Have you ever watched your child struggle with handwriting, lose their place while reading, or seem unusually clumsy compared to other kids their age? Maybe they avoid sports, lean their entire body when writing, or switch hands frequently during tasks. While these challenges can have many causes, one piece of the puzzle that often goes unnoticed is a retained primitive reflex called the Asymmetrical Tonic Neck Reflex, or ATNR.
As a pediatric Certified Occupational Therapy Assistant (COTA), I often work with children who are putting in tremendous effort just to keep up with everyday activities. Sometimes, those struggles can be linked to movement patterns that should have faded during infancy but continue to influence how the body and brain work together.
What is the ATNR reflex?
The Asymmetrical Tonic Neck Reflex (ATNR) is one of the primitive reflexes babies are born with. It develops before birth and is present at delivery. Typically, this reflex integrates by around 4 to 6 months of age as babies begin gaining more voluntary control over their movements.
ATNR is often referred to as the swordfighter or “fencing reflex” because of the position it creates. When a baby turns their head to one side, the arm and leg on that same side extend while the opposite arm and leg bend. This automatic movement pattern plays an important role in early development and helps babies prepare for rolling and later motor skills.
If you’ve ever seen a young baby lying on their back with one arm stretched out and the opposite arm bent after turning their head, you’ve seen the ATNR in action. During infancy, this reflex is completely normal and serves an important purpose.
As children grow, however, the nervous system should no longer rely on this automatic pattern. When the reflex is retained longer than it is needed, it can interfere with higher-level skills needed for learning, coordination, and everyday activities.
Learning and Attention
Many children with retained ATNR work incredibly hard during school, even though it may not always look that way from the outside. Because the reflex influences how the two sides of the body work together, it can impact visual skills, posture, and handwriting.
Parents may notice that their child:
• Has messy handwriting or inconsistent spacing between words.
• Frequently switches hands while writing or has not established a clear hand dominance.
• Struggles to copy from the board or from another piece of paper.
• Loses their place while reading or skips lines and words.
• Turns their whole body rather than moving just their eyes when reading.
• Has difficulty with visual tracking and scanning.
• Tires easily during desk work or written assignments.
• Appears distracted or inattentive because so much energy is being spent compensating for underlying motor challenges.
Sometimes children are labeled as lazy or careless when, in reality, their bodies are simply working harder to accomplish tasks that should feel automatic!
Movement and Coordination
Retained ATNR can also show up during play and everyday activities. Since the reflex affects communication between the two sides of the body, it can make coordinated movement more challenging.
Some common signs include:
• Difficulty catching, throwing, or kicking a ball.
• Trouble learning to ride a bike.
• Challenges crossing the midline of the body.
• Awkward posture while sitting or writing.
• Difficulty using both hands together for tasks like cutting with scissors or tying shoes.
• Frequent tripping, bumping into objects, or appearing clumsy.
• Poor balance and decreased body awareness.
How can parents support reflex integration?
Primitive reflex integration isn’t about “fixing” your child or forcing the reflex to disappear. Rather, it involves providing the nervous system with opportunities to develop more efficient movement patterns. Occupational therapy focuses on improving functional skills and supporting the whole child.
-Crossing-midline activities are a great place to start. Games that encourage children to reach across their bodies help strengthen communication between the two sides of the brain. Figure eights, cross crawls, and beanbag toss games are all fun options.
-Bilateral coordination activities can also be helpful. Swimming, climbing, stringing beads, catching and throwing, and playing with building toys all encourage the two sides of the body to work together.
-Core strength and postural control are equally important. Animal walks, wheelbarrow walks, yoga poses, obstacle courses, and crawling activities provide valuable opportunities to strengthen the body and support more efficient movement patterns.
-Visual tracking activities such as balloon volleyball, flashlight games, mazes, and hidden picture books can help children practice using their eyes more efficiently without moving their entire bodies.
What’s next?
If some of these signs sound familiar, remember that retained primitive reflexes are only one possible piece of the puzzle. Every child develops differently, and many factors can influence attention, coordination, and learning.
If you have concerns about your child’s development, an occupational therapy evaluation can help identify their strengths and areas of need while providing individualized strategies to support success.
Children are incredibly adaptable, and with the right support, they can continue to build the skills they need to thrive both inside and outside the classroom!