Persisting primitive reflexes in medication-naïve girls with attention-deficit and hyperactivity disorder

Reliable change in developmental outcomes of Brain Balance® participants stratified by baseline severity

The effects of comprehensive multimodal programs on developmental outcomes have not been well-studied. Emerging evidence suggests a possible role for the Brain Balance® (BB) program, a multimodal training program, in serving as a nonpharmacologic approach to addressing cognitive, attentional, and emotional issues in youth. In this analysis, we examined the effects of 3 months of participation in the BB program on the outcomes of children and adolescents with developmental difficulties (N = 4,041; aged 4-18 years; 69.7% male). Parent-rated scores on the Brain Balance-Multidomain Developmental Survey (BB-MDS) were used to assess six areas at baseline and post-program: (1) negative emotionality; (2) reading/writing difficulties; (3) hyperactive/disruptive behavior; (4) academic disengagement; (5) motor/coordination problems; and (6) social communication problems. To estimate change from pre- to post-program, we calculated effect size (Cohen's d) and the Reliable Change Index (RCI) for groups stratified by baseline severity. There was a very large effect size for the moderate/high severity (d = 1.63) and extreme severity (d = 2.08) groups, and a large effect size for the mild severity group (d = 0.87). The average percentage of participants who observed reliable change over all BB-MDS domains was 60.1% (RCICTT) for extreme severity, 46.6% (RCICTT) for moderate/high severity, and 21.1% (RCICTT) for baseline mild severity. In additional assessments of primitive reflexes and sensory motor activity, students demonstrated significantly diminished primitive reflexes from pre- to post-participation and significant improvements in sensory motor skills including fine motor skills, gait and aerobic ability, proprioception, rhythm and timing, and eye-gaze stability. Overall, these results demonstrate improvements in primitive reflex integration and sensory motor skills, as well as statistically significant reliable change in emotionality, reading/writing, behavior, academic engagement, motor skills, and social communication in BB participants from pre- to post-program, with the probability and degree of change increasing as the participants' baseline severity increases. These results contribute to the growing literature on the need for evidence-based nonpharmacologic approaches to addressing developmental issues. Future research with well-controlled designs, longitudinal follow-up, implementation across settings, and participant groups in which diagnoses are known, will help to more fully characterize the effects of the BB program.

Attention deficit hyperactivity disorder is associated with (a)symmetric tonic neck primitive reflexes: a systematic review and meta-analysis

Introduction

Investigation on the association between attention deficit hyperactivity disorder (ADHD) and primary reflexes is in the initial stage, with considerable differences in the findings. This study evaluated the association between ADHD and primitive reflexes using systematic review and meta-analysis.

Methods

Data were obtained from PubMed, Cochrane Library, Web of Science, EBSCO (Medical Literature Analysis and Retrieval System Online, American Psychological Association Psyclnfo, and Education Resources Information Center), Embase, Scopus, and ProQuest. Articles were searched from the date of inception of the respective databases to January 01, 2023, and StataCorp Stata (version 15) was used for the analysis.

Results

Four articles with 229 samples were included in the meta-analysis. Results showed a significant positive and moderate correlation between ADHD and primitive reflexes, particularly asymmetric tonic neck reflex: summary r value = 0.48, 95% CI = 0.27-0.64; symmetric tonic neck reflex: summary r value = 0.39, 95% CI = 0.25-0.52. Overall, findings from the sub-group analysis indicate that the behavioral problem measuring tool (Conners' scale), sex, and primitive reflex test could significantly moderate the relationships between ADHD and ATNR and STNR primitive reflexes.

Conclusion

ADHD symptoms in children are closely related to the non-integration of (a)symmetric tonic neck primitive reflexes. Longitudinal or experimental studies should be conducted to reveal the causal relationship between ADHD and primitive reflexes in the future.

Retained Primitive Reflexes and Potential for Intervention in Autistic Spectrum Disorders

We provide evidence to support the contention that many aspects of Autistic Spectrum Disorder (ASD) are related to interregional brain functional disconnectivity associated with maturational delays in the development of brain networks. We think a delay in brain maturation in some networks may result in an increase in cortical maturation and development in other networks, leading to a developmental asynchrony and an unevenness of functional skills and symptoms. The paper supports the close relationship between retained primitive reflexes and cognitive and motor function in general and in ASD in particular provided to indicate that the inhibition of RPRs can effect positive change in ASD.

Primitive Reflex Factors Influence Walking Gait in Young Children: An Observational Study

Background: Primitive reflexes (PRs) are observed as an automatic response to a specific stimulus. They are vivid from intrauterine life to 6 months postnatal. The reactions are inhibited with the growing maturation of the central nervous system (CNS). In some cases, when the natural process of development is incorrect, PRs manifest later. The analysis of differentiation in gait parameters in children with persistent PRs is important for better understanding their specific behaviour and movement. This study’s aim was to investigate the influence of active PRs on the gait parameters of preschool children. Methods: There were 50 children examined, 30 girls and 20 boys. They were 3.5−6 years old. The children had persistent PRs in the trace form. Each child was examined by S. Goddard’s Battery Test. The acquisition of the spatial-temporal gait parameters was performed using a BTS G-SENSOR measurement instrument. Participants walked barefoot, in the most natural way for them, at a self-selected speed on a 5 m walkway, then turned around and went back. They performed this twice. Results: The reflex activity influences gait cycle duration (p = 0.0099), the left step length (p = 0.0002), the left double support phase (p = 0.0024), the right double support phase (p = 0.0258) and the right single phase. Difficulties in recreating the crawling pattern and GRASP reflex influence gait cadence (p < 0.05). The left GRASP reflex corresponds to step length (p < 0.05). The activeness of the symmetrical tonic neck reflex correlates with the right single support (p < 0.05). Conclusion: The presence of PRs affect walking gait in preschool children.

Primitive Reflex Activity in Relation to Motor Skills in Healthy Preschool Children

Psychomotor development in the first year of life is possible due to activity and then integration of primitive (neonatal) reflexes. The presence of active primitive reflexes (APRs) in preschool and school-aged children indicates neuromotor immaturity. Studies show dependencies between the preserved activity of primary reflexes and developmental problems such as learning difficulties (problems with reading, writing, reduced mathematics skills, and dyslexia), difficulties with coordination, and attention deficit. The primary purpose of this study is to present the activity of three tonic reflexes in a sample of 112 Polish children aged 4–6 in relation to their motor skills. The children were examined for the presence of the asymmetric tonic neck reflex (ATNR), symmetric tonic neck reflex (STNR), and tonic labyrinthine reflex (TLR). Motor performance was examined with the MOT 4–6. Statistical analysis shows an inverse correlation between the score in the test of reflexes and motor efficiency (MOT 4–6) at p < 0.05 (−0.33). Children with increased reflex activity presented a lower level of motor efficiency. The multiple regression model showed that with the older age of the child and the decrease in the level of reflex activity, the motor skills of children improve. Thus, there is a need for early screening of primitive reflexes in children. Properly selected exercises and therapeutic activities aimed at integrating APRs in children with developmental difficulties can improve their motor skills, perceptual abilities, and emotional behavior.

Persistent Childhood Primitive Reflex Reduction Effects on Cognitive, Sensorimotor, and Academic Performance in ADHD

A study was performed on 2,175 individuals between the ages of 3.2 and 22.04 years diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and drawn from 89 separate locations across the United States in satellite clinics with common practices and common staff training and equipment. The objective was to determine the efficacy of a hemispheric-based training program to reduce extant retained primitive reflexes (RPRs) and examine the relationship to motor function by metronome-based motor, DL, and cognitive tasks measured by subtests of the Wechsler Wide Range Achievement Test. After a 12-week program, RPR's were significantly reduced, as well as performance on all motor and cognitive measures significantly increased. Listening comprehension demonstrated significant increases between pre- and post-testing of 7% (W = 1213000; df = 2094; p < 0.0001) and mathematical problem solving revealed a significant increase of 5% (W = 1331500; df = 2091; p < 0.0001) associated with a significant reduction in primitive reflexes. The study concluded that the incorporation of relatively simple hemispheric-based programming within the educational system worldwide could relatively inexpensively increase academic, cognitive, and motor performance.

Primitive Reflex Activity in Relation to the Sensory Profile in Healthy Preschool Children

The presence of active primitive reflexes (APRs) in healthy preschool children can be an expression of immaturity in the functioning of the nervous system. Their trace presence may not significantly affect the quality of child functioning. They may also undergo spontaneous and complete integration within the stages of child development. However, a higher level of active reflexes and their significant number can disturb sensory-motor development and lead to additional problems in a child’s motor activities, social life, and education. The main purpose of this study was to examine the types of sensory disorders noticed by parents of children, if any, that accompany the presence of active primitive reflexes. The study was conducted in a group of 44 preschool children (aged 4–6 years). The sensory profile of children was determined using Child Sensory Profile Cards, and Sally Goddard-Blythe tests were used to measure their primitive reflexes. The coefficient of determination (R-squared) indicated that the level of reflex activity was most strongly associated with sensory disorders such as dyspraxia, sensory-vestibular disorders, and postural disorders, at a level of p < 0.005. The obtained research results show that the examination of non-integrated reflexes might be a screening tool for children of preschool age. Knowledge of the subject of reflexes and their impact on sensory-motor functions may contribute to more accurate diagnoses of the causes of problems and higher effectiveness of possible therapy.

Association of Affected Neurocircuitry With Deficit of Response Inhibition and Delayed Gratification in Attention Deficit Hyperactivity Disorder: A Narrative Review

The neural networks that constitute corticostriatothalamocortical circuits between prefrontal cortex and subcortical structure provide a heuristic framework for bridging gaps between neurocircuitry and executive dysfunction in attention deficit hyperactivity disorder (ADHD). “Cool” and “Hot” executive functional theory and the models of dual pathway are supposed to be applied within the neuropsychology of ADHD. The theoretical model elaborated response inhibition and delayed gratification in ADHD. We aimed to review and summarize the literature about the circuits on ADHD and ADHD-related comorbidities, as well as the effects of neurocircuitry on the executive dysfunction in ADHD.

Catching-up: Children with developmental coordination disorder compared to healthy children before and after sensorimotor therapy

The aims of the present study were to (a) compare healthy children in terms of sensorimotor maturity to untreated children diagnosed with developmental coordination disorder (DCD) and (b) compare healthy children to diagnosed children following completed treatment with sensorimotor therapy. Participants were 298 children, 196 boys and 102 girls, distributed into a Norm group of healthy children (n = 99) and a group of children diagnosed with DCD (n = 199) with a total mean age of 8.77 years (SD = 2.88). Participants in both groups were assessed on instruments aimed to detect sensorimotor deviations. The children in the DCD group completed, during on average 36 months, sensorimotor therapy which comprised stereotypical fetal- and infant movements, vestibular stimulation, tactile stimulation, auditory stimulation, complementary play exercises, gross motor milestones, and sports-related gross motor skills. At the final visit a full assessment was once more performed. Results showed that the Norm group performed better on all sensorimotor tests as compared to the untreated children from the DCD group, with the exception of an audiometric test where both groups performed at the same level. Girls performed better on tests assessing proprioceptive and balance abilities. Results also showed, after controls for natural maturing effects, that the children from the DCD group after sensorimotor therapy did catch up with the healthy children. The concept of "catching-up" is used within developmental medicine but has not earlier been documented with regard to children and youth in connection with DCD.

Dynamic balance in children with attention-deficit hyperactivity disorder and its relationship with cognitive functions and cerebellum

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is linked to the presence of motor deficiencies, including balance deficits. The cerebellum serves as an integrative structure for balance control and is also involved in cognition, including timing and anticipatory regulation. Cerebellar development may be delayed in children and adolescents with ADHD, and inconsistent reaction time is commonly seen in ADHD. We hypothesized that dynamic balance deficits would be present in children with ADHD and they would correlate with attention and cerebellar functions.

METHODS

Sixty-two children with ADHD and no other neurological conditions and 62 typically developing (TD) children were examined with five trials of the Phyaction Balance Board, an electronic balancing platform. Cerebellar clinical symptoms were evaluated using an international ataxia rating scale. Conners' Continuous Performance Test was used to evaluate patterns of reaction.

RESULTS

Children with ADHD had poorer performance on balancing tasks, compared to TD children (P<0.001). They exhibited significantly greater sway amplitudes than TD children (P<0.001) in all of the five balancing trials. The effect size of the difference between the groups increased continuously from the first to the last trial. Balance score in both groups was related to the variation in the reaction time, including reaction time standard error (r =0.25; P=0.0409, respectively, r =0.31; P=0.0131) and Variability of Standard Error (r =0.28; P=0.0252, respectively, r =0.41; P<0.001). The burden of cerebellar symptoms was strongly related to balance performance in both groups (r =0.50, P<0.001; r =0.49, P=0.001).

CONCLUSION

This study showed that ADHD may be associated with poor dynamic balance control. Furthermore, we showed that maintaining balance correlates with neuropsychological measures of consistency of reaction time. Balance deficits and impaired cognitive functioning could reflect a common cerebellar dysfunction in ADHD children.