movement daily can make a meaningful difference over time.

The part I really want you to hear

These exercises are free. They take five to ten minutes a day. They require no equipment, no program, and no specialist. Just consistent movement over time.

The brain is plastic. It builds new pathways at almost any age. You do not have to wait for a formal evaluation to start moving in the right direction. Start today and see what happens over the next few months.

How to find out if your child has retained reflexes.

The best starting point is a referral to a pediatric occupational therapist trained in primitive reflex assessment. Not all OTs specialize in this area so ask specifically. Your child's pediatrician can refer you, or you can contact your school district's special education department since OT services are sometimes available through the school as part of an evaluation or IEP.

If cost is a barrier, remember the university clinic option I wrote about in my post on psychoeducational evaluations. Many university OT programs offer assessments at significantly reduced cost and the quality is excellent.

Some signs that make it worth investigating: poor handwriting that does not improve with practice, fidgeting that seems triggered by clothing or chair backs touching the lower spine, persistent bedwetting, significant sensitivity to sound or touch, poor coordination that seems out of proportion to other abilities, or a general sense that their body is working against them even when their mind is trying hard.

One more thing about our son.

I want to circle back to something because it feels important to say.

Our son went to occupational therapy. He loved every session. He made a list at the start of every appointment of what they were going to do and how, which was itself a form of executive functioning practice that carried into his regular life. Did it dramatically resolve his retained reflexes? Honestly I cannot say for certain. What I can say is that I never regretted trying it. And I know I would have regretted not trying it after it had been recommended.

His handwriting, which was once not something you would trust with a wedding invitation, is now genuinely lovely. He has learned cursive. He is proud of it. Was that the OT? The new school? The pencil and paper environment? The at-home practice? Probably all of it together, which is how most things work when you are raising a child whose nervous system is figuring itself out on its own timeline.

The journey does not have to be as heavy as it sometimes feels. There is real hard stuff in navigating all of this, yes. But there is also a lot that is fascinating and surprising and, if you give yourself permission to find it funny, genuinely amusing. My son once had the fencing reflex. He is now a cursive-writing, list-making, baseball-playing kid who won MVP. I will take that story every single time.

This is one more piece of the puzzle. It might be relevant to your child. It might not be. But now you know it exists. And knowing is always better than not knowing.

Trust the weird thing. Look into it. You might find something that finally makes another piece click.

I am not a doctor, occupational therapist, or medical professional. The exercises shared here are based on widely cited resources from occupational therapy literature and are intended as a general introduction. Please consult a licensed occupational therapist or your child's pediatrician before starting any reflex integration program, especially if your child has any medical conditions or developmental concerns. These exercises are not a substitute for professional evaluation or treatment.