Retained Reflexes and Learning

by

If your child struggles with handwriting, can’t seem to sit still, or finds reading harder than you’d expect for their age, you may have come across the term “retained primitive reflexes.” It’s a topic that generates a lot of interest among parents and tutors, but also one where the evidence is more nuanced than some websites suggest. Here’s a clear, balanced look at what’s known.

What are primitive reflexes?

Primitive reflexes are automatic, brainstem-controlled movements present from birth, things like the Moro (startle) reflex or the palmar grasp reflex, which helps a baby hold onto a finger placed in their hand. They support survival and movement in infancy and are typically expected to fade, or “integrate,” as the nervous system matures and a child develops voluntary motor control.

When a reflex doesn’t fully integrate on schedule, it’s described as “retained.” Several smaller studies have found associations between retained reflexes and difficulties with handwriting, reading, balance, and attention in school-aged children. A pilot study published in the International Journal of Environmental Research and Public Health, for example, found links between residual primitive reflexes and specific academic tasks such as clock-reading in school-aged children.

What does the research actually show?

This is the part worth slowing down on, because the picture is genuinely mixed.

  • A study published in the American Journal of Occupational Therapy found a relationship between retained primitive reflexes and handwriting difficulty in elementary-age children, but the authors were careful to note the finding came from one school district and needs replication, and recommended reflex work be paired with standard handwriting instruction rather than used alone.
  • A randomised, double-blind controlled trial published in The Lancet (McPhillips, Hepper & Mulhern, 2000) tested a movement programme replicating primary reflex patterns in children with specific reading difficulties and reported improvements in reading-related outcomes.
  • Reviews looking at reflexes and ADHD or autism describe correlations between retained reflexes and motor or attention difficulties, but consistently stop short of claiming the relationship is causal.

The clearest professional statement comes from the American Occupational Therapy Association (AOTA), which includes reflex integration in its “Practice Smart” guidance for clinicians. Its position is direct: interventions designed solely to integrate retained reflexes do not, by themselves, improve a child’s participation in everyday tasks. The presence of a retained reflex doesn’t automatically mean a child has a functional problem, and reflex work should only be used where it’s clearly linked, through proper assessment, to a specific difficulty the child is having at school or at home, as part of a wider, occupation-focused plan.

In short: there’s a real, growing body of research here, but it’s an emerging field, not a settled one, and reflex integration shouldn’t be presented or sold as a stand-alone fix.

What this means practically for parents

  • Look for proper assessment, not just a label. A reputable therapist will assess your child’s actual difficulties; handwriting, reading, coordination, and sitting tolerance, rather than starting from “your child has X retained reflex” and working backwards.
  • Reflex work should sit alongside other support, such as occupational therapy for fine motor skills, structured literacy teaching, or input from your child’s school’s SENCO, not replace it.
  • Check qualifications. In the UK, the protected title “occupational therapist” can only be used by someone registered with the Health and Care Professions Council (HCPC), you can check this on the HCPC’s online register. Many practitioners offering reflex integration are OTs, physiotherapists, or specialist tutors; others use the term more loosely, so it’s worth asking directly about their professional registration and training.
  • Be cautious of absolute claims. If a practitioner presents reflex integration as a guaranteed cure for dyslexia, ADHD, or autism-related difficulties, that’s a sign to ask more questions, the evidence doesn’t currently support claims that strong.

Where it can fit into a child’s wider support

For some children, particularly those with co-occurring motor coordination difficulties, reflex-based approaches delivered by a properly qualified therapist as one part of a broader plan may be a reasonable thing to try alongside, not instead of, established interventions like OT-led handwriting programmes, speech and language therapy, or specialist tuition. As with most developmental approaches, what matters most is whether it’s tied to a clear goal for your child, delivered by someone properly qualified, and reviewed for whether it’s actually helping.

If you’re unsure where to start, a good first step is usually a conversation with your GP, school SENCO, or an HCPC-registered occupational therapist, who can help assess whether reflex integration is relevant to your child’s specific difficulties.

References

  1. McPhillips, M., Hepper, P.G. & Mulhern, G. (2000). Effects of replicating primary-reflex movements on specific reading difficulties in children: a randomised, double-blind, controlled trial. The Lancet, 355, 537–541.
  2. American Occupational Therapy Association. Practice Smart! Recommendation 8: Reflex Integration Programs.https://www.aota.org/practice/practice-essentials/evidencebased-practiceknowledge-translation/practice-smart
  3. American Journal of Occupational Therapy (2022). Relationship of Retained Primitive Reflexes and Handwriting Difficulty in Elementary-Age Children. https://research.aota.org/ajot/article/76/Supplement_1/7610505010p1/23577/
  4. Kalemba, A., Lorent, M., Goddard Blythe, S. & Gieysztor, E. (2023). The Correlation between Residual Primitive Reflexes and Clock Reading Difficulties in School-Aged Children — A Pilot Study. International Journal of Environmental Research and Public Health, 20(3), 2322. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9915247/
  5. Health and Care Professions Council. Check the Register. https://www.hcpc-uk.org/check-the-register/
  6. Royal College of Occupational Therapists. Find an Occupational Therapist. https://www.rcot.co.uk/learn-about-occupational-therapy/what-occupational-therapy/find-occupational-therapist

This article is for general information only and is not a substitute for individual professional advice. If you have concerns about your child’s development or learning, speak to your GP, school, or a qualified, HCPC-registered professional.

View All