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I was diagnosed with ADHD at 15. For years, I assumed my struggles with focus, organization, and sitting still came down to brain chemistry and genetics alone. Those things absolutely play a role, but occupational therapy school taught me there’s often another piece of the puzzle: retained primitive reflexes.
A retained ATNR reflex is when the Asymmetrical Tonic Neck Reflex (an automatic movement pattern present from birth that’s supposed to fade as the brain matures) stays active well past infancy. A 2023 systematic review and meta-analysis found a significant, moderate correlation between ADHD and primitive reflexes, particularly ATNR, with a summary r value of 0.48 across the studies reviewed.
This doesn’t mean retained reflexes cause ADHD. It means they may be one overlooked contributor worth screening for, and you can check for it at home in under five minutes.
What Are Primitive Reflexes, and Why Do Some Stay “Retained”?
Primitive reflexes are automatic movement patterns every baby is born with, they assist the birthing process, support survival during the first year of life, and lay the foundation for more mature, voluntary movement. As the brain develops, these reflexes are supposed to integrate, or fade into the background, making room for coordinated, controlled movement.
For dozens of possible reasons — birth history, limited tummy time, missed developmental movement stages, that integration doesn’t always happen on schedule. The reflex stays “retained,” meaning it continues to fire automatically well past the age it should have disappeared.
As a pediatric occupational therapist, I assess primitive reflexes as one of the very first steps when working with kids who struggle with focus, learning, coordination, or emotional regulation. It’s one of the most clinically useful and most overlooked pieces of the puzzle.
What Is ATNR, and How Does It Show Up in Kids With Focus Challenges?
The Asymmetrical Tonic Neck Reflex (ATNR) causes a baby’s arm to extend automatically on the side their head turns toward, like a built-in fencing position. It’s present from before birth, emerging in utero around 18 weeks, and typically integrates 3 to 9 months after birth, clearing the way for skills like crawling, midline coordination, and reading.
When ATNR remains active beyond infancy, children often develop compensation patterns that can look strikingly similar to ADHD symptoms, because the nervous system is working overtime to override an automatic reflex just to complete simple tasks like writing or reading a line of text.
This overlap is exactly why reflex screening matters for any child already struggling with attention, regardless of whether they have a formal ADHD diagnosis.
Could Your Child Have a Retained ATNR? Use This Checklist
Nine specific behaviors can signal a retained ATNR, and checking three or more is worth a closer look. Go through this list and count how many apply to your child:
- Difficulty crossing midline (switches hands or avoids reaching across the body)
- Poor or messy handwriting
- Difficulty with left/right directionality
- Frequently loses their place while reading
- Poor visual tracking
- Clumsy or poor hand-eye coordination
- Difficulty catching or throwing a ball
- Frequently fidgets or changes positions while seated
- Difficulty sustaining attention, especially during desk work
If you checked three or more, it may be worth screening further, which takes about sixty seconds using the movement test below.
How Do You Test for a Retained ATNR at Home? Try the “Zombie Walk”
The Zombie Walk is a sixty-second screening test that reveals whether ATNR is still influencing your child’s movement. It’s simple, it’s playful, and kids genuinely enjoy it, which makes it easy to repeat as a progress check later.
Here’s how to do it:
- Stand tall with both arms stretched straight out in front, like a zombie.
- Slowly march in place, or walk forward.
- While marching, slowly turn the head fully to one side for 3–5 seconds, then repeat to the other side.
- Use a flashlight or laser pointer to encourage a full head turn while keeping the arms extended and marching continuing.
What should happen: Your child should be able to keep marching with both arms extended while turning their head, without losing form.
Signs ATNR may still be active:
- One arm bends or drops when the head turns
- The shoulders or body rotate in the direction of the head turn
- Balance is lost, or the arms can’t stay steady
This isn’t a diagnostic tool, but if these patterns show up alongside several checklist items above, it’s worth a conversation with a pediatric occupational therapist.
Can a Retained ATNR Actually Be Addressed?
Yes… the nervous system is highly adaptable, and targeted, playful movement can help integrate a retained ATNR over time. This is the part that makes reflex work exciting rather than discouraging: it’s not a fixed trait, it’s a movement pattern that can change with consistent practice.
As an OT, I’ve seen firsthand how the right movement activities, done consistently, strengthen the foundational skills that support coordination, attention, body awareness, and learning. This is the same principle behind why short, structured daily movement routines (rather than occasional, unstructured play) tend to produce the most noticeable shifts.
A good sign of progress: previously difficult tasks like the Zombie Walk start to feel easy.
FAQs: Retained ATNR and ADHD
Q: What is a retained ATNR reflex? A: A retained ATNR is when the Asymmetrical Tonic Neck Reflex — a newborn reflex that should integrate by around six months — stays active well beyond infancy. It can cause the arm to bend or the body to rotate automatically whenever the head turns, interfering with tasks like handwriting and reading.
Q: Does a retained ATNR cause ADHD? A: No — research shows a moderate association, not causation. A 2023 meta-analysis published in Frontiers in Psychiatry by Wang and colleagues found a summary correlation of r = 0.48 between ADHD and ATNR, suggesting retained reflexes may be a contributing factor for some kids rather than a root cause.
Q: How can I test my child for a retained ATNR at home? A: Try the “Zombie Walk”: have your child march in place with both arms extended forward, then slowly turn their head fully to each side while continuing to march. If an arm drops, the shoulders rotate, or balance is lost during the head turn, ATNR may still be active.
Q: At what age should the ATNR reflex disappear? A: ATNR typically emerges in utero around 18 weeks and integrates 3 to 9 months after birth in typically developing infants. When it persists well beyond this window, it’s considered “retained” and can affect coordination, reading, and attention as the child grows.
Q: Can retained reflexes be corrected through movement exercises? A: Yes — many pediatric occupational therapists use targeted, playful movement activities to help retained reflexes integrate over time. Consistency matters more than intensity; short daily practice, often 10–15 minutes, tends to produce steadier progress than occasional longer sessions.
The Bottom Line
A retained ATNR reflex won’t show up on a standard ADHD evaluation, but it can quietly shape how a child writes, reads, sits, and focuses every single day. The checklist and the Zombie Walk test give you a fast, free way to find out if it’s worth exploring further.
The encouraging part: this is a movement pattern, not a permanent trait, and movement patterns can change.
If you’d like to start working on ATNR integration at home, the ATNR collection inside Focus in 15 walks you through specific exercises designed for this exact reflex.