Helping Kids Succeed: How Integrating Primitive Reflexes Can Boost Academic Skills at School and Home

Helping Kids Succeed: Understanding Primitive Reflexes, Movement, and School Performance

How early movement patterns relate to motor development—and practical ways parents, teachers, and occupational therapists can support children’s success.

By Irene Hannam, MS OTR/L

Introduction: Why Primitive Reflexes Matter

Have you ever noticed a student who has difficulty maintaining an upright sitting position, frequently changes positions during writing, or struggles to coordinate both hands during classroom activities?

Perhaps a child leans heavily on the desk while writing, has difficulty copying from the board, or becomes frustrated when completing fine-motor tasks.

These observations may reflect challenges involving postural control, bilateral coordination, visual-motor integration, attention, or other developmental skills.

One aspect of motor development that occupational therapists may consider is the influence of early primitive reflexes.

Primitive reflexes are automatic movement responses that emerge during prenatal development or infancy. These responses play a role in early development and are gradually inhibited or modified as the nervous system matures and more voluntary movement patterns develop.

In some children, elements of these reflex responses may remain observable beyond infancy. Researchers have investigated associations between persistent primitive reflex responses and difficulties with motor coordination and school-related skills.

However, it is important to understand that the presence of a reflex response does not automatically indicate a developmental disorder or explain a child’s academic difficulties.

The goal of occupational therapy is not simply to eliminate a reflex. It is to help children develop the functional skills needed to participate successfully in school and everyday activities.

What Are Primitive Reflexes?

Primitive reflexes are involuntary motor responses triggered by specific sensory input or changes in head and body position.

These responses are most prominent during infancy. As children develop, increasingly sophisticated voluntary movements and postural reactions support activities such as crawling, walking, reaching, manipulating objects, and maintaining balance.

The timing and characteristics of reflex development vary by reflex and by child. Therefore, primitive reflexes should not all be expected to disappear at one specific age.

Common Primitive Reflexes and Their Associated Movement Patterns

Primitive Reflex	Typical Reflex Response	Related Functional Skills to Observe
Moro Reflex	Automatic startle response involving changes in arm and body position	Recovery from unexpected events, body awareness, and regulation
Asymmetrical Tonic Neck Reflex (ATNR)	Turning the head produces associated changes in arm and leg posture	Bilateral coordination, crossing midline, and head–body independence
Symmetrical Tonic Neck Reflex (STNR)	Head flexion and extension produce associated changes in arm and leg posture	Quadruped stability, head control, and upper/lower-body coordination
Tonic Labyrinthine Reflex (TLR)	Head position relative to gravity influences flexor and extensor responses	Antigravity posture, balance, and body-position control
Palmar Grasp Reflex	Pressure against the palm triggers automatic finger flexion	Voluntary grasp and release, hand opening, and manipulation
Spinal Galant Reflex	Stimulation alongside the spine produces an associated trunk response	Trunk movement and postural control

Important: The functional skills listed in the final column are areas an OT may observe during evaluation. They are not specific symptoms that establish whether a primitive reflex has been retained.

What Does Research Tell Us?

Research has identified associations between persistent primitive reflex responses and certain aspects of motor development. However, evidence that specific reflex-integration exercises reliably improve academic performance remains limited.

Primitive Reflexes and Motor Coordination

Gieysztor et al. (2018) investigated primitive reflex persistence and motor performance in a sample of preschool children.

The researchers identified associations between primitive reflex activity and measures of motor performance.

These findings suggest that early reflex responses may be relevant when examining motor development.

However, this was an observational study. It did not establish that persistent reflexes caused the motor difficulties or that reflex-integration exercises would resolve them.

Primitive Reflexes and Handwriting

Richards et al. (2022) examined relationships between retained primitive reflex responses and handwriting difficulties in 74 children ages 7–9.

The researchers reported an association between reflex retention and handwriting difficulties.

This is relevant to school-based occupational therapy because handwriting requires coordinated control of the head, trunk, shoulders, hands, and eyes.

However, the study was cross-sectional and published as a conference abstract. It does not establish that retained reflexes cause poor handwriting or that reflex-integration exercises improve handwriting performance.

 

Evidence for Motor and Handwriting Interventions

Research supports directly addressing the motor and handwriting skills that affect children’s classroom participation.

Engel et al. (2018) conducted a systematic review of 13 studies examining curriculum-based handwriting interventions for children from preschool through second grade. The researchers found small-to-medium improvements in handwriting legibility. However, findings regarding handwriting speed were mixed, and evidence for improvements in fluency was insufficient.

Chen et al. (2024) examined structured and unstructured movement interventions for preschool children. Their meta-analysis of 23 studies involving 4,068 children found that both types of interventions improved fundamental motor skills, including locomotor and object-control skills. Structured interventions demonstrated particular advantages for locomotor development. These findings support purposeful movement opportunities in early childhood but do not establish improvements in handwriting or primitive reflex integration.

Together, these findings support providing children with purposeful movement opportunities and direct instruction in the skills needed for classroom participation. However, neither study investigated primitive reflex integration or established that reflex-based exercises improve handwriting or academic performance.

Clinical Implication: Occupational therapy interventions should prioritize the functional skills affecting school participation. Foundational motor activities may complement handwriting instruction, but they should not replace direct practice of letter formation, sizing, spacing, and other handwriting skills.

What Does AOTA Recommend?

The American Occupational Therapy Association (AOTA), through its Practice Smart initiative, advises occupational therapy practitioners against using reflex-integration programs without clear connections to occupational performance.

AOTA emphasizes that observing retained reflex responses does not necessarily mean a child has functional impairment.

For school-based OT, the most meaningful question is not simply whether a reflex is present, but whether the child experiences difficulty participating in school activities and what interventions will help improve that participation.

How Motor Development Supports Academic Participation

Several foundational motor skills contribute to successful participation in classroom activities.

1. Postural Control and Handwriting

Writing requires more than finger movement.

Children must maintain an appropriate body position while coordinating movements of the shoulder, forearm, wrist, and fingers.

Postural control provides a stable base for these movements.

When a child demonstrates decreased postural endurance or stability, teachers may notice:

• Leaning heavily on the desk during writing
• Frequently changing sitting positions
• Supporting the head with one hand
• Difficulty maintaining paper position
• Fatigue during longer handwriting tasks

These observations warrant consideration of postural control, seating, task demands, and endurance. They do not automatically indicate a retained TLR or STNR.

Helpful activities:

• Tummy-time puzzles
• Wall pushes
• Bear walks
• Reaching while maintaining a stable sitting position
• Short, developmentally appropriate postural-control games

Teachers can also support participation by adjusting chair and desk height, providing foot support, and positioning writing materials appropriately.

2. Bilateral Coordination and Written Work

Bilateral coordination involves using both sides of the body together in an organized manner.

Children rely on this skill when:

• Holding paper with one hand while writing with the other
• Cutting with scissors while rotating the paper
• Opening containers
• Managing clothing fasteners
• Manipulating school supplies
• Organizing materials during classroom routines

Some children have difficulty stabilizing materials while performing a skilled movement with the opposite hand.

An occupational therapist may observe head–body coordination and ATNR-associated responses during assessment, but intervention should address the child’s actual functional difficulties.

Helpful activities:

• Cross-body treasure games
• Crawling through obstacle courses
• Stabilizing paper during coloring
• Two-handed construction activities
• Cutting and manipulating paper
• Reaching across the body during play

3. Visual-Motor Integration and Copying

Copying letters, numbers, shapes, and classroom information requires children to coordinate visual information with motor output.

For example, copying from a classroom board involves:

• Locating the correct information
• Shifting visual attention between the board and paper
• Remembering a short amount of information
• Returning to the appropriate place on the page
• Forming letters and words accurately

Students may have difficulty with these tasks for many reasons, including visual-motor challenges, oculomotor difficulties, attention, working memory, or handwriting mechanics.

It is not appropriate to assume that retained primitive reflexes are responsible for reading or eye-tracking difficulties.

Helpful strategies:

• Reduce copying demands when appropriate.
• Provide near-point models.
• Use visual guides and organized worksheets.
• Practice copying simple shapes and patterns.
• Teach letter formation explicitly.
• Consult appropriate professionals when visual concerns persist.

4. Attention and Classroom Regulation

Some students demonstrate frequent movement, fidgeting, or difficulty maintaining attention during seated activities.

These behaviors may reflect many factors, including attention, sensory processing, developmental differences, the environment, or the demands of the task.

Although primitive reflexes are sometimes discussed in relation to attention and self-regulation, current evidence does not justify treating a retained reflex as the primary explanation for these difficulties.

Teachers and occupational therapists can support students by providing predictable routines, appropriate movement opportunities, environmental modifications, and individualized strategies.

The goal is to improve meaningful participation—not to suppress normal movement or expect every child to sit completely still.

When Should Parents or Teachers Seek Additional Support?

Children develop at different rates, and occasional difficulty with motor tasks is common.

However, persistent challenges that interfere with school participation may warrant further observation or consultation.

Functional Classroom Observation Checklist

Consider whether the child frequently:

• Has difficulty maintaining a comfortable position for classroom tasks
• Struggles to use both hands together during cutting, writing, or manipulation
• Demonstrates unusually slow or difficult handwriting
• Has difficulty copying age-appropriate shapes, letters, or classroom information
• Avoids playground or movement activities because of motor challenges
• Demonstrates difficulty with balance, coordination, or motor planning
• Becomes unusually fatigued during fine-motor activities
• Requires substantial assistance with age-appropriate classroom routines

These observations are not a primitive reflex screening tool.

They can help parents and teachers identify functional areas that deserve closer attention.

A school-based occupational therapist may examine postural control, fine-motor coordination, visual-motor integration, sensory processing, motor planning, and other performance components based on the child’s educational needs.

How Can Movement Activities Help?

Purposeful movement activities provide opportunities to practice postural stability, bilateral coordination, strength, balance, and motor planning.

Activities should be selected according to the child’s developmental abilities and functional goals.

Practical Movement Activities for School and Home

Activity	What It Practices	Functional Connection
Bear Walk	Shoulder stability, bilateral coordination, weight bearing	Supporting the upper body during school activities
Cross-Body Treasure	Crossing midline and coordinated reaching	Using both hands during classroom tasks
Wall Push	Upper-extremity stability and force awareness	Postural support and body awareness
Tummy-Time Puzzle	Prone endurance and shoulder stability	Maintaining stable positions during play
Puppy Rocking	Controlled weight shifting in quadruped	Postural control and movement coordination
Play-Dough Bakery	Pinch, grasp, and finger manipulation	Handwriting, scissors, and self-help skills
Snow Angels	Bilateral movement and body awareness	Coordinating both sides of the body
Obstacle Course	Motor planning, balance, and sequencing	Moving through classroom and playground environments

These activities can support movement practice but should not be presented as proven methods for integrating specific primitive reflexes.

Five-Minute Movement Break

Here is an example of a short classroom movement routine.

Minute 1: Wall Push

• Stand facing a wall. Place hands flat against the surface and complete 3–5 gentle pushes.
• Focus: Shoulder stability and force awareness.

Minute 2: Bear Walk

• Bear walk or crawl along a short, safe pathway.
• Focus: Bilateral coordination and postural control.

Minute 3: Cross-Body Treasure

• Reach across the body to retrieve beanbags or classroom objects.
• Focus: Crossing midline and controlled reaching.

Minute 4: Puppy Rocking

• Begin on hands and knees. Slowly shift the body forward and backward while maintaining a comfortable, relatively neutral head position.
• Focus: Quadruped stability and weight shifting.

Minute 5: Starfish Hug

• Stand or sit with arms extended. Slowly bring the arms across the body for a gentle hug, then return to the starting position.
• Focus: Body awareness and a predictable transition.

Important: Movement responses vary. Some children may benefit from active movement, while others may require a quieter or more individualized approach.

When Is the Best Time to Use Movement Activities?

Movement activities may be incorporated at different times during the school day.

The timing should reflect the child’s needs, classroom schedule, and purpose of the activity.

Classroom Routine	Possible Movement Activity	Intended Purpose
Before handwriting	Wall Push or Play-Dough Bakery	Practice upper-extremity stability and hand movements
Before fine-motor centers	Bear Walk or Cross-Body Treasure	Practice bilateral coordination and reaching
During transitions	Short obstacle course	Motor planning and participation
Before floor activities	Tummy-Time Puzzle or Puppy Rocking	Practice postural stability
Following active play	Starfish Hug and comfortable breathing	Support a predictable transition

There is no established evidence that performing a specific reflex-related movement immediately before an academic task reliably improves academic performance.

Teachers should select activities based on observable needs and determine whether they help the child participate more successfully.

How Long Does It Take to See Improvement?

There is no established timeline for integrating retained primitive reflexes through classroom movement exercises.

Motor skill development depends on several factors, including the child’s starting abilities, opportunities for practice, task demands, and individual developmental needs.

Rather than expecting a specific result after 8–12 weeks, focus on observable functional progress.

For example:

Handwriting: Can the child form letters more accurately, use appropriate spacing, or complete written work with greater independence?

Postural Control: Can the child participate in a classroom task with improved comfort, stability, or endurance?

Bilateral Coordination: Can the child hold paper while cutting or writing with less assistance?

Classroom Participation: Can the child complete familiar routines more successfully with appropriate supports?

Parents and teachers can document progress through observations, work samples, and simple data collection.

Three Practical Recommendations for Teachers:

1. Choose Activities with a Functional Purpose

• Identify the skill you want students to practice before selecting an activity.
• If a child has difficulty stabilizing paper during writing, activities involving bilateral hand use and paper stabilization may be more relevant than a generalized movement routine.

2. Combine Foundational Motor Activities with Direct Skill Practice

• Movement activities can complement handwriting, cutting, and self-help instruction.
• However, they should not replace direct practice of the classroom skills the child needs to learn.
• For example, a student with handwriting difficulties may benefit from appropriate postural support and motor activities while also receiving explicit instruction in letter formation, sizing, placement, and spacing.

3. Monitor Meaningful Outcomes

• Select one or two observable goals.

Examples include:

• Maintains paper position during a five-minute writing activity
• Cuts along a simple path with improved bilateral coordination
• Completes a classroom copying task with increased legibility
• Transitions between classroom activities with less assistance

Monitor progress and modify strategies when necessary.

The Role of Occupational Therapy

School-based occupational therapists help identify and address motor, sensory, visual-motor, and other performance factors that interfere with a student’s access to and participation in educational activities.

An OT evaluation may consider primitive reflex-related responses when clinically appropriate, but these observations should be interpreted within a comprehensive assessment.

Intervention planning should be guided by the student’s functional needs and meaningful educational outcomes.

The goal is not to eliminate every observable primitive reflex response. The goal is to help children participate more effectively and independently in the activities that matter.

Final Thoughts: Building Stronger Foundations for School Success

Children need opportunities to move, explore, practice, and develop confidence in their abilities.

Early movement patterns are one part of the broader story of motor development. Understanding them can contribute to clinical reasoning, but they should not become the sole explanation for academic or behavioral difficulties.

A functional, evidence-informed approach focuses on what the child needs to do, what makes that task challenging, and which supports or interventions can improve participation.

Whether a child is learning to stabilize paper, maintain a comfortable writing position, coordinate scissors, or navigate a classroom routine, meaningful practice and appropriate support can make a difference.

At Write Expectations™, our goal is to help children develop the foundational skills they need for successful participation in school and everyday life.

References

American Occupational Therapy Association. (n.d.). Practice Smart! https://www.aota.org/practice/practice-essentials/evidencebased-practiceknowledge-translation/practice-smart

Chen, D., Zhao, G., Fu, J., Shun, S., Su, L., He, Z., Chen, R., Jiang, T., Hu, X., Li, Y., & Shen, F. (2024). Effects of structured and unstructured interventions on fundamental motor skills in preschool children: A meta-analysis. Frontiers in Public Health, 12, Article 1345566. https://doi.org/10.3389/fpubh.2024.1345566

Engel, C., Lillie, K., Zurawski, S., & Travers, B. G. (2018). Curriculum-based handwriting programs: A systematic review with effect sizes. American Journal of Occupational Therapy, 72(3), 7203205010p1–7203205010p8. https://doi.org/10.5014/ajot.2018.027110

Gieysztor, E. Z., Choińska, A. M., & 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

Richards, L., Avery, R., Gray, S., & Price, R. (2022). Relationship of retained primitive reflexes and handwriting difficulty in elementary-age children [Conference abstract]. American Journal of Occupational Therapy, 76(Supplement 1), S250. https://doi.org/10.5014/ajot.2022.76S1-RP10 

Educational Disclaimer

This article provides general educational information and does not replace individualized occupational therapy evaluation, medical assessment, or intervention. Motor and classroom participation difficulties can have multiple contributing factors. Consult appropriate professionals when concerns persist.

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