What Does the Research Tell Us About Primitive Reflexes?
INPP UK | Research & Professional Practice
Primitive reflexes are an important part of early neurological development. Their emergence and integration form part of the developing nervous system's transition towards increasingly controlled, purposeful movement.
But what does the research tell us about primitive reflexes beyond infancy? What do studies show about their relationship with learning, attention and motor development? And how should these findings inform professional practice?
Research into primitive reflexes has grown, with studies investigating their persistence beyond infancy and possible associations with developmental and educational difficulties. However, evidence of an association is not the same as evidence of cause, and findings from individual studies need to be considered within the wider research context.
For INPP UK, engaging with this research means recognising both what is known and what remains to be established.
Primitive reflexes: a brief introduction
Primitive reflexes are automatic movement responses that emerge during early development and are mediated through developing neural pathways.
They include the Moro reflex, asymmetrical tonic neck reflex (ATNR), symmetrical tonic neck reflex (STNR) and tonic labyrinthine reflex (TLR), among others.
These responses have a role in early neurological development. As the nervous system matures, reflex activity typically becomes modified and increasingly integrated with more voluntary and adaptable movement.
This process takes place alongside the development of postural control, balance, sensory processing, coordination and purposeful motor skills.
Primitive reflexes are therefore best understood as one part of a much wider developmental picture—not as a complete explanation for a child's movement, learning or behaviour.
What does the research show?
One of the challenges in this field is that studies do not all investigate the same questions. Some examine the prevalence of primitive reflex responses in children of different ages. Others explore associations with motor skills, attention or academic performance. A smaller number investigate interventions.
These different types of research contribute to our understanding, but they cannot automatically be treated as equivalent evidence.
Primitive reflexes and motor development
A 2026 systematic review by Provazník and colleagues examined research into persisting primitive reflexes and motor and cognitive development in children aged 3–11 without neurodevelopmental disorders.
The review included 14 studies published between 2004 and 2023. Six investigated motor development, and all reported negative associations between persisting reflexes and aspects of motor performance, particularly locomotion, balance and manual dexterity.
These findings are relevant because motor development involves much more than the acquisition of individual movement skills. Balance, postural control, coordination and the ability to adapt movement to changing demands are important aspects of children's interaction with their environment.
However, the review also identified limitations in the available evidence. The studies were heterogeneous, meaning that their methods and measures differed. The findings therefore need to be interpreted with care.
The research identifies relationships worthy of further investigation; it does not establish that persisting reflex activity is the sole or direct cause of motor difficulties.
Primitive reflexes and learning
The relationship between primitive reflexes and learning has also been investigated.
A systematic review by McWhirter, Steel and Adams examined research exploring learning disorders, motor function and primitive reflexes in preschool children.
The review included 27 studies, although only three included primitive reflexes. These studies reported associations between higher levels of the asymmetrical tonic neck reflex (ATNR) and measures including fine motor skills, school readiness, impulsivity, hyperactivity and inattention.
The authors emphasised the need for caution because of significant differences between studies and called for further research to clarify the mechanisms that might connect these areas of development.
This is an important distinction. The findings suggest that primitive reflex activity may be relevant to the wider study of development, but they do not establish that a particular reflex response predicts a child's educational progress or explains a learning difficulty.
Learning is influenced by many interacting factors, including language, memory, attention, teaching, emotional wellbeing and the child's wider developmental experiences.
Primitive reflexes and attention
Attention has received particular interest in research into retained primitive reflexes.
A 2023 systematic review and meta-analysis examined the relationship between attention-deficit/hyperactivity disorder (ADHD) and primitive reflexes. It included four studies involving 229 participants.
The authors reported moderate positive correlations between ADHD and the ATNR and STNR. They also identified differences related to the measures and assessment methods used.
The authors concluded that further longitudinal and experimental research was needed to investigate whether there is a causal relationship.
This limitation matters. A correlation does not tell us whether one factor contributes to another, whether both are influenced by other developmental processes, or whether the relationship is more complex.
ADHD is a recognised neurodevelopmental condition with multiple contributing factors. Primitive reflex assessment is not a diagnostic test for ADHD and should not be presented as one.
What about intervention research?
For practitioners, one of the most important questions is whether movement-based programmes designed to address persisting primitive reflexes can produce meaningful changes.
The 2026 systematic review by Provazník and colleagues included five studies investigating interventions aimed at reducing persisting primitive reflexes. Most reported improvements in developmental outcomes, with effects ranging from small to large. The authors nevertheless highlighted the limited and heterogeneous nature of the evidence.
These findings are encouraging enough to warrant further investigation, but they should not be interpreted as definitive proof that reflex integration programmes are effective for every child, or that changes in reflex responses necessarily explain changes in learning or behaviour.
Several questions remain important:
Were the studies sufficiently large to detect meaningful effects?
Were comparison groups used appropriately?
Were outcomes measured using reliable and valid tools?
Were improvements maintained over time?
Could other aspects of the intervention have contributed to the outcomes?
Were the findings replicated independently?
These are not simply academic questions. They help determine how confidently research findings can be translated into clinical practice.
Understanding the limitations of the evidence
Research into primitive reflexes is developing, but several challenges need to be recognised when interpreting the literature.
Different assessment methods
Studies may use different reflexes, testing procedures, scoring systems and thresholds. This makes direct comparison difficult and highlights the importance of standardised assessment.
Different populations
Findings from typically developing children cannot automatically be applied to children with diagnosed neurodevelopmental conditions, or vice versa.
Association and causation
Observational studies can identify relationships, but they cannot establish whether persisting reflex activity causes a particular difficulty.
Measuring meaningful change
A reduction in a reflex response is not necessarily equivalent to an improvement in everyday function. Both need to be investigated.
Recognising these limitations does not diminish the value of research. It helps establish what conclusions can reasonably be drawn and where further investigation is needed.
Where does INPP fit within this research?
The INPP approach is based on the assessment of neuromotor development and the use of an individualised programme of movement exercises.
Primitive reflex assessment forms one part of this approach, considered alongside postural control, balance, coordination and other aspects of development.
The research discussed in this article provides context for why these areas are being investigated. It does not, by itself, establish the effectiveness of the complete INPP programme.
For INPP UK, maintaining professional standards means making this distinction clear.
Our responsibility is to support practitioners in understanding the principles of the method, applying assessment appropriately, recognising the limits of their professional role and engaging critically with the research.
It also means remaining open to new evidence, including findings that challenge existing assumptions.
What do we need to know next?
The current literature points towards several priorities for future research.
Standardised assessment: Greater consistency in how primitive reflex activity is assessed would help researchers compare findings across studies and populations.
Longitudinal research: Following children over time could help clarify how reflex activity relates to changes in motor development, learning and other developmental outcomes.
Well-designed intervention studies: Controlled studies with clearly described interventions, appropriate comparison groups and validated outcome measures are needed to establish whether programmes produce meaningful benefits.
Functional outcomes: Research should examine not only changes in reflex responses but also whether children experience measurable improvements in everyday activities and participation.
Independent replication: Findings need to be replicated by research groups working independently, using transparent methods and clearly reported results.
These priorities are central to developing a more robust evidence base and understanding where primitive reflex assessment and intervention may have a role within broader developmental practice.
Looking beyond the reflex
Primitive reflexes offer one perspective on the developing nervous system. They are not a complete account of a child's development, nor should they be used to explain complex learning or behavioural differences in isolation.
The research to date identifies associations between persisting primitive reflexes and aspects of motor and cognitive development. It also highlights promising areas for further investigation, alongside important limitations in the available evidence.
For professionals, the task is to consider these findings within the wider context of child development, use appropriate assessment methods and remain clear about what the evidence does—and does not—support.
For parents, the message is equally important: a child's development is complex, and no single reflex, test or explanation can capture the whole picture.
At INPP UK, we believe that professional practice must continue to develop alongside the research. By combining careful assessment, appropriate training and critical engagement with emerging evidence, we can contribute to a more informed understanding of neuromotor development and its relationship with learning and everyday life.
References and further reading
Provazník, A. et al. (2026). Persisting primitive reflexes and motor and cognitive development in children: A systematic review. Acta Psychologica, 266, 106915. Read the paper.
McWhirter, K., Steel, A. & Adams, J. (2024). The association between learning disorders, motor function, and primitive reflexes in pre-school children: A systematic review. Journal of Child Health Care, 28(2), 402–428. Read the paper.
Attention deficit hyperactivity disorder is associated with (a)symmetric tonic neck primitive reflexes: a systematic review and meta-analysis. Frontiers in Psychiatry (2023). Read the paper.
Explore the INPP UK Research & Evidence section for further reading on neuromotor development, primitive reflexes and learning.