By Nicole Pates | Paediatric Physiotherapist | Western Kids Health

If you have ever scrolled past a reel telling you your child has “retained primitive reflexes” that need integrating and felt that flicker of worry, you are not alone. Maybe it came up at an appointment. Maybe a friend has done one of these programs. Maybe you have just seen it pop up so often in your feed that you are starting to wonder if you are missing something.

So let me break it down for you in plain language. Because the marketing for these programs is everywhere, and parents deserve a clear, honest summary of what primitive reflexes actually are and what the research really shows.

What are primitive reflexes?

Primitive reflexes are automatic motor patterns a baby is born with, including the Moro (startle), the rooting reflex, and the asymmetric tonic neck reflex. They support feeding, protection, and early movement in the first months of life, and they are gradually inhibited across the first year as the developing brain matures and voluntary movement takes over.

Let me be frank with you. They are a thing, they are real, and yes for some children they do hang around longer than they should.
In paediatric physiotherapy we sometimes assess primitive reflexes as one piece of understanding how a child’s nervous system is developing. They are one piece of information we look at alongside everything else.

Are retained reflexes always a problem?

What does the research actually say about integration programs?

The most-cited trial supporting reflex-based programs is McPhillips, Hepper and Mulhern’s 2000 Lancet study of 60 children with specific reading difficulties.³ Let me walk you through what it actually found, because the headline parents usually see (“reading improved”) leaves out the rest of the picture.

The study had three groups of 20 children. One did the reflex-based movements daily for a year. One did a placebo program of similar-looking movements that were not reflex-based. The third had no treatment at all. After 12 months, the experimental group gained an average of 19.6 months in reading age. That sounds impressive, and it is. But the placebo group gained 7.3 months in reading age, and the no-treatment control group gained 6.9 months. The authors themselves note that children at this age and reading level would normally be expected to gain 4 to 6 months in reading age over 12 months. So both control groups gained more than expected. The study authors are honest about what that probably means: a placebo or attention effect was at work across the trial.

Two more things you should know about this study. It has never been independently replicated at scale in the 26 years since it was published. And the movements used in the trial were developed by the Institute for Neuro-Physiological Psychology (INPP), the UK organisation that delivers and sells the program. The foundational trial supporting reflex integration is a trial of an INPP-developed program, by researchers with declared ties to INPP, that has never been independently replicated. That is a fragile foundation for a worldwide industry.

The other foundational paper is Jordan-Black 2005, which followed 683 children across 13 Northern Ireland schools over two years.⁶ It is the largest study in this literature. It reported moderate effect sizes for reading (around 0.5 to 0.6), larger effect sizes for mathematics (around 0.8 to 0.9, which is interesting because the program contained no maths content), and a small effect on spelling (around 0.2). When the comparison was tightened to a within-school control (different classes in the same school), the spelling effect disappeared. The programme developer (McPhillips) trained the teachers and advised on the study design.

What to know about this study: it is quasi-experimental rather than a randomised trial, the teachers and assessors were not blinded, and the program developer was directly involved in training and design. The disappearance of the spelling effect under tighter comparison, and the maths effect appearing in a program with no maths content, both suggest that at least some of the gains are non-specific to the reflex part.

Other school-based programme summaries (Goddard Blythe 2005)² consistently show the program reliably changes scores on the INPP’s own test battery, which measures reflex retention, balance, and visual-motor integration. Where academic outcomes were measured, gains in reading, spelling, and mathematics were typically only present in a defined subgroup of children with both elevated reflex scores and below-age reading. Children outside that subgroup did not gain academically. And none of these studies measured what actually matters day-to-day for a child and their family: function, participation, friendships, school engagement, the things your child wants to be able to do. The author of these summaries (Goddard Blythe) is openly honest about the subgroup limitation.
What to know about this paper: the author is the Director of INPP itself. These are summaries of INPP’s own program, written by the developer, using INPP’s own test battery. The structural conflict is direct.

Hickey and Feldhacker (2022) explicitly note that no systematic review of reflex-based interventions in children with developmental conditions has yet been published.¹

The bigger problem for parents is that no published research directly compares “primitive reflex integration” with the other movement-based approaches paediatric clinicians use every day. Paediatric physiotherapy and occupational therapy, balance and strength training, sensorimotor work, and structured daily movement all have evidence behind them in real-world things like walking, climbing, dressing, handwriting, and joining in at school and sport.⁵

The Wang et al (2023) systematic review pooled studies showing reflex retention correlates with ADHD symptoms, but correlation is not the same as treatment effect, and the authors themselves call for experimental work.⁴

What to know about this review: it pooled only four primary studies, three of which are from the same research group in the Czech Republic. The same lead authors went on to develop the CPRIMS reflex assessment scale, so the same team is producing both the construct synthesis and the measurement instrument used to study it.

To be clear, integrating primitive reflexes will not “fix” ADHD. ADHD is a neurodevelopmental condition. There are decades of strong evidence behind the supports that genuinely help children and families, and I will come back to those below.

Pull the studies together and a clear picture emerges. The foundational trial is small, has not been independently replicated in 26 years, and was a trial of an INPP-developed program by researchers with declared INPP ties. The largest school study was run with the program developer directly involved in training and design. The programme summaries are written by the developer of the program, using the developer’s own test battery. The systematic review on ADHD is on correlation, not treatment effect, and rests on four primary studies from a single research group. None of this evidence directly compares reflex integration to the movement-based approaches that already help children build real-life skills.

And here is what the literature really does not show. None of the studies measured how children were doing in their everyday lives. The outcomes researchers chose to measure were reflex scores and academic test results, not function, not participation, not friendships, not family life, not the things that actually matter to a child and their family.

That is the strongest body of evidence reflex integration programs currently have. It is a long way from the confident clinical claims being made in your social media feed.

How to read a research claim

Across the small handful of intervention studies on reflex integration, the same patterns keep showing up. They are useful patterns to know about beyond this topic, because they show up in any space where the marketing has run ahead of the science.

Small sample sizes.

Most studies have 20 to 60 children. With small samples, results can look impressive when they are really just chance variation.
In-house outcome measures. Several studies use a test battery developed by the same group that designed the program. When you measure success using your own ruler, you tend to find what you are looking for.

Programme developers studying their own programmes.

The McPhillips group developed the Primary Movement program and authored the foundational RCT. INPP staff authored the school programme summaries. In one recent pilot, two of the three authors were employees of the centre delivering the intervention. None of this means anyone is acting in bad faith. It does mean the cumulative evidence is structurally vulnerable to bias.

Effects only in subgroups. Several studies report a positive headline finding that, when you read on, applies only to a defined subgroup of children. The subgroup analyses are often underpowered.

No active comparison group. Most studies compare a reflex program to no-treatment controls. They rarely compare reflex programs against another movement program that is already known to help children. Without that comparison, we cannot say it is the reflex-targeted part doing the work, rather than the daily movement, the adult attention, or the routine.

When a program pitches itself as evidence-based, here are the questions worth asking.

Who ran the study. What they were comparing against. How big the sample was. Where it was published. Who funded it.

The answers tell you a lot.

Reflex integration programs are most often marketed as helping with ADHD, reading difficulty, coordination, and anxiety. There are well-established, evidence-based supports for each of these. They are what your paediatrician, GP, or paediatric therapist will point you towards, and they have decades of research behind them.

ADHD.

There are well-established, evidence-based supports for paediatric ADHD. The right combination depends on your child’s age and what is going on for them, and might include parenting support, school-based accommodations, physical activity, and where appropriate, medical management.⁷⁻¹⁰ Cognitive behavioural therapy is helpful for older children and adolescents. References at the bottom of this blog will take you deeper if you want to read more.

Reading difficulty.

Structured, systematic phonics-based literacy intervention is the approach most heavily supported by reading research. You will sometimes see this described as “structured literacy” or “the science of reading.” The research evidence here is strong and consistent. For any child with reading difficulty where first line school based supports are not helping, an assessment by a Speech Pathologist can provide further understanding and support.

Coordination challenges (including DCD).

Task-based motor learning, where children practise the actual real-life skills they want to do, with the challenge graded over time. The Cognitive Orientation to daily Occupational Performance approach (CO-OP) is one well-known method. Goal-directed and task-specific practice is also the strongest recommendation in the international cerebral palsy clinical practice guideline.⁵

Anxiety.

Cognitive behavioural therapy and graded exposure, with parent involvement for younger children. Sleep, daily movement, and connection sit underneath as foundations.

(please not I have not touched on pharmological intervention in any of the above)

If your child is struggling with any of these, your paediatrician or GP can refer you to the right professional. The supports are out there.

International best practice for paediatric physiotherapy and occupational therapy focuses on participation and your child’s goals, with impairment scores held in context.⁵ Good therapy starts with whether your child is participating in the things they want to do, whether they are connecting with the people in their world, what they are already doing well, and where they want to go next.
The framework I work within is the F-words in childhood disability, a parent-friendly way of picturing what good therapy is paying attention to:

Function: what your child can do in everyday life
Family: you are the expert in your child, and your goals shape the plan
Fitness: physical and mental health for the long haul
Fun: play and joy are how kids learn
Friends: connection and being included with their peers
Future: supporting your whole child as they grow up

If you are weighing up a program for your child, three things are worth checking before you commit your time and money.

Start with who is delivering it, because in Australia only registered therapists (paediatric physiotherapists, occupational therapists, speech pathologists, psychologists) can diagnose, assess, and design a therapy plan. Therapy assistants deliver parts of that plan under the supervision of a registered therapist, and many do that work brilliantly. A coach or trainer without those qualifications, no matter how warm and well-meaning, sits outside that scope.

Then look at the goal of the program, which should be built around something that matters in your child’s day, like climbing the play equipment, holding a pencil, or joining in at sport.

And ask how progress will be measured. It should be tracked against your child’s real-life goals, with reflex retesting as one small piece of information at most.

When to Check in

A chat with your GP, paediatrician, paediatric physio or OT is worthwhile if:

A good clinician will start with your whole child and your family’s goals, with reflex testing held as one small piece of clinical information.

Take home message

Some retained primitive reflex activity in childhood is common and on its own is not a diagnosis. The research supporting “reflex integration” programs is small, mostly in-house, and missing the comparison studies parents need to make a fair call. There is no published evidence that reflex integration outperforms the movement-based approaches that already help children, and integrating reflexes will not fix ADHD or other neurodevelopmental conditions. There are well-established, evidence-based supports for the things these programs market themselves to, and your paediatrician or GP can point you to the right one.
Your child is not broken. You are the expert in your child, and a reflex score does not change that.
If something is on your mind about your child’s development, see your GP, paediatrician, paediatric physio, or OT and get the support that fits your child.
If you would like to chat with one of our team, book below.

References:

1. Hickey J, Feldhacker DR. Primitive reflex retention and attention among preschool children. Journal of Occupational Therapy, Schools and Early Intervention. 2022;15(1):1–13.
2. Fylan F, Grunfeld B. An evaluation of the pilot INPP movement programme in primary schools in the North Eastern Education and Library Board, Northern Ireland. Brainbox Research Ltd; 2004. Reported in Goddard Blythe SA. Releasing educational potential through movement. Child Care in Practice. 2005;11(4):415–432.
3. McPhillips M, Hepper PG, Mulhern G. Effects of replicating primary-reflex movements on specific reading difficulties in children: a randomised, double-blind, controlled trial. The Lancet. 2000;355(9203):537–541.
4. Wang M, Yu J, Kim H-D, Cruz AB. Attention deficit hyperactivity disorder is associated with (a)symmetric tonic neck primitive reflexes: a systematic review and meta-analysis. Frontiers in Psychiatry. 2023;14:1175974.
5. Jackman M, Sakzewski L, Morgan C, Boyd RN, Brennan SE, Langdon K, et al. Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline. Developmental Medicine and Child Neurology. 2022;64(5):536–549.
6. Jordan-Black JA. 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.
7. Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4):e20192528.
8. Shah N, Nadella H, Williams S. Non-pharmacological Approaches to Managing Attention-Deficit Hyperactivity Disorder in Pediatric Populations: A Scoping Review. Cureus. 2025;17(7):e87810.
9. Vergara Nieto AA, Halabi Diaz A, Hernández Millán M, Sagredo Oyarzo D, Arriagada Gacitúa J. Physical exercise as a non-pharmacological strategy for ADHD considering neurobiological mechanisms, cognitive benefits, and practical recommendations: a narrative review. European Archives of Psychiatry and Clinical Neuroscience. 2026.
10. Da Silva LA, Doyenart R, Salvan PH, et al. Swimming training improves mental health parameters, cognition and motor coordination in children with Attention Deficit Hyperactivity Disorder. International Journal of Environmental Health Research. 2020;30(5):584–592.

Further reading on ADHD
Palakodeti SS, Sarangi A, Mehta TR. The ADHD Conundrum: A Review of Non-pharmacological Approach to Management. Current Developmental Disorders Reports. 2025;12:6.
Tseng PT, Cheng YS, Yen CF, et al. Peripheral iron levels in children with attention-deficit hyperactivity disorder: a systematic review and meta-analysis. Scientific Reports. 2018;8:788.
Kumar V, Juneja M, Kaushik S, Gupta A. Iron Supplementation in Children with Attention Deficit Hyperactivity Disorder: A Single Centre Study. Indian Pediatrics. 2024.