The OT said something I had never heard before. She was watching Tate move around the room — his constant shifting, the way he could not sit still, the big reactions to the smallest surprises — and then she pointed to his ears. “See how they are going red?” she said. “That is him changing state.” That moment started us down a path of understanding what retained primitive reflexes and ADHD actually have to do with each other, and it has completely changed how I see my son’s behavior.
Since then I have spent more hours than I want to admit reading about primitive reflexes, the Moro reflex, vestibular processing, all of these automatic body systems that most kids’ brains integrate by age two but sometimes do not. And honestly, it has been equal parts eye-opening and heartbreaking — because it means he has been working so much harder than I realized, and his body has genuinely been working against him.
What Are Retained Primitive Reflexes?
Primitive reflexes are involuntary movement patterns that babies are born with to help them survive. The Moro reflex — that full-body startle a newborn does — the Spinal Galant, the Tonic Labyrinthine Reflex. These exist for specific reasons in early development and are supposed to integrate (essentially get absorbed by the higher brain) as the nervous system matures, usually within the first year of life.
When they do not fully integrate, they keep firing at inappropriate times, long after they should have gone dormant. Research shows retained primitive reflexes are found at significantly higher rates in children with ADHD than in neurotypical children. They are not a diagnosis in themselves, but they create conditions in the body that make regulation much harder — because the body is reacting before the brain can regulate it.
The Link Between Retained Primitive Reflexes and ADHD
Here is the plain-English version of what our OT explained: these are automatic body systems, not conscious choices. When a retained reflex fires, the body reacts before the brain can step in and regulate. That is why you can have a child who is clearly intelligent, clearly trying, clearly not doing this on purpose — and still cannot sit still, still has explosive reactions, still cannot control their impulses in the moment.
The body is working against them. With retained primitive reflexes and ADHD together, the behaviors are not always just a brain chemistry issue. They can also be a body integration issue — and that changes the treatment picture significantly, because you can work on it.
The Reflexes Behind the Behavior: A Plain-English Breakdown
The Moro Reflex — Why He Is Always on Edge
The Moro reflex is the newborn startle response. When it is retained, it essentially keeps the fight-or-flight system chronically activated. You see this as big reactions to noises or surprises, constant low-level anxiety, a child who takes forever to calm down after being upset, and impulse control issues. For Tate, this looked like going from zero to one hundred in seconds over something that seemed completely minor to everyone else. He was not being dramatic. His nervous system was genuinely alarmed.
The Spinal Galant and STNR — Why He Cannot Sit Still
The Spinal Galant reflex runs along the spine and causes the hips to twist when the back is stimulated. If it is retained, sitting in a chair with a backrest literally triggers an involuntary wiggle response. The chair is the problem — not the child. The STNR (Symmetric Tonic Neck Reflex) links head position to arm and leg movements, which is why you get big shoulder-driven movements, hitting, throwing, and pushing. The OT explained that these behaviors are often the body seeking the movement it needs to feel regulated.
The ATNR and TLR — Posture, Coordination, and Vision
The ATNR (Asymmetric Tonic Neck Reflex) causes one side of the body to tense when the head turns. The TLR (Tonic Labyrinthine Reflex) controls head position relative to balance. When these are retained, you see one side of the body dominating, hunched posture, difficulty standing straight, and poor cross-body coordination. It also affects vision — specifically binocular vision, where the eyes are not working together well, which causes fatigue, avoidance, and makes reading much harder than it should be.
The Vestibular System — the Foundation Everything Else Sits On
The vestibular system handles balance and body awareness — and it also deeply influences emotional regulation, posture, and vision. When it is underdeveloped, kids seek intense physical input to regulate themselves: jumping, crashing, spinning, rough play. This is not bad behavior. This is a nervous system actively trying to do its job by finding the input it is missing. The destruction zone we built in our garage? It makes a lot more sense now.
What Is HANDLE Therapy?
HANDLE stands for Holistic Approach to NeuroDevelopment and Learning Efficiency. It was developed by Judith Bluestone and focuses on identifying and treating the neurological roots of behavior and learning differences — including retained primitive reflexes — rather than addressing the behaviors directly.
Think of it less like behavioral therapy and more like physical therapy for the brain and body. The approach uses repetitive, rhythmic, gentle movements to help the nervous system build new patterns from the bottom up — what the therapist calls building patterns into the “lower brain.” There are no flashcards, no reward charts, no behavioral contracts. Just very specific exercises repeated consistently until the nervous system learns a different default.
Sessions start with a thorough assessment — ours was about two hours — where the therapist identifies which reflexes are still active and how the different systems are interacting. From there, she creates a home exercise program: usually 5 to 15 minutes of specific movements done daily. We reassess every four to six weeks. The cost was $480 for the initial assessment and $160 for follow-ups, which is not covered by insurance but is honestly the first thing we have done that came with an actual explanation.
Signs Your Child Might Have Retained Primitive Reflexes
This is not a diagnostic list — only a trained OT or HANDLE therapist can do a proper assessment — but these are the patterns that showed up for us:
- Cannot sit still or constantly shifts and squirms in a chair (especially with a backrest)
- Extreme reactions to unexpected noises, touch, or surprises
- Takes a long time to calm down after being upset — “0 to 100 and stays there”
- Hunched posture or one-sided dominance in how they hold their body
- Difficulty with cross-body movements like skipping, catching, or crawling patterns
- Sensitivity to texture or touch on the back and the soles of the feet
- Sleep differences — nesting, needing to position the body a specific way to fall asleep
- Red ears or visible facial flushing when overwhelmed (a state change signal)
- Bedwetting past typical age (the Perez reflex runs along the spine and connects to bladder and bowel regulation)
- Vision fatigue — avoids reading, loses place easily, uses peripheral vision instead of tracking
When I read this list the first time, I had a physical reaction. That is just Tate. All of it. And knowing there is a neurological reason behind each one of those things — not a behavior problem, not a parenting failure — changed something in me.
Tools We Use at Home to Support Nervous System Regulation
While we work through HANDLE therapy, the OT also pointed us toward some tools that help the body stay regulated in daily life. These are not replacements for therapy, but they give the nervous system consistent sensory input throughout the day — which is exactly what it needs.
What Our HANDLE Therapy Journey Looks Like So Far
We are early in this. The assessment was two hours and it was genuinely one of the more clarifying experiences we have had in years of trying to figure out what Tate needs. Watching the OT work through the reflex testing — and seeing his body’s involuntary responses — was the first time things really clicked. He was not imagining it. I was not imagining it. His body really is doing things outside of his control.
We now have a daily home program — about 10 minutes of specific movements that look a bit like gentle yoga mixed with games. Tate does not know he is doing therapy. He thinks it is just a thing we do before breakfast. So far, two weeks in, I have noticed his ears going red less frequently. The OT said that is a good sign — his nervous system is starting to have a wider window of tolerance before it tips into overload.
I will keep updating here as we go further into it. If you are in the middle of something similar — the appointments, the assessments, the feeling that you keep getting halfway answers — I see you. This felt like a real answer for the first time.
Frequently Asked Questions
What are retained primitive reflexes?
Retained primitive reflexes are involuntary movement patterns that babies are born with to help them survive. They are supposed to integrate into the nervous system within the first year of life. When they do not, they keep firing at inappropriate times and create significant challenges with behavior, focus, coordination, and emotional regulation.
Can retained primitive reflexes cause ADHD-like behaviors?
Yes. Retained primitive reflexes are found at significantly higher rates in children with ADHD. They do not cause ADHD itself, but they create conditions where the body reacts before the brain can regulate — showing up as impulsivity, hyperactivity, emotional dysregulation, and sensory sensitivity.
What is HANDLE therapy for kids?
HANDLE stands for Holistic Approach to NeuroDevelopment and Learning Efficiency. It addresses the neurological roots of behavior and learning differences using repetitive, rhythmic movements that help the nervous system build new patterns. It starts with a thorough assessment and then a customized daily home program.
How do I know if my child has retained primitive reflexes?
Common signs include inability to sit still, extreme reactions to noise or surprise, difficulty calming down, hunched posture, sensitivity to touch on the back or feet, poor cross-body coordination, and visible ear flushing when overwhelmed. A trained OT or HANDLE therapist can do a formal assessment.
What does a red ear mean in a child with sensory issues?
Red ears can be a visible sign of a nervous system state change — the body is shifting from regulated into fight-or-flight mode. It is not just temperature. For some children it reliably appears before emotional dysregulation or an outburst, making it a useful early warning signal for parents to step in before things escalate.
What’s Next?
If you are navigating the nervous system side of ADHD and PDA, these posts might help: How I Set Up a Destruction Zone for Kids with ADHD and PDA | Why My PDA Kid Won’t Eat (And What Finally Helped) | What Homeschooling a PDA Kid Actually Looks Like