Neuro-Developmental Delay (NDD) refers to immaturity in the central nervous system. One of the main things we look for is the presence of retained infant (primitive) reflexes and underdeveloped adult (postural) reflexes. It refers to a condition where a child’s neurological development lags behind the expected milestones for their age. This delay can affect various aspects of development, including motor skills, speech and language skills, cognitive abilities, and social and emotional development. Reaching milestones is therefore difficult to reach such as sitting up, crawling, walking, speaking, or interacting with others.
Primitive Reflexes are instinctive responses that emerge during fetal development, aiding in the birthing process and supporting survival and early development in the first year of life. Ideally, these reflexes should manifest, serve their purpose, and naturally integrate within the first year, some closer to three years of age. The timely integration of primitive reflexes signifies the expected maturation of the nervous system. A well-developed nervous system forms a robust foundation for the acquisition of skills, overall health, and general well-being.
When a primitive reflex undergoes integration, it paves the way for the emergence of more sophisticated movement patterns and the development of higher-level learning.
To delve into a more scientific explanation, the establishment of a new movement pattern results in the formation of fresh neural pathways in the brain, consequently facilitating the advancement of higher-level skills. For instance, an infant must first attain control over their head and neck before achieving the ability to sit upright independently. Failure to acquire this foundational control would impede the infant’s capacity to sit upright without external assistance.
In cases where a reflex fails to integrate, developmental progress may be impeded, potentially preventing the acquisition of advanced skills by the infant.
Symptoms:
Anxiety Speech and articulation challenges
Motion sickness/car sickness Hypersensitivity to sound, touch, movement
Clumsy Poor short-term memory
Poor hand-eye coordination Bedwetting past the age of 7
Poor right / left discrimination after the age of 8 Challenges sitting still – ADHD symptoms
Challenges with reading at age level W-sitting and/or toe walking
Poor handwriting at age level Challenges with sequencing
Low muscle tone Decreased coordination with sporting activities
What causes primitive reflexes to be retained?
- The stress of the mother and/or baby during pregnancy
- Lack of movement in utero
- Infants spending extended time in car seats/carriers, jumpers, walkers… all of which restrict movements required for healthy brain development.
- Illness, trauma, injury, chronic stress
- Other developmental delays
- Reflexes that were integrated can also reactivate due to injury, trauma, illness, or stress.
- Both children and adults can experience symptoms from primitive reflexes that were not integrated.
Some of the most important primitive reflexes:
1 Moro reflex
Moro Reflex is the first primitive reflex to emerge, is the first to inhibit after birth, forming a foundation for life and living. The Moro reflex serves as the infant’s ‘alarm reflex.’ Since a newborn lacks the ability for reasoned thought, it is unable to evaluate the legitimacy of a threat. Consequently, the Moro reflex acts as an involuntary, automatic reaction to a perceived danger.
Similar to other primitive reflexes, the Moro reflex originates from the (unconscious) brainstem, which is the initial segment of the brain to mature and operate. When the Moro reflex is triggered , the baby’s ‘fight or flight’ response is activated, releasing adrenaline and cortisol ( the ‘stress hormones’) into its bloodstream .This results in an increase in the baby’s rate of breathing and heart rate, as well as a rise in blood pressure and reddening of the skin. Once the Moro is triggered, we tend to perceive everything in our environment as a potential threat to our survival.
a. In the flight mode, these children tend to exhibit anxiety, fearing various stimuli, internalising their emotions, and maintaining social independence, often with limited or no close friendships. They tend to resist change and new situations.
b. In the fight mode, these children display overexcitability, aggression, a dominating attitude, and difficulties in interpreting other people’s body language. Despite their heightened sensitivity, perceptiveness, and imagination, these children frequently demonstrate immature behaviour and exaggerated reactions to ordinary situations.
The Moro affects the overall emotional profile of the child but also the vestibular, oculomotor, and visual perceptual skills.
The heightened sensitivity can be noticed through becoming overly reactive to stimuli such as sound, touch, movement, smell, temperature changes, environmental shifts, light variations, and dietary influences/ basic baby food.
Their preference for the company of either younger children or adults often stems from their struggle to understand the intricacies of peer interaction.
In a classroom setting, a child retaining the Moro reflex may manifest disruptive behaviour, excessive noise, inattention, distractibility, and an inability to remain seated or still.
Possible symptoms of a retained Moro reflex may include:
| BEHAVIOURAL AND EMOTIONAL Anxiety and fearfulness Panic attacks Low self-esteem and lack of confidence Dislike of change or surprise Shy and withdrawn behaviour Fear of separation from loved ones Difficulty accepting and giving affection Mood swings Depressive feelings and behaviours Defiant behaviours OCD type behaviours Impulsivity Emotional immaturity Aggressive outbursts, both verbal and physical Frequent meltdowns Hyperactivity hypersensitivity to sensory stimuli Avoidance of certain places and situations Excessive daydreaming and fantasising Inability to relax Distractibility Fussy eating Controlling behaviour |
PHYSIOLOGICAL Lowered immune system – frequent ear, nose and throat infections Digestive problems Allergies – asthma, eczema as well as food allergies Adverse reactions to medication Fluctuating blood sugar levels ( minor hypoglycaemia) High blood pressure Sleep problems Headaches Neck and shoulder pain Reduced or increased appetite |
2. Tonic Labyrinthine Reflex (TLR)
The TLR is closely linked to the Moro Reflex and is seen with movement of the head forwards or backwards – providing a method of response to gravity (an infant experiences gravity for the first time after birth, so this reflex is a direct response to this newfound challenge). The TLR develops in utero and has a direct influence on the development of muscle tone throughout the body.
The TLR should be integrated by 3 years of age. However part of the TLR should be integrated as early as six months (this is the approximate age when the Moro Reflex should be integrated – quite the connection!).
Some potential symptoms of a retained TLR in toddlers and older children are:
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- Challenges with crawling
- Poor posture- toe walking
- Low muscle tone, poor balance and coordination
- Vision challenges
- Poor sequencing skills, including poor sense of time
- Auditory processing challenges
- Poor sense of space, time, and organization
- Challenges with sports
- Poor sense of balance and tendency to car sickness
- Visual-perception issues and spatial problems
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3. Asymmetrical Tonic Neck Reflex (ATNR)
The ATNR emerges in the fetus at around 18 weeks and should integrate by six months after birth. The ATNR, along with other reflexes, assists the baby in travelling down the birth canal and is fully reinforced by the birthing process. Caesarean or forceps can interfere with the reflex fully reaching its potential. A retained ATNR can impede the two sides of the body from working graciously together.
Possible effects of a retained ATNR:
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- Eye tracking may not function smoothly, and reading and comprehension skills can be hindered
- Poor balance and coordination
- Difficulty establishing laterality (i.e dominant hand, eye, or ear)
- Difficulty crossing the midline (e.g., a right-handed child may find it difficult to write on the left side of the page)
- Discrepancy between oral and written performance
- Poor hand-eye coordination (e.g., difficulty catching a ball)
- Poor fine motor skills (i.e., handwriting)
- Difficulty learning to ride a bicycle and swim
- Sideways writing – with paper on an angle
- Can impede the two sides of the body from working graciously together
- May have difficulty multi-tasking
- The extended palm and arm can cause an immature pencil grip which hinders the development of a mature pincer grip.
- Awkward non-symmetrical movements when running or swimming
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4. Symmetrical Tonic Neck Reflex (STNR)
The STNR is directly related to the TLR – because the STNR assists the infant with moving from prone (laying on belly) into quad (on all 4s – pre crawling position), it additionally assists with integrating the TLR. According to a report from 2020, the STNR develops between 6-9 months after birth.
The STNR should be integrated – not present – by 9-11 months of age (a very short life span compared to some of the other Primitive Reflexes).
Possible symptoms if retained:
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- Challenges with crawling
- Poor posture, low muscle tone
- W-sitting
- Clumsiness
- Poor sustained attention
- Challenges with reading and writing
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5. Spinal Galant Reflex
The Spinal Galant Reflex emerges 20 weeks after conception. It should be actively present at birth and should inhibit by 3 to 9 months of age. If you stroke a baby to either side of its spine, it will cause the hip on that side to flex or rotate. Like the ATNR, the Spinal Galant Reflexes important in the birthing process as it facilitates movement of the hips as the baby work