Primitive reflexes in school-age kids: why an OT might screen them, what the evidence says, and how to spot non-functional programs
Disclaimer: Y’all. This is not my area of expertise. I specialize in birth to three. However, I do work with some older children and am in several OT circles at an organizational and advocacy level. When reading through AOTA’s Practice Smart initiative, a few points really stood out to me. One of them was primitive reflex exercises, which really seem to be a fad in some circles. I wanted to learn more about the “promises” and how primitive reflex integration should be (or should not be) appropriately addressed in treatment plans according to evidence. In a time of life where so many quick fixes can be found online, research matters.
This post took me awhile because I had to do a lot of learning myself, but without further ado..
Primitive reflexes are early movement patterns that support infancy and typically fade as the nervous system matures. In older kids, an OT may screen for lingering reflexes when there are real classroom concerns such as poor handwriting, trouble copying from the board, poor postural control, or difficulty coordinating eyes and hands. Reflexes should not be the goal in itself. It is one clue that helps explain participation problems in writing, reading, self-care, or playground play. The intervention still centers on the tasks the student needs to do at school and at home.
What AOTA’s Practice Smart recommendation actually says
AOTA’s (American Occupational Therapy Association) Practice Smart list includes recommendation number 8: Do not use reflex integration programs for individuals with delayed primary motor reflexes unless there are clear links to occupational outcomes. AOTA explains that interventions designed only to integrate retained reflexes do not in themselves promote participation, and that the presence of a retained reflex does not automatically equal functional impairment. If a clinician is considering reflex techniques, they should use standardized tools and assessment approaches to connect any impairment to occupational performance, and intervention should focus on occupational participation and performance rather than reflex integration as the end point. AOTA
What the research shows
Several studies report links between active primitive reflexes and weaker motor or attention performance in preschool and school-age cohorts. This shows correlation, not inevitability, and many children with observable reflexes still function well. PMC
Reflex-only programs have mixed or limited support. A well-known randomized, double blind trial reported reading gains after a program that replicated primary reflex movements for children with specific reading difficulties. Results apply to a narrow group and do not prove that reflex drills alone improve broad school participation for most learners. Later work is heterogeneous and often preliminary. Function-first, task-oriented OT remains the safer bet. PMC
Use reflex findings within comprehensive assessments and not alone. AOTA’s Practice Smart (Choosing Wisely) initiative emphasizes shared decision making and avoiding low value services by tying assessments to outcomes that matter in daily life functioning. PubMed
When addressing reflexes is appropriate and functional?
There is a documented link to participation.
Example: Minnie Mouse consistently turns her head and abducts her writing arm (moves her arm away from her body) during copying, and this pattern results in spacing errors and fatigue. The OT notes this pattern and then targets legibility, speed, and endurance with task specific practice, visual modifications, and environmental adjustments. Reflex findings informed the plan rather than defined the goal.
Reflex-style activities are used briefly as a primer.
Short movement games that encourage prone extension or midline stability can be embedded before handwriting or keyboarding, and their value is judged by improvements in the real task such as legibility, line alignment, or reduced prompts.
Progress is tracked with functional metrics.
Functional gains such as legibility and writing speed are weighed more heavily than reflex scores.
When it is not appropriate
The goal is to integrate reflexes rather than to improve participation.
Assessment relies on reflex checklists alone with no tie to function.
The program replaces task specific instruction with a one size fits all sequence of reflex drills that is not individualized to child’s goal.
Red flags in home programs that are not function based
Big promises with vague outcomes.
Example: guaranteed integration in a set number of weeks, rewiring the brain, or curing dyslexia or ADHD, and no mention of functional goals.
No baseline or progress data beyond reflex scores.
One size fits all daily drill lists that do not match the child’s real tasks or school routines.
Example: Every child is getting the same or similar reflex integration exercises in a home program.
Integration listed as the only goal, with no accommodations, environmental changes, or task practice.
Takeaway
OTs may screen primitive reflexes to better understand why a student is struggling with real tasks. The presence of a retained reflex does not automatically equal functional impairment. If reflex oriented activities appear in a plan, they should be brief, purposeful, and clearly connected to school participation, with progress measured by what the student can do in class. That is consistent with AOTA’s Practice Smart guidance.
