The Asymmetrical Tonic Neck Reflex (ATNR) is one of the fundamental primitive reflexes that babies are born with. These reflexes are automatic responses to certain stimuli, and they play a crucial role in early development. When a baby turns its head to the right or left, typically in response to a sound or visual cue, the ATNR kicks in. If the baby is lying on their back and turns their head to one side, the arm on that side will extend while the opposite arm flexes inward. There’s often some coordination between leg and arm movements, though leg movements are usually less noticeable.
ATNR develops before birth and helps during the birthing process. The kicking sensations that pregnant mothers feel are often due to this reflex. Since ATNR is triggered by head movements, it’s closely linked to the vestibular system, which influences balance and muscle tone. It also plays a significant role in hand-eye coordination and the development of skills on each side of the body.
Typically, ATNR integrates around six months of age, which coincides with milestones like reaching for objects intentionally, gaining better head control, and starting to crawl.
Factors Contributing to Unintegrated ATNR
Several factors can contribute to unintegrated primitive reflexes like ATNR:
- Stress during pregnancy
- Substance abuse during pregnancy
- Cesarean section birth
- Brain damage during labour
- Premature birth and low birth weight
- Significant illness during the first year of life
- Insufficient stimulation and tummy positioning
- Lack of free movement time on the floor
- Stressful environment
- Inadequate nourishment or insufficient weight gain
- Additionally, even if a child successfully integrates their primitive reflexes, trauma, stress, or injury can reactivate these reflexes.
Impact of Unintegrated ATNR
Since ATNR is directly related to the vestibular system and physical reactions, it significantly impacts movement, balance, muscle tone, and coordination. Older children with unintegrated ATNR might experience challenges such as:
- Difficulty crawling as infants
- Reduced engagement with toys
- Poor balance when learning to walk
- Gravitational insecurity and fear of movement
- Difficulty crossing the midline
- Poor hand dominance establishment
- Challenges with reading and writing
- Left/right confusion
- Issues with visual tracking
- Poor coordination for bilateral tasks
- Strong co-relation to Dyslexia and/or Dysgraphia
Supporting ATNR Integration
Engaging children in diverse sensory experiences and motor activities can help integrate the ATNR, fostering adaptive behaviours and overall development. Here are some practical strategies for different age groups:
For Infants:
- Natural Movement: Use a wrap to carry your newborn, providing natural movement instead of a stroller.
- Varied Positions: Rotate your infant through different positions—tummy, back, and side.
- Tummy Time: Incorporate regular tummy time sessions, exposing your baby to various sensory stimuli.
- Toy Placement: Place and move toys in different planes to encourage visual tracking and head turning.
- Sensory Experiences: Introduce a variety of sights, smells, sounds, and tactile experiences frequently.
For Children Under 3 Years Old:
- Tummy Time Toys: Place toys on the left and right side of your child during tummy time to engage different sensory systems.
- Visual Tracking: Hold a toy above at eye level and slowly move it to the left and right, ensuring a full head turn.
- Environmental Cues: Point to objects in the environment to encourage head turning.
- Crawling Activities: Use tunnels, chairs, and tables to promote crawling, encouraging head turning.
- Obstacle Courses: Facilitate crawling through various floor textures with obstacle courses.
For Older Children:
- Cross-Midline Activities: Promote activities that require crossing the midline, such as completing puzzles on the floor with pieces on the opposite side.
- Lizard position: start by having them lie on their stomach. Have them turn their head to the right, extend their right arm straight out from the body, and keep their right leg straight down. Then, have them bend their left elbow with the hand pointing towards the back of the head, and bend their left knee so the foot touches the opposite knee. Next, ask your child to turn their head to the left and switch the position of their arms and legs to the opposite side. This means extending the left arm out, straightening the left leg, bending the right elbow with the hand pointing towards the back of the head, and bending the right knee so the foot touches the opposite knee. Encourage your child to repeat this movement, turning their head and switching their limbs to the opposite side each time.
- Quadruped Position: encourage activities in the quadruped position, like obstacle courses or eye tracking activities while on quadruped position.
- Mummy Walk: Try the “mummy walk,” where the child walks on their knees with arms straight forward, turning their head from side to side.
While these activities may not guarantee full integration of the ATNR, they provide valuable support in navigating the challenges associated with retained reflexes. By fostering a sensory-rich environment and promoting active engagement, we empower children to overcome obstacles and thrive in their developmental journey.
If you believe your child need support with their daily living activities and independence skills, please contact us on 9913 3823 or email hello@occupationaltherapy.com.au.
