Understanding the Asymmetrical Tonic Neck Reflex (ATNR)
The Asymmetrical Tonic Neck Reflex (ATNR), alongside the Symmetrical Tonic Neck Reflex (STNR), plays a pivotal role in the early developmental stages of children, significantly influencing their learning and motor skills. As a pediatric occupational therapist, I prioritize the assessment and integration of these reflexes (along with the Moro reflex), recognizing their profound impact on developmental progress.
Present from birth, these primitive reflexes naturally integrate as part of the child’s growth. These reflexes, automatic responses to stimuli, are foundational in the development of more complex motor and cognitive functions.
The process of reflex integration therapy, designed to facilitate the absorption of these primal reflexes at the expected developmental stages, remains a topic of considerable debate within the realm of pediatric therapy. Advocates highlight its potential in enhancing functional outcomes for children facing developmental challenges.
Challenges in child development emerge when these reflexes persist beyond their natural phase of integration. This can manifest as difficulties in concentration, auditory processing, and motor coordination.
A key observation in children with unintegrated primitive reflexes is their struggle with midline crossing — the ability to use arms across the center of the body — underscoring the interconnectedness of neurological development and physical capabilities.
The asymmetrical tonic neck reflex is also known as the fencing response because it looks like someone who is fencing. The fencing response is a normal reflex in babies, but can sometimes be a sign of a problem if it persists into adulthood. Problems that can be associated with the fencing response include poor balance and coordination, and neurological conditions.
What Does the ATNR Reflex Look Like?
The reflex is activated when the head is turned to one side, causing the arm and leg on that side to extend while the opposite arm and leg flex. The ATNR reflex is characterized by the following movement patterns:
- Head turned to one side
- Arm and leg on the side of the head turn extend
- Opposite arm and leg flex
Purpose of the ATNR Reflex
The ATNR reflex is believed to play a role in the development of hand-eye coordination, visual tracking, and midline crossing skills. It also helps infants to develop muscle tone and strength in their neck, arms, and legs.
Testing for a Retained ATNR Reflex
The ATNR can be tested with the child on all 4s in a quadruped, crawling position. While in this position the therapist moves the child’s head side to side. And observing the effect on the child’s arms. The ATNR is still present and not integrated if the child’s opposite arms bend when the head is turned to the side..
Integration Timeline of ATNR
The ATNR reflex should integrate by 4-6 months of age. If the reflex is still present after this time, it may indicate a developmental delay or neurological issue.
Signs of Non-Integrated ATNR Reflex
Signs of a non-integrated ATNR reflex may include:
- Difficulty with hand-eye coordination
- Poor visual tracking
- Difficulty with midline crossing
- Delayed motor development
Consequences of Non-Integrated ATNR
If the ATNR reflex is not integrated, it can interfere with a child's development and lead to difficulties with motor skills, coordination, and learning. However, with proper intervention, the reflex can be integrated and the child can develop the necessary skills for optimal development.
Activities and exercises to support the integration of the Asymmetrical Tonic Neck Reflex?
What’s next? How can we help these children integrate and inhibit an unintegrated ATNR reflex so they can better participate in occupations?
The key is to have the child participate in:
- Activities on all 4s such as crawling but looking around with their head to each side.
- Crossing midline activities.
- I love using the tree yoga pose for ATNR integration activities. Using yoga cards makes these activities more engaging for the children.
Are you a therapist who wants to incorporate reflex testing and integration exercises into your practice?
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Have other fun ideas to work on the ATNR reflex? Let me know!
