Beyond Attention: How Retained Primitive Reflexes Impact Executive Functioning in Children

When children struggle with focus, emotional outbursts, or completing tasks, we often think it’s just an attention issue. But what if the real root lies deeper—in the body’s early wiring?

Executive functioning is the brain’s command center, responsible for planning, emotional regulation, working memory, and task management. While attention plays a role, executive dysfunction often has broader origins—especially in children with persistent challenges.

One overlooked factor? Retained primitive reflexes—automatic movement patterns from infancy that may interfere with brain-body communication if not fully integrated.

💡 What Are Primitive Reflexes?

Primitive reflexes are involuntary movement patterns babies are born with to help them survive and develop. Examples include:

• Rooting reflex – Helps babies find food

• Moro reflex – The classic “startle” response

• Palmar grasp – Causes babies to tightly grip a finger

These reflexes should naturally integrate (fade away) in the first year of life as the brain matures and voluntary control takes over. But when they don’t, retained reflexes can hijack a child’s physical and emotional resources—interfering with learning, self-regulation, and even posture.

🧠 What Is Executive Functioning?

Executive functioning includes the high-level mental processes that help children:

• Plan and initiate tasks

• Remember multi-step directions

• Control impulses and behavior

• Shift between tasks or ideas

• Regulate emotions and stay calm

• Monitor their own progress

Each of these skills depends on smooth communication between the brain and body. If primitive reflexes are still active, they can divert attention and energy away from these crucial processes.

Executive Functions, Explained:

Executive Skill What It Looks Like How Reflexes Might Interfere Working Memory Holding onto directions or remembering what to do next Sensory overload or poor body awareness can make this harder Inhibitory Control Not blurting out, resisting distractions A hyper-alert nervous system (Moro reflex) makes self-control more difficult Cognitive Flexibility Switching gears when plans change Rigid motor patterns or sensory defensiveness can cause “stuck” thinking Task Initiation Starting work independently Difficulty organizing the body or thoughts may cause avoidance or procrastination Emotional Regulation Managing big feelings like frustration or excitement An unsteady sensory system increases the likelihood of meltdowns Self-Monitoring Noticing when off-task and making adjustments Poor internal awareness (interoception) from retained reflexes hinders this self-check-in

⚠️ Signs of Retained Primitive Reflexes in Children

If you notice several of these signs, it might indicate that primitive reflexes are still active:

• Difficulty sitting still or slouching at a desk

• Toe-walking or “W-sitting” posture

• Strong reactions to sensory input (e.g., avoiding loud noises or light touch)

• Poor handwriting, awkward grip, or fatigue with fine motor tasks

• Trouble transitioning between activities or frequent meltdowns

• Coordination issues or clumsiness

• Emotional outbursts that seem disproportionate

These signs aren’t just behavioral—they’re neurological.

🧩 How Retained Reflexes Disrupt Executive Functioning

Here are a few specific reflexes and their known impacts:

Reflex Impact on Executive Functioning Moro Reflex (Startle) Triggers stress response → leads to hypervigilance and emotional reactivity ATNR Interferes with crossing midline → affects reading, writing, and bilateral coordination STNR Causes poor sitting posture → makes sustained attention and visual focus difficult TLR Affects balance and spatial awareness → impacts seated tasks and body orientation Palmar Grasp Reflex Limits fine motor skills → contributes to handwriting fatigue and weak task persistence

🛠️ What Can Help? Reflex Integration and Movement-Based Therapies

The good news is that retained reflexes can be addressed—often with life-changing results.

Reflex integration therapy involves targeted movement patterns that help the brain inhibit outdated reflexive responses and promote more efficient neurological functioning.

Therapies that can help include:

• Rhythmic movement training

• Crawling and cross-pattern exercises

• Balance and vestibular activities

• Sensory integration therapy

• Occupational therapy with a reflex integration focus

These methods support body-brain regulation—laying the foundation for improved attention, behavior, and emotional resilience.

✅ Why This Matters for Parents and Professionals

Understanding the link between primitive reflexes and executive functioning transforms how we view a child’s challenges. It shifts the lens from blaming behavior to recognizing unmet neurological needs.

This deeper insight:

• Helps parents advocate for targeted support

• Empowers therapists to tailor intervention plans

• Provides hope when traditional strategies fall short

• Validates children’s lived experiences

✨ Takeaway: Address the Root, Not Just the Symptoms

If your child struggles with focus, behavior, or emotional regulation, don’t stop at attention. Explore whether retained primitive reflexes could be quietly interfering with their executive functioning. With the right support, integration is possible—and with it, greater calm, confidence, and cognitive clarity.

Looking for support or an evaluation?
Connect with a pediatric occupational therapist trained in reflex integration to explore the next steps for your child’s development.

Blog Post by Sam Muchoney