#306 - Curious About Primitive Reflexes? Answering Common Questions!

We are answering questions that we’ve received inside our primitive reflex digital course, Assessment And Integration Of Primitive Reflexes For Improved Independence In Daily Activities.

One of our favorite things about our digital course is that you can ask questions inside the course, start discussions, and get feedback!

In today’s episode, we talk about how to base a treatment plan and goals around retained primitive reflexes, how to test for reflexes when the child struggles with following instructions, the difference between ADHD and retained primitive reflexes, how to prioritize the reflexes during integration, and more!

Tune in for the full conversation!

Make sure to check out all of our links below!

We’d love to answer your questions on the podcast! Fill out this form -> https://harkla.typeform.com/to/ItWxQNP3

Brought To You By Harkla

This podcast is brought to you by Harkla.  Our mission at Harkla is to help those with special needs live happy and healthy lives. We accomplish this through high-quality sensory products,  & child development courses.

Podcast listeners get 10% off their first order at Harkla with the discount code "sensory". Head to Harkla.co/sensory to start shopping now.

Links
All Things Sensory Podcast Instagram
Harkla YouTube Channel
Harkla Website - Shop Sensory Products!
Harkla Instagram
Primitive Reflex YouTube Library
Free Primitive Reflex Webinar

Transcript

Rachel: 0:00

What I do with my clients is look at the functional assessment. The screening tool that goes along with our course specifically, and identify. If a child scores a one on a Moro reflex test, and their symptom tracker like checklist shows that they are struggling in a lot of the areas of the Moro reflex, I would participate in therapeutic intervention for the Moro reflex, even though they only scored a one. Because that's what we have to take into consideration. We really have to use our clinical experience and our clinical lens to be like, okay, they're having symptoms of this reflex. Is that the reflex? Is there something else going on? Let's address the reflex and see if some of these other symptoms improve. I'm Rachel.

Jessica: 0:52

And I'm Jessica. And this is All Things Sensory by Harkla.

Rachel: 0:55

We are both certified occupational therapy assistants and together with Harkla, we are on a mission to empower parents, therapists, and educators to help raise confident and strong children of all abilities.

Jessica: 1:07

On this podcast, we chat about all things sensory, diving into special needs, occupational therapy, parenting, self care, overall health and wellness and so much more.

Rachel: 1:17

We're here to provide raw, honest and fun strategies, ideas and information for parents, therapists, and educators as well as other professionals to implement into daily life.

Jessica: 1:28

Thank you so much for joining us.

Rachel: 1:34

Hey, everyone, welcome back to All Things Sensory by Harkla. We are so happy to have you here today. We are kind of rapid firing, going through our questions that we've received from our primitive reflex course. So like we kind of already mentioned, we're just

Jessica: 1:47

If you're not familiar with our primitive reflex digital course, this is one of our big courses, where we teach you how to test for primitive reflexes, and then we teach you going to like rapid fire these questions. Just like we would be how to integrate them if they are retained. It's geared towards children who are five and up. We also have some adults who have benefited from this course. We will link all of the information for this digital course in the show notes of this episode. Also, keeping in mind that if you are an OT practitioner, you do earn continuing education units through AOTA after you go through the course and take the post test. So anyways, like Rachel said, we're answering questions from inside the course. Everyone who's in the answering them if we were talking to you in person. So the course can get into the discussion forum and ask first one, when assessing the reflexes, is there a therapeutic questions. Rachel and I go in there and we answer them, other people, other students in the course respond and have discussions, and we just thought it would be a really cool podcast episode to talk more about primitive reflexes because we're obsessed with primitive reflexes. intervention necessary for any reflex that scores a one or above? So when we test for retained primitive reflexes, we score it on a scale of zero to four. Zero being that the reflex appears to be fully integrated, it's no longer impacting function, and a four is that the reflex is significantly retained. The test shows the the signs, the physical signs that this reflex is actually still very active in the body. So this question is, if the reflex scores a one or above.

Rachel: 3:39

Like a one or a zero, I think is what they are saying. No, it says one or above, so 1, 2, 3, or four.

Jessica: 3:44

So like if the child scores a one on the Moro reflex, that it's very slightly retained, do we still need to intervene?

Rachel: 3:58

My thought with this and what I do with my clients is look at the functional assessment. The screening tool that goes along with our course specifically, and identify. If a child scores a one on a Moro reflex test, and their symptom tracker, like checklist, shows that they are struggling in a lot of the areas of the Moro reflex, I would participate in therapeutic intervention for the Moro reflex even though they only scored a one because that's what we have to take into consideration. We really have to use our clinical experience and our clinical lens to be like, okay, they're having symptoms of this reflex. Is that the reflex? Is there something else going on? Let's address the reflex and see if some of these other symptoms improve. So long story short, that wasn't rapid fire but hopefully that helps.

Jessica: 4:51

And next question. Do you have a list of reflex integration goals that are functional and insurance will often approve? No, we do not because every child is different. What we have done in the clinic setting for primitive reflexes is the goal has to be function based. It has to be related to their ADLs and their IADLs in order for insurance to approve the goal and the assessment and whatnot. So, if you do primitive reflex testing as part of your assessment process, just make sure that you're using the checklist to identify what the family is seeing from a functional level and how the reflexes are impacting the child, and then write your goals based on that. And then include the reflex integration into the treatment plan.

Rachel: 5:44

Okay, the next question. If a child has difficulties with comprehension, how do we instruct them while testing the Moro reflex? That's a great question. Because unfortunately, it's not always going to be the most accurate. This is again, where we have to use our clinical experience to go off of a caregiver checklist. Is the child struggling with their Moro reflex in a functional way? And we can modify the test in order to get kind of an idea. Are they struggling to even just lay down on their back? Are they really uncomfortable? Are they anxious? Are they struggling with the Praxis side of testing? Struggling to understand like how to move their body into certain positions? And that's something to keep in mind. So really, modeling and getting down on the floor with them. Showing them like what it's going to look like maybe showing them a video of what position they need to be in. And with the Moro reflex, we're holding their head and we're going to drop it, they might not give us an accurate test because they're not relaxing. They're not totally grasping the concept that we need. So I feel like I've already mentioned using the checklists, using the physical tests, identifying what their body language is doing, and what those functional checklists are telling us to get a better idea.

Jessica: 7:07

Next question. How effective would this be towards integrating the reflex when more than minimal assistance is provided to complete it with good accuracy of form? So this question comes from the module in the course, where we are showing how to do an integration exercise and when we teach this, we teach from a an active standpoint. So the child is doing the exercise actively themselves versus passively, letting us move them through exercise and there's a couple of different protocols out there that are more passive. But our the way we do it is active. So if the child is unable to complete the exercise with good form accuracy, independently, we do want to provide assistance when needed. And the goal here is to provide the assistance and take the assistance away slowly as the child practices and gains, the coordination, the skill and as the reflux starts to integrate, so it's not a quick thing that happens. This requires consistency every day, and potentially might take a little bit longer than a child who can grasp it a little quicker.

Rachel: 8:35

Next question. I love this question. When a child has symptoms of ADHD, how do you determine if their reflex is retained or if it's a symptom of ADHD? It's like what came first the chicken or the egg? How are we deciding this? And that I feel like is one of the challenging parts with primitive reflex integration is identifying like, is it causation or is it correlation? And what we're going to try to do is to work on integrating the reflexes that have potential symptoms of ADHD. So we're going to look at the STNR and we're going to look at the ATN. We're going to look at the Spinal Galant. We're really going to look at all of them because they all have their own connection with ADHD symptoms. And you can work on integrating the reflexes and then keep track of those ADHD symptoms that they are struggling with and see if they improve. Also, we're working on the ocular motor skills because that's a big component of, potentially, miss diagnosing ADHD. So we're going to identify if these things are improving through integrating these reflexes, if they're still struggling, then we can pursue looking into more of the sensory processing challenges and more of the ADHD diagnoses. So I think it's not going to harm them to integrate their reflexes and see how they're doing.

Jessica: 9:51

Also, keeping in mind that ADHD is an executive functioning disorder and our executive functioning skills are not accessible unless primitive reflexes are integrated because primitive reflexes live in the lower brainstem. If our body is stuck in that lower part of our brain, the higher level cognitive functioning, the prefrontal cortex is not accessible. So think that's important to keep in mind as well. Next question, is there a specific age when these activities would be most appropriate? I read somewhere that retained primitive reflexes aren't a problem until around age five. But these reflexes are supposed to be integrated well before that. So just wondering if I should avoid some of these things with my younger kiddos. Primitive reflexes, in our course, what we teach based on the research is that primitive reflexes should be integrated by the latest three years old. Now, the exercises that we teach in our course, are geared toward children, who are five and up, because many of the exercises require a higher level of physical and bilateral coordination. So like three and four year olds, likely, are not going to be able to do the starfish or potentially the lizard without a lot of assistance. And I know Rachel is doing a lot of these with her son who is younger, but he requires a lot of assistance. He requires a lot of modifications because he's younger. So in our primitive reflex digital course is geared towards children who are five and up where our infant and toddler digital course is for children birth to three or four years old. So we kind of fit in all of the ages between those two courses. And our infant toddler course, does have a big section on primitive reflexes. So I don't know if that answers the question.

Rachel: 11:45

Well, I just want to mention, because the person said, I read somewhere that retain primitive reflexes aren't a problem until around age five. I wouldn't necessarily say that they aren't a problem until age five, I would say that it's difficult to categorize them as retained primitive reflexes until the child is in school, and they have these higher expectations put on them. And then these kiddos are really falling through the cracks and we're identifying, okay, there's a problem here we need to intervene. But a child can have a retained Moro Reflex at three years old. It's just a little bit more challenging to do the specific, like the starfish exercise, it's more challenging to get them to do those activities. So in our infant-toddler, our blueprint course, we are focusing on more of the natural integration exercises and activities through play. So we're not having them sit down and like do a very specific activity with them to integrate the reflexes. More of like, Let's prevent, if possible, these reflexes from becoming retained. Does that make sense?

Jessica: 12:52

Yeah.

Rachel: 12:53

Yeah.

Jessica: 12:53

I don't know if we answered the question.

Rachel: 12:54

I hope so. Okay, next question. What are some ways you can identify whether the movements in the face are due to a retained reflex and not because the child is sensitive? This is a great question. And again, I think it requires our clinical experience and kind of our lens to be put on. If you are testing someone's rooting, or their palmar reflex, and there are movements in the face or in the hands, you can identify, ideally, based on their occupational profile that you've done prior to testing their reflexes. Okay, they have some sensitivity. So we already know that going into it. But again, what came first the chicken or the egg? That's what we have to identify and working on integrating these reflexes, even if maybe it is a tactile sensitivity, reflexes and sensory integration go hand in hand. And so I don't necessarily think that we need to be so specific in separating them. If it's a sensitivity or if it is the retained reflex, I think we can kind of address them simultaneously.

Jessica: 14:02

And if you think about it, some of the symptoms of a retained rooting reflex is sensitivity in the mouth, and picky eating for textures. Some of the symptoms of a retained palmar grasp reflex is tactile sensitivity specifically to the hands. So that sensory is impacted by the reflex.

Rachel: 14:26

Yeah, so I just think we can address them together.

Jessica: 14:30

Yep. Next question. What populations would you not target reflex integration? I've learned from a course in the past that individuals with CP or neurological differences should not complete reflex integration. Because their reflexes will not be able to integrate and they are protecting the client through appropriate compensatory strategies. I do think that's a very interesting thing to look at. We look at a child with cerebral palsy and there's something going on so the reflexes are stuck in the body in order to protect the child from injury with certain movements. So that does make sens. I think that we can still use primitive reflex integration techniques and strategies and activities. But making sure that we are being safe. We're using our best clinical judgment so that the child does not get injured. And if you are working with a population with where they have higher physical needs, make sure you're taking the continuing education that's appropriate to learn more about that.

Rachel: 15:41

Yeah, I just want to say this isn't necessarily our area of expertise to work with cerebral palsy, and our course doesn't necessarily go into a lot of detail. We do have one module that talks a little bit more about more physical disabilities with reflex integration. But just know that isn't our focus in this course. It's a really relevant topic and should be looked into, but just know that that's not our like, goal with the course or our area of expertise.

Jessica: 16:10

Yeah, that's not the population that we have the most experience with.

Rachel: 16:13

Exactly. Okay. Next question. I have a kiddo who has a retained spinal galant reflex and has a strong reaction to most tactile stimuli, even deep pressure. If I were to steamroll on their back, they appear very ticklish and laughing while squirming. Any thoughts on how to modify or is this all about increasing exposure and tolerance to deep pressure over time? This is a good question. I almost would want to have the activities be more like child directed. So instead of you, I'm not saying you're doing anything wrong, I think that it's important to include that deep pressure and it's very beneficial. But having the child like rollover on their back and crawl through a tunnel on their back, inching their way through on their back, or maybe you can have them try to roll a ball. Have like a playground ball on their back and holding against the wall so it's more of like, active, like we've been mentioning. They're controlling it or with the snow angel exercise, having them do the snow angels in certain ways. So I feel like maybe trying some more active integration activities rather than stimulating the back. That's my first thought.

Jessica: 17:30

I would also look at the other reflexes that the child has retained. Oftentimes, a retained spinal galant reflex is going to go hand in hand with a retained STNR because of the connection to the hips. So I would look into that, and potentially work on some of the other reflexes first, because that could potentially help the child integrate the spinal galant, either simultaneously or later on. But if they are having strong reactions to most tactile stimulation, even deep pressure, you want to look at more sensory strategies as well. More vibration, more heavy work, oral motor inputs. So looking at that from a very sensory standpoint as well.

Rachel: 18:20

Now that I'm reading it again, I'm thinking, what about the Moro Reflex? Is the ticklish, the laughing, the squirming, is that more of like their defense mechanism? If they're like uncomfortable or anxious in this position or doing certain activities? Like Jessica mentioned the sensory standpoint, we know that sensory integration and primitive reflex integration go hand in hand. So that's another one to look at. They're all connected.

Jessica: 18:43

It's all connected. Alright. Next one. If you find that a child has several retained reflexes, is there an order or priority for the integration exercises that you have the child work on to integrate them or do you try to have them do all of the integration exercises for each of the reflexes that they have retained? We get this question a lot. Great that it's here. I'm glad we can address it. Typically, we focus on one reflex at a time, for a couple of reasons. First of all, when you are integrating a primitive reflex, you are creating new neural pathways in the brain and this can be very challenging. It can cause regression, emotional regulation challenges, because you are challenging the brain in the body in new and different ways and the brain doesn't like that. The brain wants to stay the same. The brain doesn't want to do newer, hard things. So primitive reflex integration can be difficult from that standpoint. So it's much simpler to just focus on one at a time, but, also, because many, if not most families have a lot on their plate already. And it is already going to be a lot to ask a family to do an exercise twice a day for a minimum of 30 days. So, by focusing on one exercise is going to be a lot easier than asking them to do four or five. Now we have seen and heard about some families, some people working on multiple reflexes and I even took a course, a couple years ago, on dyslexia, dysgraphia, and dyscalculia. Were they included primitive reflexes in that and the instructor, I think her name was Kathy Johnson, talked about focusing on multiple reflexes at a time and how it can be effective. So you can do that that is an option. But generally, focusing on one at a time is the best, most effective, easiest place to go. And then the order of operations. Typically, we say from a developmental standpoint, focus on them in the order that they naturally integrate, which we do include a timeline, and we talk about that in the course. Sometimes you can focus on the reflex that's having the most impact functionally. So if the child has a slightly retained Moro, slightly retained TLR, but a very routined ATNR, you can totally start on with the ATNR first if you want if it's having the most impact.

Rachel: 21:16

Love that. Next question. What might it indicate if the child, when in a quadruped or like a crawling position before head movements, is hyperextending and externally rotating the elbows? When we're hyperextending, that means that our elbow joints are

Jessica: 21:34

Going the opposite direction almost.

Rachel: 21:37

There's no bend in them. They're like.

Jessica: 21:40

They're not neutral.

Rachel: 21:41

Exactly. I'm having a hard time describing. I'm showing it right now, but no one can see me.

Jessica: 21:46

I know. I know.

Rachel: 21:47

And externally rotated elbows means that the hands are turned outwards, away from the body. And so generally, this is a compensatory movement. And so we are taking the strength required for this quadruped head position out of the equation,. Because when we hyperextend, we externally rotate our elbows, we're locking out our joints, we're not using any strength to hold that position. Especially when we're doing this quadrate head position for testing primitive reflexes, we can actually kind of get like a miss response or a misguide. They're not going to be as accurate.

Jessica: 22:25

It's almost like a false positive or false negative.

Rachel: 22:27

Yes. exactly, thank you.

Jessica: 22:29

Often, it can be a false negative. But no, I think that's fine. Yeah, focus on the forum

Rachel: 22:30

Yes. That's exactly what we're gonna see. Because if we're, let's say, for the ATNR, we're testing, we're turning the head side to side in this quadruped position, and the child has their arms externally rotated or their elbows are hyper extended, they likely won't have that elbow flexion and that's exactly what we're looking for with this test, because they're locking out their joints. So it's just something that we want to be aware of. We want to make sure that we are helping to turn those hands forward. Kind of teach the child how to have a little bit of bend in their elbows, not a lot of bend, just rotate, like from the shoulder. So that way, their elbows are more neutral, like the middle of their elbows are more neutral, and pointing towards each other rather than like the elbows turning like pointing forwards. This is really hard to explain. quality, right? When you have the child position on all fours for the test, focus on the quality of their position, the quality position of their arms. See if you can teach them how it feels, how it looks, use visual feedback, demonstrate it yourself. I just have to say going back to the question, what might it indicate? It could indicate that they're compensating in this position. They could have low muscle tone. They could have hypermobile joints. That's generally what we'll see with these like symptoms.

Jessica: 23:52

Yes.

Rachel: 23:53

These challenges. These compensatory movements.

Jessica: 23:55

Yep. Okay, great. All right, one more question. What do you suggest saying to explain to a child why they need to do the integration exercises? Explaining why they have to commit to these exercises seems important to help them buy in. What would you say to a preschooler? What would you say to an elementary age school aged child? I love this question because I think that that is so so so, so important. Explaining the why to the child helps them to just understand what's going on, what their body needs, how their body feels., and it does it increases the buy in. It takes away the fight to do this; instead of you, the adult, being like, you have to do these. It's more of like, hey, let's do these together.

Rachel: 24:43

Let's play together.

Jessica: 24:44

Let's do this. So the way I explain it oftentimes is your brain and your body. There's like a little mix up between your brain and your body right now. It makes things harder sometimes. and the goal with these exercises is to help your brain in your body becomes stronger. And oftentimes, I will ask them what something that they love to do. Do you love to ride your bike? Do you love to go hiking? Do you love to wrestle? Like, what do you love to do physically or what do you love to do mentally? Do you love puzzles? Do you love...you know. Whatever it is you love, and identify those things

Rachel: 25:19

Sudoku. Yeah. And I think the only thing I would add because I that the child really likes to do and talk about how doing these exercises is going to help them feel stronger, feel faster, maybe help them teach their friends how to do it, that kind of thing. So it does depend on the child, of course. But also, if you are a parent, or even a therapist, doing these exercises

Jessica: 25:42

Yep. with a child, make sure you're doing it with them. Always, always recommend that this is a family affair. This is a way to connect with your child. If you're a therapist, doing these exercises with your client, instead of just sitting on the sidelines and correcting their form is huge. If you are just sitting on the sidelines telling your client okay, do this Superman for 10 seconds. Oh, keep your legs up up, keep your

Rachel: 26:08

Okay, great. hands up. Nope, that's not right. That clients not going to get buy in. But if you are on the floor being like, Hey, we're holding the Superman. We're gonna hold it together as long as we can. We're gonna count together. Like the change is huge. have a preschooler right now that I'm doing these with and I make it kind of a challenge and a game and we try to beat one another and we incorporate it as part of our routine. So we can incorporate in our morning routine, our evening routine, and it kind of explaining that this helps wake our brain up and it helps to make our muscles strong so we're ready for school. And just a very simple explanation but keeping it fun keeping up playful. We're crawling around the room. We're going to be our tigers. Let's crawl really slowly. Let's crawl really fast. Okay, look up to the sky. Okay, now look down. Okay, look back up. So we're kind of incorporating it in more of like a make believe type way, if you will. But just taking it down to play because that is how kids will be more engaged and that's how the, they'll learn how their body feels after doing these activities is through play.

Jessica: 27:27

Exactly. Hopefully, this episode was interesting, helpful in some way. If you have questions about primitive reflexes, or if you have questions just about anything that you would like us to answer on the podcast. There is a link in the show notes where you can fill out the form and we like to do those listener Q&A's every once in a while, where we answer your questions on the podcast.

Rachel: 27:52

And again, if you liked this episode, let us know. Leave us a review on iTunes or Spotify. Take a screenshot while you're listening. Tag us on Instagram. Let other people know what you're listening to and how cool you are because you're listening to our podcast.

Jessica: 28:06

How cool you are.

Rachel: 28:07

Your so cool. Oh, my goodness.

Jessica: 28:09

All right. Thanks for being here and we'll talk to you next week.

Rachel: 28:12

Okay, bye. Thank you so much for listening to All Things Sensory by Harkla.

Jessica: 28:17

If you want more information on anything mentioned in the show, head over to Harkla.co/podcast to get the show notes.

Rachel: 28:25

If you have any follow up questions, the best place to ask those is in the comments, on the show notes, or message us on our Instagram account which is at Harkla_family or at all things sensory podcast. If you just search Harkla, you'll find us there.

Jessica: 28:41

Like we mentioned before our podcast listeners get 10% off their first order at Harkla. Whether it's for one of our digital courses or one of our sensory swings, the discount code sensory will get you 10% off. That's sensory.

Rachel: 29:00

Head to Harkla.co/sensory to use that discount code right now.

Jessica: 29:05

We are so excited to work together to help create confident kids all over the world. While we make every effort to share correct information, we're still learning.

Rachel: 29:15

We will double check all of our facts but realize that medicine is a constantly changing science and art.

Jessica: 29:20

One doctor or therapist may have a different way of doing things from another.

Rachel: 29:24

We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties, and what we have found to be beneficial that will be as evidence based as possible.

Jessica: 29:36

By listening to this podcast you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your child.

Rachel: 29:44

Consult your child's pediatrician or therapist for any medical issues that he or she may be having.

Jessica: 29:50

This entire disclaimer also applies to any guests or contributors to the podcast.

Rachel: 29:55

Thanks so much for listening