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Primitive Reflex Integration

Retained Asymmetrical Tonic Neck Reflex (ATNR)

ATNR Exercises

The Asymmetrical Tonic Neck Reflex, like the Spinal Gallant Reflex (SGR), helps the infant do their part of emergence through the birth canal and learn hand and eye control. You will notice it in an infant if you gently turn their head to one side. The arm and leg on the same side will straighten, while the arm and leg on the opposite side will flex. The Asymmetrical Tonic Neck Reflex develops at 18 weeks after conception and should be integrated and gone by about 6 months after birth. If not, it can cause motor issues, reading, math, and other learning problems.

The connection between the hand and eyes help develop depth perception and eye-hand coordination. If the ATNR is retained the child will have difficulty walking normally when turning his head or problems writing and reading when head movement is needed, which is always. For example, writing while looking back and forth to the blackboard or a book.

Asymmetrical Tonic Neck Reflex Symptoms

  • Reading Difficulties
  • Dyslexia
  • Hand eye coordination problems
  • Awkward walk or gait
  • Difficulty in school
  • Immature handwriting
  • Difficulty in sports
  • Math and reading issues
  • Poor balance
  • Eye, ear, foot, and hand dominance will not be on the same side
  • Difficulty in things that require crossing over the midline of the body
  • Poor depth perception
  • Shoulder, neck and hip problems
  • Even if they don’t display any of these symptoms, it is a good idea to do the quick test on them, as there may be other functions that are affected by it that are still unknown.



Check out the latest studies on Primitive Reflex Integration. My favorite is the newest study by Harvard.

Asymmetrical Tonic Neck Reflex Tests

Test 1:  Have the child stand facing you with arms and hands straight out in front of them. Ask the child to keep that position while turning their head to one side and then to the other. They should be able to move their head only. Look for elbows to bend or shoulders to turn in the direction of the head. If so, their neck movements are still associated with their shoulders and the reflex is most likely present. Exercises are needed.

Retained Asymmetrical Tonic Neck ReflexRetained ATNR


Test 2:  You can also have them get down on their hands and knees like a “kitty” with their head straight out and face toward the floor. Ask them to look to one side then to the other side, keeping their neck and arms straight. When their head is turned to the side, look for elbows to bend or the body to shift from one side to the other. If so neck and shoulder movement is still connected. The reflex is most likely present.


Retained Asymmetrical Tonic Neck Reflex 2

Retained ATNR



Asymmetrical Tonic Neck Reflex Exercises