Occupational Therapy’s Role in Reflex Integration

Primitive reflexes are those reflexes that develop in a newborn to help a child survive and develop. These are automatic movements. The common ones are the Moro Reflex, Rooting Reflex, Palmar Grasp, Asymmetric Tonic Neck Reflex (ATNR), Spinal Galant Reflex, Tonic Labyrinthine Reflex (TLR), Symmetric Tonic Neck Reflex (STNR), and Landau Reflex.¹ These are necessary for helping the child navigate the world around them when their brain is still developing.

These primitive reflexes integrate at a certain period in a child’s development as they no longer need to automatically turn their head towards a food source or startle and hold on to their mother, for example. When the reflexes do not integrate, they can, in some cases, significantly affect a child's motor skills and cause sensory sensitivity. However, retention of primitive reflexes does not always affect a child’s functionality and participation in occupations, so it’s important to understand how to approach reflex integration properly.

Research Findings

In the article “Choosing Wisely In Pediatric Practice,” AOTA looked deeply into the history of reflex integration (RI) research. They discovered that it was believed that the primitive reflexes that were not integrated at the right developmental stage were indicators of sensory processing problems and were related to motor and learning difficulties. However, this research showed a correlation between all these things, which does not necessarily indicate causation. In other words, research has not proven there is a definite tie between retained primitive reflexes and functional impairment.

RI’s place in OT

Reflex Integration (RI) techniques are those that try to help integrate these retained primitive reflexes. Since it is the OT’s job to provide evidence-based interventions, it’s important to keep in mind that retained primitive reflexes have not been proven as a cause of sensory or motor deficits, although “they may indicate difficulties in how the higher levels of the brain organize incoming sensory information.”² Therefore, RI should never be the sole focus of an intervention. Intervention should focus on improving a child’s functionality and participation in occupations.

• Sources/Citations

  1. Heidenreich, Samantha, OTD, MOT. “Understanding Primitive Reflexes: How They Impact Child Development and Intervention Strategies for Integration,” OccupationalTherapy.com, 6 May 2021, https://www.occupationaltherapy.com/articles/understanding-primitive-reflexes-they-impact-5409-5409

  2. Piller, Aimee. “Choosing wisely in pediatric practice,” AOTA OT Practice, 1 October 2022, https://www.aota.org/publications/ot-practice/ot-practice-issues/2022/practice-improvement-perk-choosing-wisely-pediatric