Primitive Reflexes Impact Attention and Learning

Last time we talked about how weak auditory processing can affect attention.  In this newsletter, we discuss primitive reflexes.  Primitive reflexes are involuntary movements that develop in-utero and are essential to the survival of the newborn.  Typically, these reflexes will be integrated by age one.  If they don’t “disappear,” they continue to fire and cause neurological interference that inhibits efficient development and easy learning.

Okay, so what does this mean in layman’s terms?  Basically, if a reflex is present, the brain has to divert energy to prevent the reflex from occurring.  This means there is less “brain” to pay attention to the task at hand.  This is why we evaluate for the presence of reflexes.

Below, we talk about 5 primitive reflexes that are known to affect educational progress.

The Moro Reflex is also known as the “Startle Reflex.”  When an infant becomes startled by a loud noise, sudden movement, or bright light, he responds by extending their arms outward and inhaling sharply.  The reflex is normally integrated by 2-4 months of age, and is replaced by the adult startle reflex.  If it isn’t integrated, the individual will often over-react to auditory stimulation.  The retention of this reflex causes the person to remain in a “fight or flight” mode.  Staying in this fight or flight mode causes the nervous system to be over activated.  This can cause the child to become fatigued and the child may have a weakened immune system.


Symptoms of a retained Moro Reflex include:

  • Excessive blinking
  • Fixation/Staring
  • Difficulty maintaining eye contact
  • Vestibular problems (Imbalance, dizziness, motion sickness, vertigo)
  • Sensitivity to bright lights
  • Anxiety
  • Frequent ear and throat infections
  • Depleted energy, fatigue, mood swings
  • Easily overloaded by sensory input, hypersensitivity to sound
  • Difficulty catching a ball or processing visual stimuli
  • Dislike of change


The Tonic Labyrinthine Reflex (TLR) helps prepare the infant for rolling over, creeping, crawling, standing, and walking.  This reflex is linked to balance and muscle tone.  If it is retained, it will disrupt balance and gross motor skills.

To see if the reflex is present, have the child do a “superman” movement.  Lying flat on his stomach, have the child raise his chin off the floor, bring his extended arms overhead close to his ears, and lift his straightened legs off the floor.  His body should be taut, only touching the floor at the midriff.  A school-aged child should be able to hold this for 20 seconds (see picture below).  If the child bends his legs or his body is shaking, it indicates the reflex is still present.


Symptoms of a retained Tonic Labyrinthine Reflex include:

  • Poor posture
  • Toe walker
  • Poor balance and coordination
  • Poor eye movement control
  • Information processing problems
  • Visual-perceptual difficulties
  • Afraid of heights
  • Weak or rigid muscle tone


spinal galant

The Spinal Galant Reflex is present at birth and usually disappears by 9 months of age.  It is activated when the child is touched on the side of the spine.  The child will usually flex toward the side that is stroked (see picture).

A student who has this reflex usually can’t sit still because every time his back is up against the chair, the reflex is activated, so he wiggles in his chair.  The student will want to pay attention, so he focuses on sitting still, but then he isn’t able to focus on what the teacher is saying or his assignments.

Symptoms of a retained Spinal Galant Reflex include:

  • Can’t sit still; fidgety
  • Short term memory problems
  • Bedwetting beyond age 5
  • Sensitive to tight clothing around waist
  • Constant noise making


The Asymmetrical Tonic Neck Reflex (ATNR) is fully developed at the time of birth.  It helps with movement down the birth canal.  If there is intervention during birth, such as use of forceps or caesarean birth, it can disturb the integration of the reflex.  The ATNR should go away between 4-6 months of age.

This reflex is caused by the rotation of the neck.  When a baby turns its head to one side, the limbs on that side straighten, and the limbs on the other side bend.


Now clearly, when an older child turns its head, the arm doesn’t pop out, but what happens is that the brain has to divert energy to prevent the reflex from occurring and it takes away from the attention to the task on which the child was supposed to be focusing.

The retention of this reflex causes the most interference with the learning process.

Symptoms of a retained Asymmetrical Tonic Neck Reflex include:

  • poor handwriting
  • heavy pencil grip and tension in the body when writing
  • All the energy that goes to the physical part of writing distracts the student from the writing content.  There is often a big discrepancy between the child’s ability to express themselves orally and in writing
  • Difficulty reading and tracking
  • Left-right confusion (Mixed laterality)
  • Difficulty copying from the board
  • Difficulty learning to ride a bike
  • ADD and ADHD characteristics

ATNR handwriting

Sample of a student with retained ATNR


The Symmetrical Tonic Neck Reflex (STNR) allows the baby to straighten its arms and bend its legs when in looks up.  It should be gone by 9-11 months of age.  This reflex allows the child to be able to crawl.  Crawling allows the baby to learn eye-hand coordination.

Symptoms of a retained Symmetrical Tonic Neck Reflex include:

  • Poor posture (– when head bends, the arms will bend causing a tendency to slump when sitting – often will end up almost lying on the desk to write)
  • Clumsy
  • Problems with copying from the board
  • Inability to crawl on hands and knees
  • Difficulty sitting with legs crossed ( “W” position when sitting on the floor)
  • Poor upper and lower body integration, affecting gross motor skills
  • Poor hand-eye coordination
  • Messy eater
  • Difficulty learning to swim

STNR handwriting

Sample of how a person with a retained STNR might sit when writing.


Part of our evaluation at Learning Enhancement Centers includes testing of reflexes.  If we find that an individual has retained reflexes, we will assign exercises to help integrate them.  It takes time, but we have found that these exercises can increase a student’s attention abilities and have a great impact in all areas of their lives.


Auditory Processing or ADHD?

In our last newsletter, we talked about the symptoms that can manifest in someone with attention challenges.  While we are not opposed to medicine, we don’t feel that it should be the first line of action.  To make sure that we are actually treating what is causing the attention difficulties, we generally evaluate five other areas that can cause attention difficulties separate from, or in addition to a biochemical reason.

One area we evaluate is Auditory Processing.  Auditory processing is different from hearing.  Basically, it is how you think about what you hear.

A central auditory processing disorder (CAPD) occurs when the auditory signal is received accurately by the ear, but becomes distorted, confused, or compromised in some way before it is received by the language area of the brain.

It’s Hard to Get the Message When You Have a Bad Connection

Perhaps the best way to understand a central auditory processing disorder in our “modern age” is to think about what it is like to be in an important conversation with a bad cell phone connection. You have to listen extremely hard, and any extra noise around (i.e. kids, traffic, etc.) becomes extremely irritating and hard to block out.

Because the signal is not clear, you miss part of what the speaker is saying and you find yourself saying, “What did you say?” and struggling to fill-in the gaps.

You’re not exactly sure what the speaker said, but you don’t want to sound stupid or uninterested, so you make what you think is an appropriate response.   Oops! That backfired. Now you have to explain about the bad connection and why you misinterpreted what they said and made an “off-the-wall” response.

You don’t quite understand the speaker, yet when you have a clear connection you really don’t have a comprehension problem.

It takes so much energy to keep up with this conversation, that you find your attention drifting. You feel distracted and frustrated, and doggone it, important or not, you just want to get off the phone.

Luckily for cell phone users, the way to a better connection is to hang-up and dial again. But for students with CAPD, this is life.

Common Symptoms of Central Auditory Processing Deficit

In more clinical terms, here are some symptoms that most literature on CAPD include:

• About 75% are male

• Normal hearing acuity

• Difficulty following oral directions

• Inconsistent response to auditory stimuli (the signal isn’t always confused, just sometimes.)

• Short attention span; fatigues easily during auditory tasks.

• Poor long and short term memory

• Difficulty with phonics, reading, or spelling; mild speech-language problems

• Says “Huh?” or “What?” or often asks for things to be repeated

• History of ear infections


There is a strong relationship between language, language development, auditory skills, and attention.  This can make it hard to identify individuals with auditory processing disorders because similar behaviors are exhibited among students with attention deficit hyperactivity disorder (ADHD).

It is widely accepted that both ADHD and CAPD may co-exist or occur independently.  It can be like the chicken-egg scenario.  Does someone have poor auditory skills because of ADHD, or does the auditory processing cause the ADHD?  If the attention difficulties are due to an auditory processing, medicine might mask the symptoms, but it is not going to treat the root cause of the problem.  This is why an evaluation is so important.

Only an audiologist can confirm the presence of a Central Auditory Processing Disorder.  However, there is pattern that occurs in LEC’s evaluation that can indicate if there is an auditory processing deficit.

At LEC, if we determine that an individual has an auditory processing deficit, we will often recommend sessions and a home based sound therapy program.  We call this Auditory Stimulation Training.

Auditory stimulation training has been effective in treating a variety of disorders, including auditory processing disorders, speech and language disorders, learning disabilities, autism and spectrum disorders, attention deficit disorders, and reading and spelling disorders.

Some of the changes that we see as a result of Auditory Stimulation Training are

• Improved sleep

• Better ability to follow directions

• Improved auditory comprehension

• Improved vocal quality

• Better organization

• Improved social interaction

• Increased balance and coordination

• Improved language

• Increased attention

• Improved communication

• Reduced sound sensitivity

• Increased frustration tolerance


We have found Auditory Stimulation Training and sound therapy to be a tremendous tool in aiding in the development of attention, communication, and learning with individuals of all ages with a variety of learning challenges. We are seeing dramatic changes occur in the lives of children, teens, and adults.