Their Effect on Learning, Behavior and Quality of Life
Structural Corrections That Assist Their Integration
Written by:Keith Keen, Sydney , Australia
The Problem
It has been estimated that 15-20% of children in our society suffer some degree
of learning difficulty. “Learning Difficulty” in this paper refers to those who perform
poor academically in the absence of intellectual or gross physical impairment.
We all agree that any form of learning difficulty is worthy of attention, so the child
(or adult) has the opportunity to reach full potential and enjoy life as fully as
But the consequences of learning difficulty can be far more far reaching and
disturbing than many of us realize.
In studies of recidivism (those who break the law and continue to do so despite
being caught and punished), a very large percentage suffer from learning
Juvenile suicide is an increasing and disturbing phenomenon. The Attention
Deficit Hyperactive Disorder (ADHD) population has an attempt rate far higher
than the normal population, about half of whom succeed.
Children presenting with learning difficulty have a higher incidence of the
symptoms of depression and anxiety.
So learning difficulty and behavior disorder is not just stopping our children from
succeeding at school, it is filling our goals
it is crippling the future of our society
The Solution
On the bright side -a large proportion of those suffering from learning difficulty
can be, and have been helped.
But about 15% of students do not learn easily despite excellent teaching,
parenting and individual tutoring. That’s quite a large percent considering the
possible consequences.
It is obvious that, if teaching, parenting and individual tutoring are not
succeeding; we have to look somewhere else.
Over the last decade and a half we have found that the problem appears to be in
the physiological, neurological and biochemical systems of the body that together
provide the basis for the complex skills that are required for learning and
Retained primitive reflexes are a major problem that disrupts the physiological,
neurological and biochemical bases of learning and behavior.
Primitive Reflexes
Our Central Nervous System is our Control Centre for Living. It is essential for
perceiving the world around us, for moving around and doing things in it; for
thinking, feeling, learning, communicating, working, playing, loving, surviving.
Anatomically, the central nervous system is composed of the brain and spinal
cord. The brain may be divided into a hierarchy of centers:
1) the most evolved thinking and integrating part, the cerebral cortex at the top
2) the older brain of instinct and housekeeping in the middle
3) the oldest , the brainstem, just above the spinal cord
Of course these "centers" are not isolated, they are quite complexly interlinked,
but separating them helps to understand brain processes.
"Primitive" means "earliest of its kind" as the nerve centers controlling primitive
reflexes are in the oldest (most primitive) part of the brain, the brainstem.
In the womb and in early months of life the higher centers of our central nervous
system are not fully developed. During this time we are protected and assisted by
reflexes, controlled by lower centers of our brain. A reflex does not involve
thinking, it is an involuntary response. That is: given an external stimulus (e.g.
touch, noise, heat) or internal stimulus (e.g. hunger) there is an automatic,
involuntary reaction if the relevant reflex is active. Reflex response varies from
simple muscular movement (e.g. moving a body part away from pain) to quite
complex reflexes involving body movements, breathing, perceptual and hormonal
Primitive reflexes are needed for survival and development in the womb and in
early months of life. As higher centers begin to mature enough for conscious
control of activity, the involuntary, uncontrollable reflex responses are a
nuisance. The reflexes anatomically and neurologically stay for the remainder of
our life, but, if all is well, they are integrated into higher centre control.
Retained Primitive Reflexes
Primitive reflexes ideally begin to function in a particular order and are integrated
in a specific sequence. If they are retained out of sequence, they disturb the
development and integration of subsequent reflexes. If they are retained beyond
their normal age of integration they can disturb some or all of the functions of
higher centers, which includes behavior, learning, the integration of gross or fine
movements and more.
Basically, the perception of our inner and outer environment and our response to
it may be disturbed;
that is, conscious life may be disturbed.
Causality Like all questions on the nature of life and health there are no absolute
answers on causality. It appears that trauma of some kind is involved somewhere
between conception and early months of life. The trauma can be physical,
chemical, and hormonal or other forms not yet researched. In utero many
chemicals and hormones can pass through the umbilical cord; all manner of
traumatic events can occur in the delicate early months of life; but the big one
appears to be birth trauma. (I include caesarean section as trauma). Statistics
and clinical observation show that there may be genetic factors. These appear to
be predispositions that raise the probability of problems arising from trauma.
Consequences of Retained Primitive Reflexes
Fear Paralysis Reflex
If this reflex is retained after birth, it can be characterized by withdrawal,
reticence at being involved in anything new, fear of different circumstances, the
child who bears the brunt of teasing by normally adventurous children.
Inappropriate retention of the fear paralysis reflex can contribute to such
conditions as Sudden Infant Death Syndrome, elective mutism, hypersensitivity
to sensory information and may result in physical and psychological conditions
such as Panic Disorders. As it begins first and is normally integrated first,
retained fear paralysis reflex may effect the integration of any other primitive
Moro Reflex
The reflex is set off by excessive information in any of the baby's senses. A loud
noise, bright light, sudden rough touch, sudden dropping or tilting, turns on this
"one reflex suits all" reflex. The reflex has to cover all eventualities so the child's
sympathetic hormonal and neurological response is elicited, preparing the child's
body for whatever turned on its alarm system.
If the Moro reflex persists beyond three to six months of age it becomes an
automatic therefore uncontrollable overreaction, overriding the newly acquired
higher centre decision making. The child (or adult) may be hypersensitive to any
of the senses and so may withdraw from situations, or, as it stimulates
sympathetic fight or flight responses, the person may be an aggressive, over
reactive, highly excitable, and unable to turn off and relax.
Those with retained Moro may be very difficult to understand, they may be loving,
perceptive and imaginative but at the same time immature, over reactive and
As an adrenal response may be inappropriately elicited many times a day and is
on standby most of the time, there is a constant demand on the adrenal glands
which may become fatigued, thus leading to hypoadrenic symptoms such as
allergy, asthma or chronic illness.
Asymmetrical Tonic Neck Reflex (ATNR)
In the first months of life, while the ATNR is operating, the hand moves in
conjunction with the head. This connection between touch and vision helps to
establish distance perception and hand eye coordination. By the middle of the
first year of life this is normally accomplished and the ATNR, being no longer
required, should be integrated.
With retained ATNR, difficulty may be experienced with tasks that involve both
left and right sides of the body (including eyes, ears, limbs etc).
Turning the head may cause a visual image to momentarily disappear or parts of
the visual field to be missed. Visual tracking and judgment of distance may be
Each time the head is turned the arm wants to follow it and the fingers want to
open. Writing therefore requires enormous effort to hold the hand still while the
head is doing different things like looking up at a blackboard.
To compensate for this, excessive writing pressure often occurs and/or a
clenched fist pencil grip, both of which affect quality and quantity of writing. The
act of writing requires intense concentration at the expense of thinking about
what is being written, thus they may be fluent of speech but unable to express
ideas in written form.
Adults who suffer recurrent shoulder injury or neck stiffness, especially if always
on the same side, often have a unilaterally retained ATNR. It appears that in the
presence of some degree of retained ATNR, their hand and eye are not fully
neurologically (therefore functionally) independent. This is a constant stress,
interrupting the fine organization required for smooth head, eye, arm, and hand
coordination, which leads to structural problems, as well as affecting sports
Tonic Labyrinthine Reflex (TLR)
If the tonic labyrinthine reflex is not integrated at the correct time it will constantly
disturb the labyrinthine (balance) system.
Head-righting reflexes and therefore visual function may be impaired. The person
may experience difficulty in judging space, distance, depth and speed.
Susceptibility to motion sickness is common with retained Tonic Labyrinthine
When the sagittal (front to back) component of the tonic labyrinthine reflex is
retained, flexion of the head for more than 6-10 seconds (as in working at a desk
or reading) causes neurological disorganization. Thus the child (or adult) loses
attention soon after taking this position. Needless to say this appears as attention
deficit and is deleterious to studying or working, but is secondary to a correctable
cranial fault.
Spinal Galant Reflex
In the newborn, stroking the low back to one side of the spine will result in a
twisting away from that side, with a rising of the hip on the same side. Stimulation
down both sides of the spine simultaneously activates a related reflex, which
elicits urination.
If the spinal galant is retained beyond normal time of integration it may be elicited
at any time by light pressure in the low back region. In the classroom, the child's
belt or waistband or leaning against the back of a chair may activate the reflex,
creating the 'ants in the pants' child who wriggles, squirms and constantly
changes body position. This constant irritant affects concentration and short-term
memory (as well as getting them into trouble).
Due to the neurological association with a bladder voiding reflex, children with
retained spinal galant reflex may have poor bladder control. As the low back
region is stimulated by bed sheets, the involuntary voiding reflex may be elicited.
Thus the child may continue to wet the bed despite all attempts to stop.
When retained, this reflex may affect posture and walking gait, contribute to
spinal scoliosis, and affect fluency and mobility of movement.
Juvenile Suck Reflex
The newborn projects the tongue forwards to suck a nipple.
In the adult swallow reflex, the tongue moves backwards to push food down the
If a juvenile suck reflex is retained, the tongue projects forwards before moving
backward in the normal swallow.
This tongue thrust continually pushes the front teeth forwards, altering the shape
of the upper teeth towards a class 2 bite. It is a huge problem for dentists (and
their patients).
Palmar and Plantar Reflexes
The palmar and plantar reflexes are part of the group of reflexes which develop
in utero, and whose common characteristic is to grasp.
Retention may cause poor manual dexterity and /or pencil grip due to reduced
independence of thumb and finger movement.
Speech difficulties due to a continuing relationship between hand and mouth
Mouth movements when trying to write or draw.
Structural Corrections for Retained Primitive Reflexes
The good news is: We can greatly assist the integration of retained primitive
reflexes with specialized craniosacral correction.
The Central Nervous System is so important as a Control Centre that it is housed
in a membrane that isolates it from the rest of the body. Outside that membrane,
blood supplies nutrition and lymph carries wastage. Inside the membrane, a clear
fluid called cerebrospinal fluid provides nutrition and protection to the central
nervous system.
The outer membrane surrounding the Central Nervous System is called the Dura
Mater. It attaches at its uppermost end to the inside of our skull; it surrounds our
brain, brainstem and spinal cord, and attaches at its lowermost end to our
tailbone. Cerebrospinal fluid is circulated mainly by the rhythmic movement of our
cranial (skull) bones at the top and the movement of our sacrum (in the middle
rear of our pelvis) at the bottom, joined by the dura mater between. If this
craniosacral system is not functioning correctly, many symptoms can occur.
Basically, as the central nervous system is involved, almost anything can not
function at its best. Headaches, muscular imbalance, hormonal dysfunction,
developmental delay (including retained primitive reflexes) and learning disability
are common problems.
Cranial or sacral correction is mostly gentle pressure on a particular place or
places (on the skull or pelvis) in a specific direction, often on a specific phase of
breathing. This helps to restore normal membrane to bone relationship and
craniosacral movement. As it is the craniosacral movement which circulates
cerebrospinal fluid, its correction helps to normalize central nervous system
A decade or so ago I discovered that some craniosacral faults may be found only
in body postures related to primitive reflexes. Furthermore it appears that these
craniosacral problems inhibit normal integration of the reflex. Correction of
craniosacral faults while in those postures removes the inhibition to normal
primitive reflex integration. Higher centers may then integrate the reflexes. These
postural craniosacral faults usually stay corrected, needing no further structural
In 1998 I performed a retrospective statistical analysis on a group of children
tested behaviorally for retention of primitive reflexes by a neurodevelopmental
assessor before and after the corrections discussed in this paper. No other
intervention took place between pre and post testing.
The results of this pilot study support what we have observed clinically for a
decade, returning positive changes at probabilities ranging from p<.05 to p<.01
(Keen, 1999).
In the February 2000 edition of The Lancet, a randomized, double blind,
controlled trial indicates that there is a significant relationship between retained
primitive reflexes and learning difficulty (McPhillips et al, 2000); a relationship
well known in clinical practice.
The conclusion states:
"This study demonstrates the importance of assessing underlying
neurodevelopmental functioning and, in particular, the persistence of primary
[primitive] reflexes when considering the basis of learning difficulties."
The McPhillips et al study used only one reflex (ATNR) and for correction only
movement exercises.
Imagine the positive changes when we apply procedures that have proven to be
much more effective, and apply it to many primitive reflexes.
Brainstem Injury
Earlier this year a patient presented after having fallen 50 feet onto his head (and
survived). After his one month coma he was left with a few problems, including a
moderate left hemiplegia. Magnetic resonance imaging (MRI) indicated trauma to
his brainstem.
Four months after the accident he presented to my clinic. Most of his symptoms
responded excellently to standard structural corrections, but some left hemiplegia
When all standard indicators were clear, I applied the diagnostic tests for
retained primitive reflexes. Two were positive, despite his having no history of the
symptoms of primitive reflex retention in his earlier life. Remembering that his
MRI indicated brainstem trauma, I applied the corrections indicated. His left
hemiplegia reduced dramatically.
Interaction with Other Professions
A retained primitive reflex is by definition developmental delay. It must be
emphasized that developmental delay and learning difficulty are multifactorial
problems. Structural correction is only one factor of many. Structural correction
can be likened to fixing the "hardware" of a computer. It does not necessarily
mean that the person then functions perfectly, for there is also the "software" to
consider. Thus structural correction is only one therapy in a team which may
include: Behavioral Optometrists, Educationalists, Medical Practitioners,
Neurodevelopmental Assessors, Neurofeedback Therapists, Nutritionists,
Occupational Therapists, Psychologists, Reflex Movement Therapists, Sound
Therapists, Speech Therapists, etc. (Note that this list is alphabetical and
indicates neither order nor importance of therapy).
Other professionals with whom we interactively refer report that their therapy and
their results are greatly enhanced if retained primitive reflexes are treated first.
Structural, mostly craniosacral, corrections have been developed that assist the
integration of retained primitive reflexes, assist many aspects of learning
difficulty, reveal other hidden structural problems, reduce the symptoms of
brainstem injury and facilitate other therapies.
Primitive reflexes are automatic, stimulus-elicited without involvement of our
higher decision making processes. The child (or adult) has little or no control over
their elicitation. There is little use trying to force extra teaching or behavior
modification upon a system in which the basic intrinsic modules for learning and
behavior are not correctly functioning.
Best treat where the problem resides. That is, at an intrinsic functional level.
To assist retained primitive reflexes to integrate is to optimize human potential at
very deep level and in a far-reaching and highly effectively way.
Keen, Keith, "Structural Correction: Its effect in learning difficulty and
developmental delay", The Mind of a Child Conference Proceedings, Sydney,
McPhillips, M. et al, "Effects of replicating primary-reflex movements on specific
reading difficulties in children: a randomized, double blind, controlled trial", The
Lancet, Vol 355, February 12, 2000.
Keith Keen
Sydney, Australia 2006
This paper is an attempt by the author to present, in plain English, some aspects
of primitive reflexes, the effects of their retention, and physical correction related
to their integration. Although resourced from both literature and clinical
experience, the paper remains the opinion of the author at time of writing.
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