A neurodevelopmental basis for a range of learning difficulties, including reading delay, is suggested by the clinical and research evidence linking the persistence of primary reflexes(1, 2,3) with learning difficulties.
What are primary reflexes?
Primary reflexes are movement patterns which emerge during fetal life and are critical for the survival of the newborn - e.g. infant rooting and suck reflexes. They are obvious during the first six months of life(4) and primary reflex tests are routinely used by paediatricians to assess the neurological integrity of the newborn baby. As the nervous system develops, however, they are inhibited or transformed and the persistence of primary reflexes beyond their typical timespan (twelve months) interferes with subsequent development and indicates neurological impairment.(5) More than seventy primary reflexes have been identified(6) and they may be classified in several ways - e.g. according to function, time of appearance or the type of stimulus which releases them.
Some examples
Some reflexes are obvious and familiar - e.g. the grasp reflex (where the newborn grasps a finger placed in its palm) and the Moro reflex. The Moro reflex is usually stimulated by a sudden movement of the head backwards but it may also be activated through a sudden change of light or a loud noise. The response consists of an immediate wide abduction of the arms (both arms are flung out from the body), extension of the legs and a rapid intake of breath. This is followed by the arms coming together again as if to embrace or grasp, and flexion of the legs.
The strength and symmetry of response are very useful diagnostic indicators in a neurological examination of the newborn. The Moro reflex is not typically seen after six months of age and is transformed into the adult startle pattern.
Persistence of primary reflexes
In typical development the primary reflex system is inhibited or transformed in the first year of life and a secondary or postural reflex system emerges. However, primary reflexes may persist for some children beyond their typical timespan and disrupt subsequent development.
For example, the persistence of the Asymmetrical Tonic Neck Reflex (ATNR) will lead to problems which are particularly apparent in an educational setting. The ATNR is most obvious in the first three months after birth and is elicited by a sideways turning of the head when the baby is supine. The response consists of extension of the arm and leg on the side to which the head turns and flexion of the opposing limbs. The ATNR is involved in the orientation of the newborn in space and, as it is present when near point fixation is developing, plays an important role in visuomotor development. It should be inhibited around six months of age and persistence is a clinical indicator of atypical development.
Severe persistence of primary reflexes indicates predominantly intractable, 'organic' problems as in cerebral palsy(7) where children experience extreme motor difficulties and significant reading difficulties despite adequate levels of intelligence. Relatively milder persistence, however, is associated with less severe disorders (including specific reading difficulties).
The process of inhibition of these reflexes in the earliest months of life remains unknown but it has been assumed that this process cannot occur after early childhood. However, there is growing evidence that it may be possibble to reduce reflex persistence using specific intervention strategies.
Intervention
The Primary Movement programme developed at Queen's University, Belfast has been shown to have a significant impact on reducing reflex persisitence. It has been evaluated in a number of formal studies that have been published in peer-reviewed scientific journals.
The Primary Movement programme can be used from the age of four with small groups or whole classes of children. From the age of six it can also be used individually. The programme takes approximately fifteen minutes per day to complete and has been introduced into many nursery, primary and special schools and some secondary and higher level colleges in the UK and Ireland.
The programme can be used in the ordinary school classroom and does not require any specialised equipment. Younger children first learn a series of songs with added movement, in order to prepare them for participation in the core Primary Movement programme, a sequence of specific movements which are based on replicating or mimicking the primary reflex system of the fetus.
Research
Prevalence studies (2,3) have shown that many children with reading and motor difficulties have underlying developmental delay and that this may be related to the persistence of primary reflexes. The findings suggest that for many children in mainstream schooling, the attainment of core educational skills may be affected, in particular, by persistence of the Asymmetrical Tonic Neck Reflex (ATNR).
The efficacy of the Primary Movement programme in reducing reflex persistence in children in mainstream schooling has been examined in a number of formal trials. These studies suggest that the repetition of primary reflex movement plays a major role in the inhibition of primary reflexes and that inhibition can be brought about at a much later stage in development than had previously been thought possible.
In a double-blind, placebo controlled study, it was found that children who completed the Primary Movement programme made very significant gains in reading, writing speed, naming speed and saccadic frequency (eye movements) with a concurrent significant inhibition of the ATNR(8).
In a school-based study of children in their first year at primary school, it was found that the Primary Movement programme had a significant effect on the development of fine motor control(9). In another large, school-based study, involving more than one thousand children, it was found that the Primary Movement programme had a significant effect on ATNR persistence. This led to improved academic attainments in reading, spelling and mathematics(10).
References
1 Morrison DC. Neurobehavioral and Perceptual Dysfunction in Learning Disabled Children. Lewiston, NY: C.J. Hogrefe, Inc., 1985.
2 McPhillips M, Sheehy N. Prevalence of persistent primary reflexes and motor problems in children with reading difficulties Dyslexia 2004; 10(4): 316-338
3 McPhillips M, Jordan-Black J-A. Primary reflex persistence in children with reading difficulties (dyslexia): A cross-sectional study. Neuropsychologia 2007; 45: 748-754
4 Capute AJ, Shapiro BK, Palmer FB, Accardo PJ, Wachtel RC. Primitive reflexes: A factor in nonverbal language in early infancy. In : Stark, ed. Language Behavior in Infancy and Early Childhood. North Holland: Elsevier, 1981: 157-161.
5 Holt KS. Child development: Diagnosis and Assessment. London: Butterworth-Heinemann, 1991.
6 Illingworth RS. The development of the infant and young child: Normal and abnormal. Edinburgh: Churchill Livingstone, 1987.
7 Bobath B, Bobath K. Motor Development in the Different Types of Cerebral Palsy. London: Heinemann Physiotherapy, 1975.
8 McPhillips M, Hepper PG, Mulhern G. Effects of replicating primary-reflex movements on specific reading difficulties in children: a randomised, double-blind, controlled trial. Lancet 2000; 355: 537-41.
9 Brown CG. Improving fine motor skills in young children: an intervention study. Educational Psychology in Practice 2010; 26(3): 269-278
10 Jordan-Black J-A. The effects of the Primary Movement programme on the academic performance of children attending ordinary primary school. Journal of Research in Special Educational Needs 2005; 5(3): 101-111.