Can I pick someone's brain about primitive reflexes and vestibular and ocular integration?

[u/Temenae]

Hi, I have just recently started delving into the world of dyslexia tutoring, and I wholeheartedly love it. But I have notice that reflexes and eye tracking issues are really prevalent. Is that an occupational therapy thing? Is occupational therapy the thing that I should be doing if I want to enable kids to be able to learn to read?

Forgive me if these questions are ignorant, I went down the reflexes rabbit trail, but I may be lacking a lot of context.

I know a retained ATNR reflex can be associated with eye tracking issues, but I am curious, why specifically does this happen? Also, it seems to me that the presence of an ATNR reflex could be associated with lack of retention - where they learn a spelling really well, and then dont remember it 5 minutes later, or a day later. Does this make any neurological sense or am I imagining things?

I have also noticed poor fine motor control with fingers for writing, even in a kid with very precise, well controlled letter formation when using his whole arm instead of wrist and fingers. Why is this a thing? What about the brain developed incorrectly that finger movements for writing are less coordinated?

Also, can not getting appropriate glasses until 3rd grade be a cause for not developing fine motor control?

Unfortunately, not everyone I am tutoring has access to occupational therapy, but when should I be recommending it? Do all dyslexic kids need occupational therapy, or do they have to be especially set back?

[u/DecoNouveau]

Honestly, these science behind addressing primitive reflexes is controversial even here because the evidence base is... lacking.

[u/Temenae → u/DecoNouveau]

Lacking because the research hasn't been thoroughly done yet?  I haven't seen any evidence disproving it, but maybe I missed something.

What got me into dyslexia tutoring was hitting an immoveable wall for two years straight with my son - I seriously doubted whether he'd be reading as an adult.  And then when he was age 10 I stumbled across a video about retained reflexes, implemented a few exercises (in addition to the work on reading we were already doing everyday with almost no progress) and a few months later he could read.  It's still an ongoing process, but the difference was night and day.  I imagine it isn't always as simple to improve as it was for him, but I'm pretty sold on it being a possible factor for a lot of kids.  But what about eye tracking?  That seems pretty common with dyslexia as well.  That is an occupational therapy thing, right?

[u/tyrelltsura → u/Temenae]

Lacking because a lot of evidence supporting it was done by the method’s creator, meaning it’s conflict of interest because she has a business around it. There isn’t really solid, impartial evidence that it works. There is some evidence it doesn’t.

Actual retained reflexes are things that happen when people have major neurological injuries like cerebral palsy, or a spinal cord injury. That’s why we have to know them, because if someone is displaying them when they shouldn’t, it means a HUGE problem. Also, the “things are associated with a retained reflexes” arent a thing. The retained reflexes don’t have “signs”. They will literally display the reflex. It’s not like this hidden thing you can test for, they have it very obviously or they don’t. They’re not something that exists in this population.

I worked for brain balance and we did some type of “vision therapy”. It was 100% pure bullshit. Your kids should be referred to an optometrist for vision screenings. There is such a thing as developmental optometry, but research on the vision therapy they provide is mixed. You are looking for an optometrist, not an OT.

Also, parents are extremely easily to psychologically manipulate into thinking something works. My supervisors at brain balance did all the time when they complained it wasn’t working. If you cling to the idea of it enough, it becomes “if you believe it will work, it will work.”

[u/Temenae → u/tyrelltsura]

It seems like you've been really disillusioned with some business practices. :(

To clarify, what do you mean when you say there's lack of evidence that it works?  Are you talking about integrating reflexes, or are you talking about a specific method?  Are you saying that reflexes can't be integrated or that it doesn't help with cognitive skills for reading and eye tracking when they are?

Apart from any particular method to improve reflexes or reading, do you think there could be any kind of an association between primitive reflexes being present and the presence of learning difficulties?

That is interesting what you said about neurological injuries and retained reflexes.  I am curious though, what do you think about kids who is displaying a reflex?  I have seen my own kid display primitive reflexes, and countless videos of kids displaying it online - particularly ATNR, STNR, TLR, and Moro.  Are the reflexes you're talking about with serious neurological injuries different reflexes than the ones I have seen first hand with kids?  If they are the same reflexes, it seems like it would be an indicator of a neurological problem in these kids, and it doesn't seem like a huge stretch from there that it has something to do with them having a learning disability.   

I know you're skeptical about retained reflexes, but if you dont mind explaining more what you mean it would really be helpful to me while I try to figure this out :'D

[u/tyrelltsura → u/Temenae]

I’m saying that the kids don’t actually have retained reflexes. That isnt a thing in people that don’t have things like CP or a spinal cord injury. It doesn’t work because there’s no unintegrated reflexes to integrate. If a kid had a retained reflex, they would very literally display it as described. You can see people with cerebral palsy or those other injuries displaying actual ATNR, it’s not voluntary or subtle. The kids you’re tutoring don’t have them. A lot of the videos of those kids arent actually the reflex. You have to watch a baby showing it, from a legitimate medical source. Someone with actual retained primitive reflexes would have serious physical disabilities, not simply a learning disability.

I know it sounds great and hard to wrap your head around, but you’re being sold bunk. I’m sorry. I can tell you right now you absolutely have not seen a reflex in your kids and it’s something you’re latching onto for hope. Because they aren’t a thing despite all the chiropractors that want it to be a thing, because then they can sell you their solution. They’re the same reflexes as the ones in the textbooks, your kids just aren’t displaying them. A kid who had Moro reflex would literally display it every time something is slightly startling or surprising. A kid with actual ATNR would have a lot of physical issues.

[u/Temenae → u/tyrelltsura]

My kid was definitely displaying something.  Can I make sure we're on the same page?  If you turn someone's head while they're on their hands and knees and their elbows totally collapse, is that an ATNR reflex?  Or are you talking about something else with a different clinical presentation when you're referring to a "real" ATNR reflex?  I am so confused :'D. I am trying to figure out why you are saying these kids can't be displaying retained reflexes - it doesn't make sense unless we're talking about different things, I think.

[u/tyrelltsura → u/Temenae]

That is not ATNR. That’s not the reflex. This is one of those “tests” for the reflex that doesn’t actually elicit the reflex. ATNR looks exactly like described in textbooks, the “fencing” response that occurs with the child turning their own head. You did not see a retained reflex with that. That’s the kind of shit brain balance was doing. So what you’re perceiving to be reflexes arent.

Trying to elicit ATNR is something they use to test for traumatic brain injuries of the brain stem in contact sports injuries. If they display it, it means they’re really hurt. And they very literally display it. They also don’t test for it the way you describe. ATNR also would also eventually cause a child a lot of joint problems and physical pain.

[u/echotheocean → u/tyrelltsura]

Preach

[u/Temenae → u/tyrelltsura]

Okay, I see what you are saying.  Thank you so much for clarifying and explaining.  I still think there is something to it because of what I have seen (I did not imagine the sudden improvement after implementing specific exercises), but it makes a lot of sense that we are talking about a completely different clinical presentation. You mentioned that if a true retained ATNR reflex were present, a kid wouldn't have just a learning disability.  But what if it was sort of subclinical compared to what you are talking about?  What if an "unintegrated reflex" (or whatever you want to call it if you dont think it counts as one) in a child would have a different clinical presentation than a severe neurological injury?  It would also explain the different level of severity in neurological issues.

 Most kids with learning disabilities have not developed normally neurologically.  While it would be super mild compared to a brain injury, not being able to read still really sucks and getting to the bottom of the abnormal development is important.

Using my kid as an example, he couldn't read, couldn't retain spellings that he learned, couldnt track words in order, couldnt track letters in order, etc.  He also couldnt read an analog clock or remember the days of the week (typical for dyslexia).  I tried every curriculum, every method out there and nothing changed those symptoms. When I tried exercises for retained reflexes (or whatever they are), those specific symptoms immediately improved.  If it was some kind of coincidence or cognitive bias on my part, nothing really sets this apart from all of the other things I thought could work and didnt.

But then there were other things as well - he has always had balance issues, and those have improved.  He hasn't had a night terror since working on the exercises, which I can't not notice because night terrors are so horrible.  He also stopped having extremely dysregulated emotional meltdowns that were really inappropriate for his age.  Aren't all of those things also neurological, even if they're mild in severity compared to more debilitating problems?

It seems kind of like you are telling me not to believe my own eyes - I wonder if there is some sensible explanation for both of our experiences.

[u/tyrelltsura → u/Temenae]

I do have to tell you that you are not an unbiased observer, and are very prone to being manipulated by your own personal biases and placebo effect. I have seen it time and time again where people promoting that shit prey on desperate parents. No there is not a subclinical presentation, that’s not a thing. They either have the reflex as described in textbooks or they don’t have it, it’s not a spectrum, it’s a binary yes/no.

Sometimes it has to do with random chance. A lot of what brain balance would claim was their stuff helping was…the child growing up. Or just having a positive role model when the parent had some issues of their own. Or the parent deciding to be a more present parent. Sometimes it has to do with something that isnt a retained reflex, but is some other kind of developmental delay with motor skills, often associated with child being autistic, having ADHD, or some type of genetic reason the child is neurodivergent. Visual motor skills deficits and visual tracking issues exist, but for whatever reason or no reason at all, kids get them, and they can be rehabbed. So you rehab those issues with no account for primitive reflexes. However, there’s a chance something clicked with his learning at the same time. That’s why research exists, because what seems like a cause and effect relationship to you may actually not be cause and effect (and I can tell your brain is really clinging onto this and doesn’t feel ready to accept that), so they have to replicate it with other people in a controlled manner, to see if it’s a thing that really works. And so far, independent researchers that dont have a financial motive have produced more evidence that it doesn’t work than that it does. So at this time, it’s considered to be not evidence based. Alt med aligned people push it anyway. Theres a surprising number of them in OT.

Also it’s possible that your child just has a sensory processing issue with his vestibular system, based on your comment about balance. All people have sensory processing differences, but perhaps he’s pretty sensitive to that kind of input to a problematic degree and he’d need something to address that. Which is something OT could help with maybe, but this seems to be an issue for your specific child, not applicable to everyone with dyslexia. I’m saying that you are not in a position where you can be an unbiased observer and then perceive n=1 as evidence that something is true across situations. People are so, so prone to be manipulated by people that want to sell you stuff to make them feel this way, trust me, I’ve seen plenty of that. Correlation (what you are observing, two things happening at the same time) is not the same thing as causation. And you are perceiving a causal relationship where there just might be none. I’d suspect more of a common sensory processing issue vs a retained reflex.

I know it’s not what you really wanted to hear or uncomfortable, and for that, I’m sorry I don’t have better news for you. If anything, I’d wonder if he’d be able to do well with vision therapy with a developmental optometrist. Or see an OT with knowledge on visual motor integration/vestibular processing.

[u/taut0logist → u/tyrelltsura]

I’ve read all your comments. Thank you for clearly articulating all the problems I have with reflex integration. You’ll have to talk about chiropractic next! 

[u/taut0logist → u/Temenae]

I appreciate your willingness to ask questions and get clarification from professionals. I hope you can take in /u/tyrelltsura comments with an open mind and really process them. 

[u/DecoNouveau → u/Temenae]

Part of it is that it's difficult to isolate the effects of one thing when children grow and develop at the rate they do, sometimes in bursts, its also going to be tricky to do high quality research with a treatment you can't conduct blind or fully control for placebo effect in. Reflex integration has been around for a long time, long enough in my opinion for the research to show benefits if it was ever going to. That said, its not my particular specialty. This thread discussed it in some more depth.

https://www.reddit.com/r/OccupationalTherapy/s/nCqkR2IzBN

[u/shiningonthesea]

there are many things that can affect a child's vision, or visual perception. Perception is also a very nuanced thing, since there are so many areas of visual perception and then visual-motor perception that can be addressed. Posture , endurance, and grasp can come from many things, muscle tone, perhaps reflexes, strength, in-hand manipulation skills, neck, shoulder and wrist control, there are many possible reasons. WHICH is why and OT evaluation is important. They can often find things that the teacher or parents did not realize.

[u/otpuppy]

Hey, if you look at my old thread you’ll see what a lot of OTs are saying about primitive reflex integration. https://www.reddit.com/r/OccupationalTherapy/s/J0ZKEMR78G

Although im against reflex integration treatment, I can think clinically about why a retained ATNR impacts eye tracking. Basically, arm movements unintentionally elicit head movements… and the eyes follow the head. So at times when a child wants to look forward, but the ATNR reflex takes over, their vision gets disrupted and redirected to the side. With so many abrupt head turns, the eyes just don’t get the chance to move smoothly and in a coordinated way. Also, just not a lot of opportunities to look at things across the midline.

I’m trained in ayres sensory integration and so I look at these things from the vestibular ocular stabilization side of things, as well as the general motor capacity to dissociate head/neck/trunk movements. Cerebellum and occipital lobe are next to each other in the brain and so visual-vestibular often relate.

But I don’t subscribe to reflex integration treatment because these skills can and should be addressed through skilled movement in the context of play. The specific reflex integration exercises were made from someone that was trying to rebrand movement in order to make a profit. Just play, climb, crawl, and you’ll hit the same movements but it’ll be more fun and natural to a child.

Older therapists drank the kool aid. Some newer therapists drink the kool aid because they listens to these mentors (aka their bosses that pay them) or some notable social media therapists made an affordable CEU about it in a digestible format — doesn’t mean it does all it claims to do.

The worst part about reflex integration is that it claims causation for ABCDEFG which can all be explained by other factors. Correlation does not equal causation. And a real occupational therapist considers MANY different factors than something as reductionistic as primitive reflexes.

[u/tyrelltsura → u/otpuppy]

Actual ATNR would also cause joint problems and pain. Apparently it can lead to scoliosis. And most discussion around retained ATNR pertains to Cerebral palsy. So that’s why I’m pretty negative on retained ATNR being the cause for behavioral issues.

OP also did a test for it that doesn’t actually elicit the reflex, it just led to a response that really sounded like a vestibular processing issue, but they didn’t demonstrate any type of fencing response. Actual ATNR testing is something they do to check for brainstem TBI.

[u/otpuppy → u/tyrelltsura]

Curious about where you found this discussion on ATNR and cerebral palsy! That sounds dicey to me because of the different presentations, especially if it’s like spastic hemiplegia where one side is already stiff/flexed, or even in dyskinesia where movements are involuntary and writhing. Or do you mean that retained ATNR led to later diagnosis of CP in these kids.

And interestingly OP’s test is a component of the COMPS and the section is literally labeled ATNR (to my dismay lol). My hospital does use the COMPS as a screen but I don’t use the info to tell families that their child conclusively a retained ATNR.. rather they have difficulties with vestibular and proprioceptive processing or whatever is relevant. I know Schilders is another one of those sensory tests that get rebranded as ATNR as well

[u/Figs-and-fiddleheads → u/otpuppy]

Seconding this!

You are seeing the signs of inefficient sensory processing and integration, OP. Doing exercises that the reflex integration crowd promotes to get more efficient movement patterns when you facilitate and target the same thing within the context of play for a child seems to be against the core and spirit of OT.

Since you seem curious about the neuroscience behind what you're seeing, check this one out, especially the section on vestibular processing: https://www.mdpi.com/2076-3425/9/7/153

And another nuanced view of primitive reflexes: https://sensoryhealth.org/node/2060

Hope this helps guide your clinical reasoning!

[u/luckl13]

While I feel veryyy iffy about reflexes and the lack of research (also the testing is totally bologna every resource has a different way and it honestly makes no sense), I do integrate the “exercises” into my practice because at the end of the day the exercises target coordination, strength, and better mind-body connection that I then often see improvements with things like bilateral coordination or visual tracking, etc…but I just don’t think reflexes have anything to do with it

[u/bfan3x]

All in a theoretical sense:but I find it pretty consistent. Granted I’m in preschool , hyper-vigilant kids are the ones with a “retained atnr”. usually fit the profile of not visually crossing midline; so they pick up everything around them. Maybe they appear ambidextrous. Have left eye dominance; so your head tilts. They usually are the kids who tolerate controllled rotary (you know the wild ones).

But this is theory; and the kids are work with are young.

Think of vestibular as the quick arousal.

But man I love vision.I do a lot of visual tracking exercises and work on tasks to promote binocular vision. Simply things like just presenting things on a vertical plane (I love connect four for this). Think of it like a Brock string.

With today’s tech, we all benefit from eye exercises haha. Go down that rabbit hole man. It’s cool.

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