Evidence eBook

Innate Rhythmic Movements and Primitive Reflex Integration:

Research, Rationale, and Case Reports
by Sonia Story
 This e-Book was written to provide some of the supporting evidence for the techniques taught in the Brian and
Sensory Foundations course. If you'd like to spread the word, we ask that you send the following link to friends and
colleagues where they can download their own copy: https://www.moveplaythrive.com/free-evidence-ebook-form

Thank you!

Sonia Story developed the Brain and Sensory Foundations curriculum to provide
comprehensive training in the use of neurodevelopmental movements for addressing sensory,
learning, physical, behavioral, emotional, social, and speech challenges. Sonia is the author of
this eBook, which includes evidence, research, and rationale for the use of
neurodevelopmental movements for optimizing function. Since 2006, she has been working
with children, parents, and professionals in hands-on sessions and training courses. Sonia’s
courses are approved for professional continuing education for occupational therapists,
physical therapists, mental health counselors, myofunctional therapists, and massage
therapists. Sonia was a presenter at the 2018 Autism One conference on how innate
neurodevelopmental movements help transform sensory issues. Her work has been featured in the books Almost Autism:
Recovering Children from Sensory Processing Disorder; Special Ed Mom Survival Guide; Family Health Revolution; and Same
Journey, Different Paths, Stories of Auditory Processing Disorder.

2
© Sonia Story, October 2023 - Move Play Thrive
 Table of Contents
Introduction ................................................................................................................................................................................. 4

Spontaneous Rhythmic Movements of Infancy.............................................................................................................. 5

Primitive and Postural Reflexes ............................................................................................................................................. 7

Retained Primitive Reflexes Are Neurological Soft Signs Associated with Dysfunction .............................. 8

Brain and Sensory Foundations Tools in Relationship to Valued Occupations, Supporting Evidence ....... 10

Gross Motor and Fine Motor Skills ................................................................................................................................. 10

Learning Disorders .............................................................................................................................................................. 15

Sensory Processing Disorders, Anxiety, Emotional Dysregulation, and Social Impairments ................... 22

Attention and Behavior Regulation .............................................................................................................................. 27

Walking and Visual Skills ................................................................................................................................................... 33

Innate Infant Movements for Early Assessment and Early Intervention ........................................................... 36

Conclusion .................................................................................................................................................................................. 38

References .................................................................................................................................................................................. 39

3
© Sonia Story, October 2023 - Move Play Thrive
Introduction
As a course developer, instructor, and approved provider with AOTA since 2015, I have had the
opportunity to engage with over 1000 OTs and OTAs. These occupational therapy professionals—from
new to seasoned therapists—are highly-trained, caring, and aware individuals. They have
enthusiastically embraced the Brain and Sensory Foundations (BSF) courses because they find the tools
exceptionally useful for helping their clients of all ages to participate in meaningful occupations with
greater ease and ability. Like the OT profession itself, the BSF curriculum is holistic and incorporates a
wide variety of tools. In the BSF courses, our students (referred to here as Learners) receive training in
innate infant movements including spontaneous rhythmic movements (SRM), primitive and postural
reflex patterns, and developmental movements. Learners also receive training in integrative
movements, play-based activities, human emotional connection, and how to support clients in goal
achievement. The combination of all of these tools works synergistically to effectively support client
activities and occupations.

Our holistic, comprehensive training helps therapists with client care by providing tools that are
supported by evidence, not duplicative, free from harm, and truly necessary. The tools from the Brain
and Sensory Foundations curriculum are designed to release stress, boost development, and promote
participation in activities of daily living (ADLs). Supporting clients to achieve meaningful goals is written
into the BSF course objectives, and is a primary focus of the training. Learners who wish to earn
continuing education units in the BSF training must demonstrate competency in helping clients attain
goals (via our unique 5-Step Balance process), and must document this in the required written
assignments for the course. While a therapist’s clinical reasoning and evaluation always take
precedence, in general, we do not recommend reflex integration in isolation, but rather as one part of a
broader developmental approach, as well as within the context of valued occupations such as walking,
gross and fine motor skills, focusing, learning, playing, sleeping, and communicating.

4
© Sonia Story, October 2023 - Move Play Thrive
Spontaneous Rhythmic Movements
of Infancy
As part of the broader developmental approach to both assessment and intervention in the BSF
courses, we utilize the spontaneous rhythmic movements (SRM) that infants engage in during
development. In her landmark study of healthy infants, Thelen (1979) described 47 innate SRM, such as
rocking, arm waving, and leg kicking, and found these stereotypical infant movements were highly
correlated with advances in motor development. Similar to infant primitive reflexes, Thelen (1979)
discovered the SRM had peaks in expression that gradually diminished as the infant matured. More
recent research has found that the innate rhythmic movements of early infancy were associated with
the development of language (Iverson, 2010). Our ability to attune to rhythm and produce rhythm, also
called steady beat competency, may help us to learn language and develop reading skills (Hannaford,
2002). In typical healthy development, babies crawl rhythmically on the belly and on hands and knees.
Rhythmic crawling may make a difference in our ability to learn well. For example, crawling in infants (9
months of age) was associated with more flexible memory retrieval (Herbert et al., 2007). When infants
were engaged in rhythmic movements, they smiled more (Provasi et al., 2021; Zentner & Eerola, 2010)
which suggests that rhythmic movements may promote relaxation and positive emotional states.

The SRM appear to have critical importance to development (Provasi et al., 2021; Thelen, 1979).
In a review of 37 studies, Zuk (2011) found that assessment of the SRM in early infancy was effective for
reliably predicting neurodevelopmental outcomes. When children did not engage in the full repertoire
of these SRM in infancy, compromised functioning was often the result (Zuk, 2011). Research by Ladányi
et al. (2020) pointed to the importance of attaining competence in the perception and production of
rhythm and rhythmic movement. Children with rhythmic impairment were at greater risk for

5
© Sonia Story, October 2023 - Move Play Thrive
developmental speech and language disorders (Ladányi et al., 2020). The lack of rhythmic ability was
also associated with attention deficit hyperactivity disorder (ADHD), developmental coordination
disorders (DCD), and dyslexia (Ladányi et al., 2020). The dysrhythmia found in children with ADHD
appears to persist through adolescence (Crasta et al., 2021) without diminishing over time, suggesting
the need for intervention to address this deficit.

Sensory-motor disorders constitute a defining characteristic of autism (Torres & Whyatt, 2018)
and research points to rhythmic input as a possible beneficial intervention for individuals with
symptoms of autism. (Amos, 2013; Hardy & Lagasse, 2013). Rhythmical movement done to music could
aid an individual with autism spectrum disorders (ASD) by increasing the functional connectivity in the
brain (Barnhill, 2013). In neurorehabilitation, clinicians are advised to use rhythmic movements for
calming and to improve hypotonia (Farber, 1982).

Rhythmic sensory input has been beneficial for helping with gait in patients with Parkinson’s
disease (Kadivar et al., 2011), and following stroke (Hong & Kim, 2016; Suh et al., 2014; Hayden et al.,
2009). For example, neurodevelopmental rhythmic movements, such as crawling, have played a part in
successful rehabilitation after stroke (Doidge, 2007). Rhythmic sensory input has been effective for
helping children exposed to trauma, most likely via regulation of the brainstem (Perry, 2006). Provasi et
al. (2021) found rhythmic stimulation significantly supportive for preterm babies in neonatal intensive
care units. Preliminary evidence shows that children with neurodevelopmental challenges respond very
positively to a combination of SRM and reflex integration movements (Grigg, et al., 2018; Gazca, 2012).

continued

6
© Sonia Story, October 2023 - Move Play Thrive
Primitive and Postural Reflexes
Along with the SRM, primitive and postural reflexes are part of the broad range of movements in
which human beings engage during development. Though we do not instruct Learners to use reflex
integration in isolation, knowledge of these innate infant movements appears to be important as part of
an overall plan of holistic assessment and intervention. Further discussion of the role of infant reflexes in
development is warranted in light of the Choosing Wisely guidelines that say: “ … the presence of
retained reflexes does not necessarily equate to functional impairment.” While it is true that a poorly
integrated reflex does not necessarily equate to a lack of functional abilities to participate in activities of
daily living (ADLs), a large body of literature also indicates that the quality of daily activities may be
hindered by the presence of one or more retained primitive reflexes. For example, Gieysztor et al. (2020)
found that the asymmetrical tonic neck reflex (ATNR) in boys and girls with an average age of 5 years
resulted in pelvic asymmetries and irregular walking gait. Abnormal gait patterns in children with
autism were correlated with social impairments (Gong et al., 2020). Another study showed a correlation
between ADHD symptoms and abnormal gait patterns compared to non-ADHD controls (Manicolo et
al., 2015). These studies suggest that the quality of how we walk is significant and that a symmetric,
aligned, and proper walking gait is important for overall functioning. Proper gait is largely developed
via the innate movements of infancy. In Occupational and Physical Therapy Approaches to Sensory and
Motor Issues, the authors state: “The foundations for skills that are needed throughout life are
established in early development” (Kornhaber et al., 2007, p. 484). For children with developmental
disabilities, the use of innate infant movements as part of remediation may be critically important
because these movements build the basic developmental foundations for optimal use of the body.

7
© Sonia Story, October 2023 - Move Play Thrive
Retained Primitive Reflexes Are Neurological Soft Signs
Associated with Dysfunction
According to authors of the Nelson Textbook of Pediatrics, the presence of primitive reflexes
past the first year of life is considered abnormal and a neurological soft sign (Behrman et al., 2000). “The
finding of two or more persistent soft signs correlates significantly with neurologic dysfunction,
including attention deficit disorder, learning disorders, and cerebral palsy” (Behrman et al., 2000, p.
1800). Persistent or retained primitive reflexes (RPR) have been associated with various dysfunctions in
children and adults. In children, RPR were found to be associated with developmental language
disorder (Matuszkiewicz & Gałkowski, 2021), ADHD (Bob et al., 2021; Konicarova et al., 2013; Konicarova
& Bob, 2013; Taylor et al., 2004), headaches (Wahlberg & Ireland, 2005), learning challenges (Feldhacker
et al., 2021; McPhillips & Jordan-Black, 2007; McPhillips & Sheehy, 2004; Goddard Blythe, 2001), sensory
disorders (Pecuch et al., 2020), motor challenges (Pecuch et al., 2021; Gieysztor et al., 2018; Bly, 2011),
toe walking (Accardo & Barrow, 2015), emotional and behavioral difficulties (Taylor et al., 2020),
abnormal muscle tone (Fiorentino, 1972), and poor postural control, (Gieysztor et al., 2020; Pecuch et al.,
2020). In adults, RPR were associated with Parkinson’s disease and dementia (McGee, 2001), DCD
(Niklasson et al., 2015), and schizophrenia (Hyde et al., 2007). The reappearance of primitive oral-facial
reflexes in nursing home patients was associated with poor eating and risk of malnutrition (Hobo et al.,
2014).

RPR that are less severe than those occurring in cases of brain injury can still drive changes in
muscle tone and postural control. These reflex-driven tonal and postural changes, though less severe,
may still significantly affect function (Kohen-Raz, 1986; Goddard, 2005); and challenges with postural
control have been noted in children with learning disabilities (Kohen-Raz, 1986), ADHD (Zoccante et al.,
2021), and autism spectrum disorders (Doumas et al., 2016). In Neurorehabilitation: A Multisensory
Approach, occupational therapist Shereen Farber states:

A delay in primitive reflex integration will result in decreased segmentation of the trunk,
decreased isolation of movement, decreased rotation component in any action, postural
insecurity, decreased ability to develop anti-gravity muscles, increased synergy patterns (mass
movement patterns) and increased dependence on environmental stimulation for changes in
posture (Farber, 1982, pp. 113-114).

8
© Sonia Story, October 2023 - Move Play Thrive
Abnormal muscular and postural responses, as described by Farber, could interfere with the proper
development of other sensory systems, such as vision. Research showed that RPR were also significantly
correlated with deficits in visual skills (Shihada et al., 2018; Gonzales et al., 2008, Wahlberg & Ireland,
2005).

Through intervention, we may be able to help individuals reduce the activity of RPR while
simultaneously boosting functional capacities. “Clinical experience demonstrates that lower level
reflexes present beyond the appropriate age of disappearance can be inhibited …” (Farber, 1982, p.
204). Research validates Farber’s clinical experiences and shows that reduction in primitive reflex
activity can occur after intervention (Goddard et al., 2021) and is associated with improved functional
outcomes (Melillo et al., 2020; Grigg et al., 2018; Grzywniak, 2017; Masgutova et al., 2016; Gazca, 2012;
Goddard Blythe, 2010; Jordan-Black, 2005; Wahlberg & Ireland, 2005; Bein-Wierzbinski, 2001; McPhillips
et al., 2000).

In their AOTA continuing education article, Stallings-Sahler et al. (2019) included deficiencies in
the postural reflex system as an indication of what they call “neurodevelopmental soft signs.” In their
article, they state: “Following principles of neuroplasticity, occupational therapy that addresses both the
underlying sensory and motor origins of the child’s difficulties, as well as the occupational outcome
‘end products’ of sensory-motor processing, may be the most successful approach” (Stallings-Sahler et
al., 2019, p. CE-3, emphasis added). We utilize this same approach in our courses: Following the
principles of neuroplasticity and development, we include a range of innate infant movements, as well
as movements to enhance “end products” including goals and meaningful occupations.

continued

9
© Sonia Story, October 2023 - Move Play Thrive
Brain and Sensory Foundations Tools in
Relationship to Valued Occupations,
Supporting Evidence
The majority of OTs and OTAs we serve work with children. For that reason, supporting evidence
provided here is based on some of the valued occupations of children. Learner case studies are part of
the requirements to complete the Brain and Sensory Foundations, First Level course. To date, we have
received over 1600 case studies that show remarkable consistency in their positive results. Learner case
studies below are summarized in graphic tables along with links to the full written case study. Further
supporting evidence cited is from peer-reviewed published research, conference proceedings, or
dissertations.

Gross Motor and Fine Motor Skills

Gross and fine motor abilities are important for successful transition to formal schooling. A lack
of gross and fine motor skills is associated with peer victimization (Øksendal et al., 2022) and may affect
self-esteem resulting in withdrawal from physical activities (Missiuna et al., 2003 as quoted in Callcott,
2012). Deficits in gross motor skills in the early stages of life were associated with lower cognitive
abilities at school-age; gross motor deficits also correlated with less ability in working memory and
processing speed (Piek et al., 2008). Gross motor performance in infancy and early childhood was
predictive of the levels of anxious and depressive symptomatology for children between the ages of 6
to 12 years (Piek et al., 2010). Using tools from the Brain and Sensory Foundations course may enhance
gross and find motor skills as seen in the following case studies; further supporting evidence from the
literature follows the case studies.

10
© Sonia Story, October 2023 - Move Play Thrive
Case Study 1_ Submitted by Ingrid King, MScOT, BOT
Go here to read the full case study.

Case Study 2_ Submitted by Jessica Rilee, OTD, OTR/L

Go here to read the full case study

11
© Sonia Story, October 2023 - Move Play Thrive
Case Study 3_Submitted by Natalie Green MOT, OTRL
Go here to read the full case study.

Case Study 4_ Submitted by Ilene Miller, Occupational Therapist

Go here to read the full case study.

12
© Sonia Story, October 2023 - Move Play Thrive
Case Study 5_ Submitted by Jessica Ullmann, Occupational Therapist
Go here to read the full case study.

Further Supporting Evidence from the Literature—Gross and Fine Motor Skills

The innate infant movements drive the development of gross and fine motor skills (Utley, 2018).
Gieysztor et al. (2018) showed that the presence of retained primitive reflexes in healthy preschool
children (between the ages of 4 to 6 years) had an impact on the children’s psychomotor development.
Psychomotor efficiency is necessary for many higher-level learning tasks. As Gieysztor et al. (2018)
reported, even mild levels of retained primitive reflexes could have negative impacts on a child’s
psychomotor abilities. Another study focused primarily on handwriting issues. Richards et al. (2022)
state:

Primitive reflex retention may interfere with handwriting development. In a cross-sectional study, we
explored a possible relationship between reflex retention and handwriting difficulties among 74
children ages 7-9 years. 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 (p. 1).

In a mixed methods study of 40 Australian Indigenous children (4.6 to 5 years), Callcott (2012)
found that 65% of the children had a retained ATNR that was significantly associated with poor fine
motor skills and delays in school readiness. School readiness was determined by evaluating fine motor

13
© Sonia Story, October 2023 - Move Play Thrive
abilities such as cutting with scissors, drawing figures, and copying. For those children with moderate to
high levels of retained ATNR, teacher reports also revealed behaviors such as inattention, hyperactivity,
and impulsivity (Callcott, 2012).

Niklasson et al. (2017) hypothesized that children (from the ages of 5 to 13 years) with DCD could
reach the level of their normally developing peers on sensorimotor skills tests after undergoing
sensorimotor treatment. Part of the initial assessment included scores for retained primitive reflexes
(RPR) among other motor skills tests. Additionally, primitive reflex movements were used as a part of
the therapeutic treatment plan for the children with DCD. This research supported the idea that RPR
were associated with DCD and that the use of movements designed to integrate primitive reflexes
could be part of an overall plan of care to help developmentally delayed children catch up to the level
of functioning of their non-delayed peers. Strengths of this study included the use of comprehensive,
individualized movement programs lasting 36 months, with post-tests done three months after the end
of the treatment. The study design showed that maturity alone did not account for the observed
changes. The treated children also improved in behavioral measures according to before-and-after
surveys from parents and teachers.

Brown (2010) evaluated a program using infant reflex movements with 65 preschool children,
comparing a movement intervention to a control intervention, to determine its impact on the fine
motor skills of the children. The results from the study provided evidence that the movement
intervention had a significant effect on improving the children’s fine motor skills. For children
between the ages of 6 and 11, Grzywniak (2017) found statistically significant improvements in body
balance, motor coordination, and visual-motor skills compared to children in a control group.
Children in the experimental group received a primitive-reflex based intervention for 12 to 14
months.

14
© Sonia Story, October 2023 - Move Play Thrive
Learning Disorders
The relationship between motor deficits and learning disorders has been established in the
literature. According to the review study by Sigafoos et al. (2021), detection of RPR in children could
signify a developmental or neurological problem that could impede learning; and early, regular
assessment of primitive reflexes in children was recommended. On the question of remediation they
concluded that: “Evidence-based interventions to address the persistence of primitive reflexes are
lacking, and the development of these should be a research priority” (Sigafoos et al., 2021, p. 98). While
there is a clear need for more research to determine the usefulness of methods for intervention, it is also
important to note that in their review, Sigafoos et al. (2021) did not include key studies cited here
regarding the use of primitive reflex movements for remediation. Numerous studies have suggested
that innate infant movements could be an important factor in creating successful outcomes for children
with learning challenges. We examine a portion of the supporting evidence here, beginning with our
Learner case study summaries and following with research evidence.

Case Study 6_Submitted by Arthi Gavatre, OTR/L

Go here to read the full case study.

15
© Sonia Story, October 2023 - Move Play Thrive
Case Study 7_Submitted by Divya Joythi, Teacher and Parent
Go here to read the full case study.

4-yr-Old Boy — Not responding to Name, Becomes Able to Make

Eye Contact, Learn, Sleep, Play

continued

16
© Sonia Story, October 2023 - Move Play Thrive
Case Study 8_Submitted by Laurie Bernstein OTR/L
Go here to read the full case study.

Focus and Calm Improve Homework, Learning, and Daily Tasks for Teen

Case Study 9_Submitted by Briana Dannecker, MS, OTR/L

Go here to read the full case study.

OT “Filled with Gratitude and Excitement”; Sees Profound Results for 6YO Boy

17
© Sonia Story, October 2023 - Move Play Thrive
Case Study 10_Submitted by Jennifer Davis, COTA/L
Go here to read the full case study.

Continued

18
© Sonia Story, October 2023 - Move Play Thrive
Case Study 11_Submitted by Anneli Tromp, Registered Biokinetisist
Go here to read the full case study.

Therapist about 7YO Girl: “I Was Astounded by Her Quick Progress

Further Supporting Evidence from the Literature —Learning Disorders

Feldhacker et al. (2021) found that for typically developing children between 5 and 7 years of
age, the presence of RPR were significantly associated with poorer scholastic performance in both boys
and girls. In boys, RPR were associated with lower scholastic performance in reading, math, written
language, and spelling. For girls, RPR correlated with lower math and reading scores. Feldhacker et al.
(2021) concluded that primitive reflex screening could be useful for occupational therapists in the
course of holistic client care.

Goddard Blythe (2001) concluded that a cluster of RPR could be a contributing factor in cases of
dyslexia. The 54 children (8 to 15 years of age) in the Goddard Blythe (2001) study were independently
diagnosed with dyslexia and had not improved with standard remediation methods. Goddard Blythe
(2001) found that RPR in these children were significantly correlated with poor postural control, motor

19
© Sonia Story, October 2023 - Move Play Thrive
difficulties, visual challenges, and dyslexia. In particular, two RPR—tonic labyrinthine reflex (TLR) and
ATNR, were found in 100% of the children with dyslexia (Goddard Blythe, 2001).

In a causal-comparative study, 126 middle-school children between the ages of 10 and 13 years
were assessed for two RPR, measured using inter-rater reliability. The results showed that 50% of the
children in a Minnesota public school setting had RPR (Oliver, 2020). When comparing the children with
and without RPR, academic scores were lower in both math and reading for the children with RPR. There
were statistically significant differences in math achievement between students with and without
persistent ATNR and symmetrical tonic neck reflex (STNR). The reading scores were also lower in the
group with RPR, though were just under statistical significance, possibly because the older children in
the study may have had more access over the years to remedial reading support (Oliver, 2020).

McPhillips and Jordan-Black (2007) found further evidence of the association between RPR and
learning disabilities. They assessed a large cross-sectional sample (n = 739) of children (between ages 7
and 9 years) with and without dyslexia from mainstream schools of Northern Ireland. McPhillips and
Jordan-Black (2007) were able to uncover two important findings. First, the level of retained ATNR was
greater in children from socially disadvantaged backgrounds. Second, “Multiple regression analyses,
involving all of the sample children, revealed that persistence of the ATNR was significantly predictive of
attainments in reading” (McPhillips & Jordan-Black, 2007, p. 748).

McPhillips et al. (2000) investigated whether RPR played a role in disrupting the development of
reading in children with dyslexia, and whether the use of a primitive reflex movement program could
help reduce reflex retention and improve reading. The study participants, between the ages of 8 and 11
years, were matched in terms of age, IQ, sex, spelling skills, reading assessments, and level of ATNR
persistence. Participants were randomly distributed into one of three groups: Experimental, control, or
placebo-control, and the study was double-blinded. McPhillips et al. (2000) found that by repetition of
stereotypical infant primitive reflex movements, they were able to reduce the retention of ATNR; and as
the level of ATNR persistence decreased, reading skills improved significantly in the experimental
group.

Results corroborating McPhillip’s study were found by Wahlberg and Ireland (2005) who used
primitive reflex movements in children with reading disabilities between the ages of 7 and 11.
Wahlberg and Ireland (2005) evaluated 22 reading-disabled students on a battery of assessments

20
© Sonia Story, October 2023 - Move Play Thrive
including three primitive reflexes, balance skills, eye movement skills, and fine motor ability. A
headache questionnaire was also given. A portion of the treatment group was compared with a control
group in an examination of reading fluency. Post-tests were given on the whole test battery after the
treatment group had received nine months of a 10-minute movement program given on school days.
The movements consisted of repetition of primitive reflex movement patterns. Wahlberg and Ireland
(2005) used matched controls and a blinded design when assessing reading fluency. Post-tests revealed
a reduction of primitive reflex persistence and statistically significant improvements in reading fluency,
balance, and eye movements for children in the treatment group. Findings of this study were especially
important because children receiving the movement program also showed a decrease in headaches.

In a study in Germany, movements based on early motor development and primitive reflexes
were utilized to help elementary school children with learning challenges. The author found that as
retained reflexes were corrected, oculo-motor functioning and reading skills improved (Bein-
Wierzbinski, 2001, as quoted in Goddard, 2005). Jordan-Black (2005) conducted another study with 683
children between the ages of 6 and 11 years in two regular primary schools in Northern Ireland. The
findings showed that when ATNR was retained, it interfered significantly with student scores in reading,
spelling, and math. Jordan-Black (2005) found that the movement intervention, based on infant
primitive reflex movements and the use of child-friendly songs and rhythms, “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 (Jordan-Black, 2005, p. 101).

Goddard Blythe (2010) studied the impact of reflex integration on children between the ages of
4 and 6; all of whom had been previously identified as having literacy challenges. All children received
the same educational support in reading, writing, and spelling. Half of the group received movements
designed to mature primitive and postural reflexes. The control group received no intervention. Though
the sample size was small, there was significantly greater improvement in the reading scores of children
in the experimental group compared to the control group of children who did not participate in the
daily movement program.

A study by Grzywniak (2017) determined the usefulness of primitive reflex movements for
children ages 6 to 11 years who had learning difficulties. Children with learning difficulties participated,
54 in an experimental group and 50 in a control group. The children received pre-tests and post-tests to

21
© Sonia Story, October 2023 - Move Play Thrive
assess the level of RPR, balance, visual perception, and auditory perception. The experimental group
engaged in a primitive reflex-based movement program for 12 to 14 months. In comparisons of pre-test
and post-test scores, the experimental group showed statistically significant improvement on all 21
tests. Parent and teacher interviews revealed that children were functioning better in school and home
settings (Grzywniak, 2017). On 12 of 21 assessments, the control group also showed improvement. But
when the 12 test scores were compared with those of the experimental group, the control group did
not show the same level of improvement and the differences between the two groups were statistically
significant. Grzywniak (2017) concluded that the movement program was effective and seemed to help
learning-challenged children with a variety of other symptoms including emotional regulation,
concentration, and coordination.

Sensory Processing Disorders, Anxiety, Emotional Dysregulation, and

Social Impairments
Sensory processing disorders (SPD) impact how individuals respond to daily events and often co-occur
with other challenges such as emotional dysregulation, anxiety (McMahon et al., 2019), and social
impairments (Thye et al., 2018). Lane and Reynolds (2019) discussed research showing that sensory
over-responsivity (SOR) can negatively impact participation in daily activities, and this was true for
children without other diagnoses, as well as for children with diagnoses such as ADHD or ASD. SOR
occurs in individuals who “experience sensations more intensely or for a longer duration than is normal,
often resulting in ‘fight or flight’ behaviors” (Lane & Reynolds, 2019, p. 2). After examining children using
both behavioral surveys and neurophysiological markers, Lane and Reynolds (2019) found a
relationship between SOR and anxiety in both typical children and in children with ADHD. Their study
indicated that SOR could be one cause of anxiety in children (Lane & Reynolds, 2019). For children who
had both SOR and ADHD, there was a greater incidence of clinically significant anxiety (Lane & Reynolds,
2019). Amos et al. (2019) found SOR was a mediating factor between autistic traits and anxiety.

In a systematic review, Ghanizadeh (2011) found that sensory processing challenges were more
common for children with ADHD than for typically developing children. Sensory processing problems
were more severe in children who had both anxiety and ADHD symptoms (Ghanizadeh, 2011). Sensory
disorders are also recognized as a core symptom of ASD (Thye et al., 2018; Baum et al., 2015).

22
© Sonia Story, October 2023 - Move Play Thrive
 Sensory problems in children may affect social behaviors. Ben-Sasson et al. (2009) found that
children with SOR had more social-emotional problems and were less socially skilled than children
without SOR. In their systematic review, Thye et al., (2018) identified links between sensory disorders
and social deficits in children with ASD.

SPD does not seem to go away with the passage of time (McMahon et al., 2019; Ben-Sasson et al.,
2017). Sensory disorders in childhood were associated with poor emotional regulation leading to a
greater likelihood of anxiety disorders in adulthood (McMahon et al., 2019, p. 1). Tools from the Brain
and Sensory Foundations courses appear to be useful for helping with sensory issues, anxiety, and
emotional regulation as seen in the following case studies with further supporting evidence from the
literature below.

Case Study 12_Submitted by Alycia Marsh, Parent and former Nurse Practitioner
Go here to read the full case study.

23
© Sonia Story, October 2023 - Move Play Thrive
Case Study 13_Submitted by Kate Mitchell, MS, OTR
Go here to read the full case study.

Case Study 14_Submitted by Jennifer Everett, OTR

Go here to read the full case study.

Pushing, Hitting, and Biting Diminish

24
© Sonia Story, October 2023 - Move Play Thrive
Case Study 15_Submitted by Theresa Williams, OTR/L
Go here to read the full case study.

Young Man Reduces Anxiety and Improves Sleep, Focus, and

Academic Performance

Case Study 16_Submitted by Terran Daly, OT

Go here to read the full case study.

25
© Sonia Story, October 2023 - Move Play Thrive
Case Study 17_Submitted by Monica Carlson, MOT, OTR
Go here to read the full case study.

Further Supporting Evidence from the Literature—Sensory Processing Disorders, Anxiety,

Emotional Dysregulation, and Social Impairments

Pecuch et al. (2020) studied the effects of retained primitive reflexes (RPR) on sensory
functioning in healthy preschool children between the ages of 4 to 6 years. They found a significant
correlation between the level of RPR and “sensory disorders such as dyspraxia, sensory-vestibular
disorders, and postural disorders” (Pecuch et al., 2020, p. 1). For children having only one RPR, there was
not an associated relationship to sensory disorders, however, when a cluster of reflexes were found in
the same individual, it was significantly associated with sensory challenges (Pecuch et al., 2020).

Sensory disorders and anxiety have been strongly associated with certain types of ADHD (Lane &
Reynolds, 2019). Likewise, children with ASD have sensory disorders (Ben-Sasson et al., 2007), and in a
meta-analysis, van Steensel & Heeman (2017) found that children with ASD had elevated anxiety
compared to typically developing children. Another commonality between ADHD and ASD appeared to
be the presence of RPR at high rates of occurrence (Holmes et al., 2016).

26
© Sonia Story, October 2023 - Move Play Thrive
 Balance dysfunction was also common in ADHD (Bob et al., 2021; Kim et al., 2017; Iwanaga et al.,
2006; Zang et al., 2002) and in ASD (Odeh, 2022; McPhillips et al., 2014). It is possible that using
movements to improve balance may help reduce anxiety. That was the exact finding of Bart et al. (2009)
who studied a group of children with anxiety. Bart et al., (2009) used a sensory-motor intervention for
improving balance, which had the effect of lowering the children’s anxiety and boosting their self-
esteem. Using an animal model, Shefer et al., (2015) found that balance deficits were associated with
greater anxiety, and that balance training diminished anxious behavior in mice. Whether human or
animal, less anxiety could lead to better social, emotional, and learning skills.

Thye et al. (2018) concluded that sensory-based interventions might be helpful for individuals
with ASD. Since movements provide sensory stimulation, motor interventions could hold promise for
individuals with ASD, especially if the intervention results in improvements in balance. Researchers have
found that sensory stimulation such as that available with movement intervention can have positive
effects for children with ADHD (Melillo et al., 2020) and with ASD (Masgutova et al., 2016; Cheldavi,
2014).

Attention and Behavior Regulation

Abilities such as maintaining attention and regulating behavior are precursors to learning and
other valued occupations such as joint attention and communication. It is possible that a lack of
attention and an inability to regulate behavior are signs of neuromotor immaturity. Konicarova et al.
(2013) described RPR as “one of the most important postnatal developmental deficits” (p. 1457) because
of their influence on higher level motor abilities and cognition, and because past studies showed RPR
were associated with neuropsychiatric disorders. Konicarova et al. (2013) examined the extent to which
two RPR were present in 35 medication-naïve girls with ADHD (between the ages of 8 and 11),
compared to an age-matched control group of 30 girls without ADHD. Results revealed that RPR were
closely linked to ADHD symptoms including anxiety, impulsivity-hyperactivity, learning problems, and
perfectionism. Interestingly, the impulsivity-hyperactivity was related to muscle tension that Konicarova
et al. (2013) reasoned might lead to problems sustaining attention. This is noteworthy because the
presence of RPR generated excess, suboptimal muscle tension in a study of 5-year-old school children
(Gieysztor et al., 2020). It is reasonable then that reducing the levels of RPR, which has been shown to be

27
© Sonia Story, October 2023 - Move Play Thrive
possible with movement intervention (Goddard Blythe et al., 2021), might help reduce muscle tension
and improve attention.

Other studies have also found links between RPR and ADHD. In a 2004 study featuring boys
between ages 7 and 11 years, the authors found that, “Boys diagnosed with AD/HD had significantly
higher levels of reflex retention than non-diagnosed boys” (Taylor, et al., 2004, p. 23). Results from two
more studies showed that ADHD symptoms were closely linked to RPR in boys and girls between the
ages of 8 and 11 years. In the first study, Konicarova and Bob (2012) measured the infant Moro and
Galant primitive reflexes and compared these in children with ADHD and children without ADHD. In the
second study, ATNR was measured in children with ADHD and age-matched controls. Both studies
found that children with ADHD had a higher occurrence of RPR compared to controls, and that ADHD
symptoms seemed linked to unfinished developmental processes (Konicarova & Bob, 2013; Konicarova
& Bob, 2012).

Taylor et al. (2020) noted that children with various psychosocial problems, also called emotional
and behavioral difficulties (EBD), experienced co-occurring challenges such as family disruption, ADHD,
poor literacy, and motor deficits. They designed a study to see if there were significant differences in
motor skills among children with EBD versus children without EBD. Taylor et al. (2020) measured the
levels of ATNR retention, a marker of neurodevelopmental delay, and gained insight into the impact of
retained ATNR on EBD. Motor skills and ATNR were measured in EBD and non-EBD groups in the context
of co-occurring issues such as family disruption, ADHD, and poor literacy. They suspected that motor
difficulties were among the factors involved in severe EBD, and their study showed the relative impact
of motor difficulties even after taking into account co-occurring factors involved in EBD. Results were
statistically significant showing that motor skill deficits and the presence of ATNR were each
independent predictors of EBD in children, even after correcting for the influence of the co-occurring
problems associated with EBD.

To help children overcome challenges with inattention and behavioral issues, the assessment
and intervention tools from the Brain and Sensory Foundations courses may be useful, as seen in the
following case studies. Further supporting evidence from the literature is cited below the case studies.

28
© Sonia Story, October 2023 - Move Play Thrive
Case Study 18_Submitted by C.S., Occupational Therapist
Go here to read the full case study.

Movement Helps Sensory & Behavior for 9 year old

Case Study 19_Submitted by H.S., OTR/L

Full case study is contained in the graphic below (emphasis added).

29
© Sonia Story, October 2023 - Move Play Thrive
Case Study 20_ Submitted by D.P., Occupational Therapist
Go here to read the full case study.

Case Study 21_Submitted by Kendra Browder, OTR/L

Go here to read the full case study.

Improvements in Self-Regulation, Controlling Anxiety, and Fine-Motor Skills!

30
© Sonia Story, October 2023 - Move Play Thrive
Case Study 22_Submitted by Lisa Van Heukelom, OTR/L
Go here to read the full case study.

Boy with ADHD Symptoms Gains Emotional Regulation,

Focus, Great Improvements at School

Case Study 23_Submitted by Kendel Knudson, OTD, OTR/L

Go here to read the full case study.

31
© Sonia Story, October 2023 - Move Play Thrive
Further Supporting Evidence from the Literature—Attention and Behavior Regulation

A series of studies concluded that symptoms of ADHD are associated with a delay of normal
brain maturation (Sripada, et al., 2014; Rubia, 2007; Shaw, et al., 2007). Basic body functions appear
delayed in ADHD also. Studies of children with ADHD have confirmed developmental delays in motor-
skills, balance, and postural control (Bob et al., 2021; Konicarova et al., 2014; Iwanaga et al., 2006). In a
study of preschool children, Hickey and Feldhacker (2022), found that the activity of certain RPR among
males was significantly associated with opposition/defiance (retained ATNR) as well as with inattention
(retained Moro reflex). They noted that: “The findings of this study support prior research which
indicates a need for early screening of primitive reflexes as client factors which could impact
occupational performance” (Hickey & Feldhacker, 2022, p. 1).

It is reasonable to assume that the innate movements of development promote brain growth
and maturation in infancy. These same innate movements could promote brain growth and maturation
later in life and therefore help with ADHD symptoms. In an effort to determine whether a combined
program of innate rhythmic movements and reflex integration was effective for helping with motor
deficits and neurodevelopmental challenges in children from birth to 18 years, Gazca (2012) used an
online survey of 79 Rhythmic Movement Training (RMT) practitioners. The RMT practitioners consisted
of therapists, parents, and educators who had been using the RMT program with children for at least
three months. For five of the six ADHD-related items on the survey, between 82% and 92% of Gazca’s
respondents agreed or strongly agreed that RMT was effective for helping with ADHD symptoms. In
addition, approximately 75% of respondents agreed or strongly agreed that RMT was effective for
sensory sensitivities to touch and motion. High agreement from the respondents (94.8%) indicated that
RMT was effective in reducing muscle tension. This is significant because muscle tension is a known
element of primitive reflex activity (Gieysztor et al., 2020) and is associated with hyperactivity and
impulsivity (Konicarova et al., 2013). In Gazca’s RMT study, over 87% of respondents indicated that RMT
was effective for reducing anxiety (87.5%) and hyperactivity (87.5%), both of which are commonly
found in ADHD (Gair et al., 2021; Schatz & Rostain, 2006).

32
© Sonia Story, October 2023 - Move Play Thrive
Walking and Visual Skills
For most human beings, the ability to walk and to process visual input are fundamental to
engagement in valued occupations. The development of walking and vision begins in early infancy and
both are contingent on a variety of sensory-motor inputs over time. The innate movements of infancy
appear to be key in providing these inputs for developing both our movement capabilities (Preedy et
al., 2022) and our visual skills (Gessel, 1952). Using the innate SRM and reflex movements from the Brain
and Sensory Foundations course appears to help establish proper walking and to develop improved
visual skills, as seen in the following case studies.

continued

33
© Sonia Story, October 2023 - Move Play Thrive
Case Study 24_Submitted by Melody Edwards, PT
Go here to see video and full case study.

Case Study 25_Submitted by Michele Riak, OTR/L

Go here to read the full case study.

continued

34
© Sonia Story, October 2023 - Move Play Thrive
Case Study 26_Submitted by Sue Lapp, OTR/L
Go here to read the full case study.

Struggles with Visual Memory, Hand-Eye Coordination, and Writing All

Ease for 8-Yr-Old Girl

continued

35
© Sonia Story, October 2023 - Move Play Thrive
Case Study 27_Submitted by Michele Riak, OTR/L
Go here to read the full case study.

Innate Infant Movements for Early Assessment and Early Intervention

When it comes to neurodevelopmental delays, the call for early assessment and early
intervention appears to be unanimous by researchers, policy makers, and clinicians. Because of their
fundamental importance in human development, the innate infant movements appear to be especially
useful in assessment for risk of neurodevelopmental delays. In their review study, McWhirter et al. (2022)
found that motor function of preschool children predicts academic achievement; and they encouraged
assessment of primitive reflexes as a means of early identification of children at risk. Using innate
movements for early assessment can help address motor deficits and their co-occurring disorders
(McWhirter et al., 2022) and maximize potential (Zuk, 2011).

For children with neurodevelopmental disabilities to be more physically and academically

capable, the use of innate infant movements in remediation may be important for building the basic
foundations for optimal functioning. Research has indicated that in the absence of intervention,
children do not grow out of developmental motor deficits and their associated challenges. For example,
Salavati et al. (2021) showed that poor quality of infant movements in preterm babies were correlated

36
© Sonia Story, October 2023 - Move Play Thrive
with poor motor and cognitive skills at the ages of 2, 4, and 8 years of age. In addition, Salavati et al.
(2021) found that the gap in functioning compared with normally developing peers was greatest at the
age of 8 years for the preterm babies, indicating that the children did not grow out of the motor and
cognitive deficits that were present in infancy. The same was true in a study of children with learning
disabilities (ages 7 to 18 years): “It was found that the vestigial [retained] primitive reflexes occur in the
case of school-age children suffering from academic difficulties. Those reflexes do not decrease
simultaneously with the passage of time, but rather become more intensified” (Grzywniak, 2016, p. 113).
Without intervention, retained primitive reflexes remained in place whereas, for young children who
received intervention, their primitive reflex status improved (Goddard et al., 2022). The importance of
early intervention was also highlighted by a study showing that delays in attaining early motor
milestones resulted in more severe repetitive and restricted behaviors in children and adolescents with
ASD (Uljarević et al., 2017).

continued

37
© Sonia Story, October 2023 - Move Play Thrive
Conclusion
The underlying rationale to support the use of infant movements for helping with occupations is
based on the principles of development itself. The human brain grows faster in infancy than at any
other time in life (Carmody et al., 2004) and this development is largely fueled by the innate infant
movements. In their imaging study, Carmody et al. (2004) found great increases in myelin during
normal development of healthy infants. Sampaio-Baptista et al. (2013) found that learning new motor
skills appeared to increase myelin in the brain. Since learning new motor skills is something infants are
regularly engaged in as part of the normal course of development, it follows that the innate infant
movements stimulate myelin formation and develop important neuro-sensory-motor pathways. Given
what we have seen in healthy development, it is very possible that innate infant movements are unique
in their ability to stimulate and develop the brain and body, more so than other types of movement,
and at least one study has supported this conclusion (McPhillips et al., 2000). Further research is
necessary to confirm the possible unique qualities of innate infant movements to promote brain
growth, connectivity, and functional outcomes.
Preliminary research has suggested that innate infant movements may boost brain and body
maturity beyond infancy and help children with challenges catch up in their development. Because
development itself is holistic, with various categories of innate movements working simultaneously and
in concert, we provide supporting evidence here for the use of multiple categories of innate movement.
In the Brain and Sensory Foundations curriculum, the use of innate SRM, infant reflex movements,
developmental movements, and play is consistent with the principles of neurodevelopment and may
serve as part of an overall plan for assessment and intervention that is low-cost, non-invasive, and
effective. The Brain and Sensory Foundations program also emphasizes collaborative goal setting and
goal attainment. For these reasons, the Brain and Sensory Foundations program is a relevant
contribution to occupational therapy practitioners because it provides tools to promote improved
performance in occupations.

continued

38
© Sonia Story, October 2023 - Move Play Thrive
References
Accardo, P. J., & Barrow, W. (2015). Toe walking in autism: further observations. Journal of Child Neurology, 30(5), 606-609.
https://doi.org/10.1177/0883073814521298

Amos, G. A., Byrne, G., Chouinard, P. A., & Godber, T. (2019). Autism traits, sensory over-responsivity, anxiety, and stress: A test
of explanatory models. Journal of Autism and Developmental Disorders, 49(1), 98-112. https://doi.org/10.1007/s10803-018-
3695-6

Amos, P. (2013). Rhythm and timing in autism: Learning to dance. Frontiers in Integrative Neuroscience, 7.
https://doi.org/10.3389/fnint.2013.00027

Barnhill, E. (2013). Neural connectivity, music, and movement: A response to Pat Amos. Frontiers in Integrative
Neuroscience, 7. https://doi.org/10.3389/fnint.2013.00029

Bart, O., Bar-Haim, Y., Weizman, E., Levin, M., Sadeh, A., & Mintz, M. (2009). Balance treatment ameliorates anxiety and
increases self-esteem in children with comorbid anxiety and balance disorder. Research in Developmental Disabilities, 30(3),
486-495. https://doi.org/10.1016/j.ridd.2008.07.008

Baum, S. H., Stevenson, R. A., & Wallace, M. T. (2015). Behavioral, perceptual, and neural alterations in sensory and
multisensory function in autism spectrum disorder. Progress in Neurobiology, 134, 140–160.
https://doi.org/10.1016/j.pneurobio.2015.09.007

Behrman, R. E., Kiegman, R. M., & Jenson, H. B. (2000). Nelson textbook of pediatrics (16th Ed.). WB Saunders.

Bein-Wierzbinski, W. (2001, March). Persistent primitive reflexes in elementary school children. Effect on oculo-motor and
visual perception [Conference session]. The 13th European Conference of Neuro-Developmental Delay in Children with
Specific Learning Difficulties, Chester, UK.

Ben-Sasson, A., Carter, A. S., & Briggs-Gowan, M. J. (2009). Sensory over-responsivity in elementary school: Prevalence and
social-emotional correlates. Journal of Abnormal Child Psychology, 37(5), 705-716. https://doi.org/10.5014/ajot.61.5.584

39
© Sonia Story, October 2023 - Move Play Thrive
Ben-Sasson, A., Cermak, S. A., Orsmond, G. I., Tager-Flusberg, H., Carter, A. S., Kadlec, M. B., & Dunn, W. (2007). Extreme
sensory modulation behaviors in toddlers with autism spectrum disorders. The American Journal of Occupational
Therapy, 61(5), 584-592. https://doi.org/10.5014/ajot.61.5.584

Ben-Sasson, A., Soto, T. W., Heberle, A. E., Carter, A. S., & Briggs-Gowan, M. J. (2017). Early and concurrent features of ADHD
and sensory over-responsivity symptom clusters. Journal of Attention Disorders, 21(10), 835-845.
https://doi.org/10.1177/1087054714543495

Bly, L. (2011). The components of normal movement during the first year of life and abnormal motor development. Neuro-
Developmental Treatment Association.

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. https://doi.org/10.3389/fpsyt.2021.430685

Brown, C. G. (2010). Improving fine motor skills in young children: An intervention study. Educational Psychology in
Practice, 26(3), 269-278. https://doi.org/10.1080/02667363.2010.495213

Callcott, D. (2012). Retained primary reflexes in preprimary-aged Indigenous children: The effect on movement ability and
school readiness. Australasian Journal of Early Childhood, 37(2), 132–140. https://doi.org/10.1177/183693911203700218

Carmody, D. P., Dunn, S. M., Boddie-Willis, A. S., Demarco, J. K., & Lewis, M. (2004). A quantitative measure of myelination
development in infants, using MR images. Neuroradiology, 46(9), 781-786. https://doi.org /10.1007/s00234-004-1241-z

Cheldavi, H., Shakerian, S., Boshehri, S. N. S., & Zarghami, M. (2014). The effects of balance training intervention on postural
control of children with autism spectrum disorder: Role of sensory information. Research in Autism Spectrum Disorders, 8(1),
8-14. https://doi.org/10.1016/j.rasd.2013.09.016

Crasta, J. E., Zhao, Y., Seymour, K. E., Suskauer, S. J., Mostofsky, S. H., & Rosch, K. S. (2021). Developmental trajectory of subtle
motor signs in attention-deficit/hyperactivity disorder: A longitudinal study from childhood to adolescence. Child
Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence, 27(3), 317–332.
https://doi.org/10.1080/09297049.2020.1847265

Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. Viking.

Doumas, M., McKenna, R., & Murphy, B. (2016). Postural control deficits in autism spectrum disorder: The role of sensory
integration. Journal of Autism and Developmental Disorders, 46(3), 853-861. https://doi.org/10.1007/s10803-015-2621-4

Farber, S. (1982). Neurorehabilitation: A multisensory approach. W.B. Saunders.

Feldhacker, D., Cosgrove, R., Feiten, B., Schmidt, K., & Stewart, M. (2021). Relationship between retained primitive reflexes and
scholastic performance. The American Journal of Occupational Therapy, 75(S2).
https://doi.org/10.5014/ajot.2021.75S2-RP164

Fiorentino, M. R. (1972). Normal and abnormal development: The influence of primitive reflexes on development. Thomas.

40
© Sonia Story, October 2023 - Move Play Thrive
Gair, S. L., Brown, H. R., Kang, S., Grabell, A. S., & Harvey, E. A. (2021). Early development of comorbidity between symptoms of
ADHD and anxiety. Research on Child and Adolescent Psychopathology, 49(3), 311-323.
https://doi.org/10.1007/s10802-020-00724-6

Gawrilow, C., Stadler, G., Langguth, N., Naumann, A., & Boeck, A. (2016). Physical activity, affect, and cognition in children
with symptoms of ADHD. Journal of Attention Disorders, 20(2), 151-162. https://doi.org/10.1177/1087054713493318

Gazca, M. (2012). Rebooting development with a rhythmic motor intervention for children [Unpublished master’s thesis]. St.
Catherine University, Minneapolis.

Gesell, A. (1952). Infant development: The embryology of early human behavior. Hamish Hamilton.

Ghanizadeh, A. (2011). Sensory processing problems in children with ADHD, a systematic review. Psychiatry Investigation,
8(2), 89. https://doi.org/10.4306/pi.2011.8.2.89

Gieysztor, E. Z., Choińska, A., & Paprocka-Borowicz, M. (2018). Persistence of primitive reflexes and associated motor
problems in healthy preschool children. Archives of Medical Science, 14(1), 167-173.
https://doi.org/10.5114/aoms.2016.60503

Gieysztor, E., Pecuch, A., Kowal, M., Borowicz, W., & Paprocka-Borowicz, M. (2020). Pelvic symmetry is influenced by
asymmetrical tonic neck reflex during young children’s gait. International Journal of Environmental Research and Public
Health, 17(13), 4759. https://doi.org/10.3390/ijerph17134759

Goddard Blythe, S. (2010, April 11-12). Neuro-motor maturity as an indicator of developmental readiness for education
[Conference session]. The Institute for Neuro-Physiological Psychology Conference, Miami, Florida.

Goddard Blythe, S. (2001, April). Neurological Dysfunction as a Significant Factor in Children Diagnosed with Dyslexia
[Conference session]. Proceedings of The 5th International British Dyslexia Conference, University of York, United Kingdom.

Goddard Blythe, S., Duncombe, R., Preedy, P., & Gorely, T. (2021). Neuromotor readiness for school: The primitive reflex status
of young children at the start and end of their first year at school in the United Kingdom. Education 3-13, 50(5), 654-667.
https://doi.org/10.1080/03004279.2021.1895276

Goddard, S. (2005). Reflexes, learning and behavior: A window into the child’s mind. Fern Ridge Press.

Gong, L., Liu, Y., Yi, L., Fang, J., Yang, Y., & Wei, K. (2020). Abnormal gait patterns in autism spectrum disorder and their
correlations with social impairments. Autism Research 13(7), 1215–1226. https://doi.org/10.1002/aur.2302

Gonzalez, S. R.; Ciuffreda, K.; Hernandez, L. C.; Escalante, J. B. (2008). The correlation between primitive reflexes and saccadic
eye movements in 5th grade children with teacher-reported reading problems. Optometry and Vision Development, 39(3),
140-145.

41
© Sonia Story, October 2023 - Move Play Thrive
Grigg, T. M., Fox-Turnbull, W., & Culpan, I. (2018). Retained primitive reflexes: Perceptions of parents who have used Rhythmic
Movement Training with their children. Journal of Child Health Care, 22(3), 406–418.
https://doi.org/10.1177/1367493518760736

Grzywniak, C. (2016). Role of early-childhood reflexes in the psychomotor development of a child and in learning. Acta
Neuropsychologica, 14(2), 113-129. http://www.actaneuropsychologica.com/api/files/view/62198.pdf

Grzywniak, C. (2017). Integration exercise programme for children with learning difficulties who have preserved vestigial
primitive reflexes. Acta Neuropsychologica, 15(3). https://doi.org/10.5604/01.3001.0010.5491

Hannaford, C. (2002). Awakening the child heart. Jamila Nur Publishing.

Hardy, M., & Lagasse, A. B. (2013). Rhythm, movement, and autism: Using rhythmic rehabilitation research as a model for
autism. Frontiers in Integrative Neuroscience, 7. https://doi.org/10.3389/fnint.2013.00019

Hayden, R., Clair, A. A., Johnson, G., & Otto, D. (2009). The effect of Rhythmic Auditory Stimulation (RAS) on physical therapy
outcomes for patients in gait training following stroke: A feasibility study. International Journal of Neuroscience, 119(12),
2183-2195. https://doi.org/10.3109/00207450903152609

Herbert, J., Gross, J., Hayne, H. (2007). Crawling is associated with more flexible memory retrieval by 9-month-old infants.
Developmental Science, 10(2), 183-189. https://doi.org/10.1111/j.1467-7687.2007.00548.x

Hickey, J., & Feldhacker, D. R. (2022). Primitive reflex retention and attention among preschool children. Journal of
Occupational Therapy, Schools, & Early Intervention, 15(1), 1-13. https://doi.org/10.1080/19411243.2021.1910606

Hobo, K., Kawase, J., Tamura, F., Groher, M., Kikutani, T., & Sunakawa, H. (2014). Effects of the reappearance of primitive
reflexes on eating function and prognosis. Geriatrics & Gerontology International, 14(1), 190-197.
https://doi.org/10.1111/ggi.12078

Holmes, K., Handloser, P., Hanley, D. (2016), Retained primitive reflexes in ADHD and ASD among children in an inpatient
psychiatric setting [Unpublished manuscript]. University of Arkansas for Medical Science, Psychiatric Research Institute.

Hong, H. J., & Kim Y. M. (2016). Effect of rhythmic movement program to improve walking ability for elderly patients with
stroke. Indian Journal of Science and Technology, 9(26). https://doi.org/10.17485/ijst/2016/v9i26/97366

Hyde, T., Goldberg, T., Egan, M., Lener, M., & Weinberger, D. (2007). Frontal release signs and cognition in people with
schizophrenia, their siblings and healthy controls. The British Journal of Psychiatry, 191(2), 120-125.
https://doi.org/10.1192/bjp.bp.106.026773

Iverson, J. M. (2010). Developing language in a developing body: The relationship between motor development and
language development. Journal of Child Language, 37(2), 229-261. https://doi.org/10.1017/S0305000909990432

42
© Sonia Story, October 2023 - Move Play Thrive
Iwanaga, R., Ozawa, H., Kawasaki, C., & Tsuchida, R. (2006). Characteristics of the sensory-motor, verbal and cognitive abilities
of preschool boys with attention deficit/hyperactivity disorder combined type. Psychiatry and clinical neurosciences, 60(1),
37-45. https://doi.org/10.1111/j.1440-1819.2006.01458.x

Jordan-Black, J. (2005). The effects of the Primary Movement programme on the academic performance of children
attending ordinary primary school. Journal of Research in Special Educational Needs, 5(3), 101-111.
https://doi.org/10.1111/j.1471-3802.2005.00049.x

Kadivar, Z., Corcos, D., Foto, J., & Hondzinski, J. (2011). Effect of step training and rhythmic auditory stimulation on functional
performance in Parkinson patients. Neurorehabilitation and Neural Repair, 25(7), 626-635.
https://doi.org/10.1177/1545968311401627

Kim, S. M., Hyun, G. J., Jung, T. W., Son, Y. D., Cho, I. H., Kee, B. S., & Han, D. H. (2017). Balance deficit and brain connectivity in
children with attention-deficit/hyperactivity disorder. Psychiatry Investigation, 14(4), 452.
https://doi.org/10.4306/pi.2017.14.4.452

Kohen-Raz, R. (1986). Learning disabilities and postural control. Freund Publishing House.

Konicarova, J., & Bob, P. (2012). Retained primitive reflexes and ADHD in children. Activitas Nervosa Superior, 54(3), 135-138.
https://doi.org/10.1007/BF03379591

Konicarova, J., & Bob, P. (2013). Asymmetric tonic neck reflex and symptoms of attention deficit and hyperactivity disorder in
children. International Journal of Neuroscience, 123(11), 766-769. https://doi.org/10.3109/00207454.2013.801471

Konicarova, J., Bob, P., & Raboch, J. (2014). Balance deficits and ADHD symptoms in medication-naïve school-aged boys.
Neuropsychiatric Disease and Treatment, 10, 85-88. https://doi.org/10.2147%2FNDT.S56017

Konicarova, J., Bob, P., & Raboch, J. (2013). Persisting primitive reflexes in medication-naïve girls with attention-deficit and
hyperactivity disorder. Neuropsychiatric Disease and Treatment, 9, 1457–1461. https://doi.org/10.2147/NDT.S49343

Kornhaber, L., Ridgway, E., & Kathirithamby, R. (2007). Occupational and physical therapy approaches to sensory and motor
issues. Pediatric Annals, 36(8), 484-493. https://doi.org/10.3928/0090-4481-20070801-10

Ladányi, E., Persici, V., Fiveash, A., Tillmann, B., & Gordon, R. L. (2020). Is atypical rhythm a risk factor for developmental
speech and language disorders? Wiley Interdisciplinary Reviews: Cognitive Science, 11(5), e1528.
https://doi.org/10.1002/wcs.1528

Lane, S. J., & Reynolds, S. (2019). Sensory over-responsivity as an added dimension in ADHD. Frontiers in Integrative
Neuroscience, 13, (40). https://doi.org/10.3389/fnint.2019.00040

Manicolo, O., Grob, A., Lemola, S., & Arx, P. H. (2015). Age-related decline of gait variability in children with attention-
deficit/hyperactivity disorder: Support for the maturational delay hypothesis in gait. Gait & Posture, 44, 245–249.
https://doi.org/10.1016/j.gaitpost.2015.12.012

43
© Sonia Story, October 2023 - Move Play Thrive
Masgutova, S., Akhmatova, N., Sadowska, L., Shackleford, P., & Akhmatov, E. (2016). Progress with neurosensorimotor reflex
integration for children with autism spectrum disorder. Journal of Neurology and Psychology, 4(2), 14.
https://doi.org/10.13188/2332-3469

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. https://doi.org/10.1044/2020_JSLHR-19-00423

McGee, S. R. (2007). Evidence-based physical diagnosis. Saunders/Elsevier.

McMahon, K., Anand, D., Morris-Jones, M., & Rosenthal, M. Z. (2019). A path from childhood sensory processing disorder to
anxiety disorders: The mediating role of emotion dysregulation and adult sensory processing disorder symptoms. Frontiers
in Integrative Neuroscience, 22. https://doi.org/10.3389/fnint.2019.00022

McPhillips, M., Finlay, J., Bejerot, S., & Hanley, M. (2014). Motor deficits in children with autism spectrum disorder: A cross‐
syndrome study. Autism Research, 7(6), 664-676. https://doi.org/10.1002/aur.1408

McPhillips, M., Hepper, P., & Mulhern, G. (2000). Effects of replicating primary-reflex movements on specific reading
difficulties in children: A randomised, double-blind, controlled trial. The Lancet (British Edition), 355(9203), 537–541.
https://doi.org/10.1016/S0140-6736(99)02179-0

McPhillips, M., & Jordan-Black, J. (2007). Primary reflex persistence in children with reading difficulties (dyslexia): A cross-
sectional study. Neuropsychologia, 45(4), 748-754. https://doi.org/10.1016/j.neuropsychologia.2006.08.005

McPhillips, M., & Sheehy, N. (2004). Prevalence of persistent primary reflexes and motor problems in children with reading
difficulties. Dyslexia, 10(4), 316-338. https://doi.org/10.1002/dys.282

McWhirter, K., Steel, A., & Adams, J. (2022). The association between learning disorders, motor function, and primitive reflexes
in pre-school children: A systematic review. Journal of Child Health Care. https://doi.org/10.1177/13674935221114187

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(684).
https://doi.org/10.3389/fpubh.2020.431835

Missiuna, C., Rivard, L., & Bartlett, D. (2003). Early identification and risk management of children with Developmental
Coordination Disorder. Pediatric Physical Therapy, 15, 32–38.

Niklasson, M., Norlander, T., Niklasson, I., & Rasmussen, P. (2017). Catching-up: Children with developmental coordination
disorder compared to healthy children before and after sensorimotor therapy. PloS One, 12(10).
https://doi.org/10.1371/journal.pone.0186126

Niklasson, M., Rasmussen, P., Niklasson, I., & Norlander, T. (2015). Adults with sensorimotor disorders: Enhanced physiological
and psychological development following specific sensorimotor training. Frontiers in Psychology, 6, 480.
https://doi.org/10.3389/fpsyg.2015.00480

44
© Sonia Story, October 2023 - Move Play Thrive
Odeh, C. E., Gladfelter, A. L., Stoesser, C., & Roth, S. (2022). Comprehensive motor skills assessment in children with autism
spectrum disorder yields global deficits. International Journal of Developmental Disabilities, 68(3), 290-300.
https://doi.org/10.1080/20473869.2020.1764241

Oliver, J. L. (2020). Primitive Reflex Persistence in U.S. Middle School Students and Academic Reading and Mathematics
[Doctoral dissertation]. Grand Canyon University, Phoenix.
https://www.proquest.com/openview/9f61763613d800f8681c608de6bd3c98/1

Øksendal, E., Brandlistuen, R. E., Holte, A., & Wang, M. V. (2022). Associations between poor gross and fine motor skills in pre-
school and peer victimization concurrently and longitudinally with follow-up in school age—results from a population-
based study. British Journal of Educational Psychology, 92(2), e12464. https://doi.org/10.1111/bjep.12464

Pecuch, A., Gieysztor, E., Telenga, M., Wolańska, E., Kowal, M., & Paprocka-Borowicz, M. (2020). Primitive reflex activity in
relation to the sensory profile in healthy preschool children. International Journal of Environmental Research and Public
Health, 17(21). https://doi.org/10.3390/ijerph17218210

Pecuch, A., Gieysztor, E., Wolańska, E., Telenga, M., & Paprocka-Borowicz, M. (2021). Primitive reflex activity in relation to
motor skills in healthy preschool children. Brain Sciences, 11(8), 967. https://doi.org/10.3390/brainsci11080967

Perry, B. (2006). Applying principles of neurodevelopment to clinical work with maltreated and traumatized children: The
neurosequential treatment model. In N. B. Webb (Ed.), Working with traumatized youth in child welfare (pp. 27-52). Guilford
Press.

Piek, J. P., Dawson, L., Smith, L., & Gasson, N. (2008). The role of early fine and gross motor development on later motor and
cognitive ability. Human Movement Science, 27(5), 668-681. https://doi.org/10.1016/j.humov.2007.11.002

Piek, J. P., Barrett, N. C., Smith, L. M., Rigoli, D., & Gasson, N. (2010). Do motor skills in infancy and early childhood predict
anxious and depressive symptomatology at school age? Human Movement Science, 29(5), 777-786.
https://doi.org/10.1016/j.humov.2010.03.006

Provasi, J., Blanc, L., & Carchon, I. (2021). The importance of rhythmic stimulation for preterm infants in the NICU. Children,
8(8), 660. https://doi.org/10.3390/children8080660

Preedy, P., Duncombe, R., & Gorely, T. (2022). Physical development in the early years: The impact of a daily movement
programme on young children’s physical development. Education 3-13, 50(3), 289-303.

Richards, L., Avery, R., Gray, S., & Price, R. (2022). Relationship of retained primitive reflexes and handwriting difficulty in
elementary-age children. The American Journal of Occupational Therapy, 76 (Supplement_1), 7610505010p1.
https://doi.org/10.5014/ajot.2022.76S1-RP10

Richards, L., Avery, R., Gray, S., & Price, R. (2022). Relationship of retained primitive reflexes and handwriting difficulty in
elementary-age children. The American Journal of Occupational Therapy, 76(Supplement_1), 7610505010p1.
https://doi.org/10.5014/ajot.2022.76S1-RP10

45
© Sonia Story, October 2023 - Move Play Thrive
Rubia, K. (2007). Neuro-anatomic evidence for the maturational delay hypothesis of ADHD. Proceedings of the National
Academy of Sciences, 104(50), 19663-19664. https://doi.org/10.1073/pnas.0710329105

Salavati, S., Bos, A. F., Doyle, L. W., Anderson, P. J., & Spittle, A. J. (2021). Very preterm early motor repertoire and
neurodevelopmental outcomes at 8 years. Pediatrics, 148(3). https://doi.org/10.1542/peds.2020-049572

Sampaio-Baptista, C., Khrapitchev, A. A., Foxley, S., Schlagheck, T., Scholz, J., Jbabdi, S., DeLuca, G. C., Miller, K. L., Taylor, A.,
Thomas, N., & Kleim, J. (2013). Motor skill learning induces changes in white matter microstructure and myelination. Journal
of Neuroscience, 33(50), 19499-19503. https://doi.org/10.1523/jneurosci.3048-13.2013

Schatz, D. B., & Rostain, A. L. (2006). ADHD with comorbid anxiety: a review of the current literature. Journal of Attention
Disorders, 10(2), 141-149. https://doi.org/10.1177/1087054706286698

Shaw, P., Eckstrand, K., Sharp, W., Blumenthal, J., Lerch, J. P., Greenstein, D., Clasen, L., Evans, A., Giedd, J., & Rapoport, J. L.
(2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National
Academy of Sciences, 104(49), 19649-54. https://doi.org/10.1073/pnas.0707741104

Shefer, S., Gordon, C., Avraham, K. B., & Mintz, M. (2015). Balance deficit enhances anxiety and balance training decreases
anxiety in vestibular mutant mice. Behavioural Brain Research, 276, 76-83. https://doi.org/10.1016/j.bbr.2014.06.046

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 and Visual Performance, 6(3), 106-111.
http://www.ovpjournal.org/uploads/2/3/8/9/23898265/63c.pdf

Sigafoos, J., Roche, L., O’Reilly, M. F., & Lancioni, G. E. (2021). Persistence of primitive reflexes in developmental disorders.
Current Developmental Disorders Reports, 8(2), 98–105. https://doi.org/10.1007/s40474-021-00232-2

Sripada, C. S., Kessler, D., & Angstadt, M. (2014). Lag in maturation of the brain’s intrinsic functional architecture in attention-
deficit/hyperactivity disorder. Proceedings of the National Academy of Sciences, 111(39), 14259-14264.
https://doi.org10.1073/pnas.1407787111

Stallings-Sahler, S., Reinoso, G., & Frauwirth, S. (2019). Neurodevelopmental soft signs: Implications for sensory processing
and praxis assessment—Part one. AOTA. CE. Article code CEA0919, 1-10.

Suh, J. H., Han, S. J., Jeon, S. Y., Kim, H. J., Lee, J. E., Yoon, T. S., & Chong, H. J. (2014). Effect of rhythmic auditory stimulation on
gait and balance in hemiplegic stroke patients. NeuroRehabilitation, 34(1), 193-199. https://doi.org/10.3233/NRE-131008

Taylor, B., Hanna, D., & McPhillips, M. (2020). Motor problems in children with severe emotional and behavioural difficulties.
British Journal of Educational Psychology, 90(3), 719–735. https://doi.org/10.1111/bjep.12327

Taylor, M., Chapman, E., & Houghton, S. (2004). Primitive reflexes and attention-deficit/hyperactivity disorder: Developmental
origins of classroom dysfunction. International Journal of Special Education, 19(1), 23-37.

Thelen, E. (1979). Rhythmical stereotypies in normal human infants. Animal behaviour, 27, 699-715.

46
© Sonia Story, October 2023 - Move Play Thrive
Thye, M. D., Bednarz, H. M., Herringshaw, A. J., Sartin, E. B., & Kana, R. K. (2018). The impact of atypical sensory processing on
social impairments in autism spectrum disorder. Developmental Cognitive Neuroscience, 29, 151-167.
https://doi.org/10.1016/j.dcn.2017.04.010

Torres, E. B., & Whyatt, C. (Eds.). (2018). Autism: The movement sensing perspective. CRC Press.

Uljarević, M., Hedley, D., Alvares, G. A., Varcin, K. J., & Whitehouse, A. (2017). Relationship between early motor milestones and
severity of restricted and repetitive behaviors in children and adolescents with autism spectrum disorder. Autism Research,
10(6), 1163–1168.

Utley, A. (2018). Motor control, learning and development: Instant notes (2nd ed.). Routledge.
https://doi.org/10.4324/9781315102481

van Steensel, F. J., & Heeman, E. J. (2017). Anxiety levels in children with autism spectrum disorder: A meta-analysis. Journal
of Child and Family Studies, 26(7), 1753-1767. https://doi.org/10.1007/s10826-017-0687-7

Walhberg, T., & Ireland, D. (2005). Can replicating primary reflex movements improve reading ability? Optometry & Vision
Development, 36(2).

Zang, Y., Gu, B., Qian, Q., & Wang, Y. (2002). Objective measurement of the balance dysfunction in attention deficit
hyperactivity disorder children. Chinese Journal of Clinical Rehabilitation, 6, 1372-1374.

Zentner, M., Eerola, T. (2010). Rhythmic engagement with music in infancy. Proceedings of the National Academy of Sciences,
107(13) 5768-5773. https://doi.org/10.1073/pnas.1000121107

Zoccante, L., Ciceri, M. L., Chamitava, L., Di Gennaro, G., Cazzoletti, L., Zanolin, M. E., Darra, F., & Colizzi, M. (2021). Postural
control in childhood: Investigating the neurodevelopmental gradient hypothesis. International Journal of Environmental
Research and Public Health, 18(4), 1693. https://doi.org/10.3390/ijerph18041693

Zuk, L. (2011). Fetal and infant spontaneous general movements as predictors of developmental disabilities. Developmental
Disabilities Research Reviews, 17(2), 93–101. https://doi.org/10.1002/ddrr.1104

47
© Sonia Story, October 2023 - Move Play Thrive