ATNR and Sensory Processing

For my last blog we explored the Moro reflex and its connection to sensory processing disorder (SPD). If you missed it you can check it out here. For the next few months I will continue to delve into the most commonly retained primitive reflexes, so keep watching if we haven’t talked about the one you are looking to learn more about! Today’s blog is about ATNR (Asymmetrical Tonic Neck Reflex). Since sensory processing is what we are all about here at Sensory Sid, I also want to tie in to how these may be connected.

Okay, what is the Asymmetrical Tonic Neck Reflex (ATNR)? Learn this, what to do for a retained ATNR and why it matters for those with SPD (sensory processing disorder). We will connect some dots in this blog today, but let’s get familiar with primitive reflexes first.

A quick recap of primitive reflexes is that they are automatic movement patterns that are prompted by a specific stimulus. They are useful during birth and in infancy. As babies grow and develop, these reflexes are “replaced” by tracks of higher level brain and body nervous system communication that result in more refined movement and body use. This is called integration. We call a reflex “retained” if it continues to show up past its expected timeframe. Check out this recent blog if you want to learn even more.

These short periods of primitive reflexes in use are important in a baby’s development and in sensory processing. When reflexes are retained, the nervous system is losing out on opportunities for sensory processing development and other higher level skill development.

What is Asymmetrical Tonic Neck Reflex?

Asymmetrical Tonic Neck Reflex (ATNR) is an automatic movement pattern that can show up very early in gestation—as early as 13 weeks. This pattern looks like a fencer’s pose, which is why it sometimes is called fencer’s reflex. The stimulation (what prompts the reflex) is typically the head turning to one side. This results in the arm and leg extending on the side the head is turned toward. This is the ‘en garde’ fencing pose.

This reflex’s purpose is to help the baby make its way through the vaginal canal during birth. It commonly remains in place until the 5-7 month old range and then ‘disappears’. This is when it is considered integrated. This is typically when the child is mastering other motor tasks like sitting up. The more advanced motor movements replace the primitive reflex.

What happens if the ATNR is retained?

When the ATNR is not integrated at the 5-7 month mark, it is retained. Someone with a retained ATNR may demonstrate the following¹:

• Difficulty with self feeding
• Challenges with visual tracking
• Poor hand-eye coordination
• Challenges crossing midline
• Difficulty with handwriting
• Inappropriately tight grip on tools and utensils
• Challenges with translating ideas into written words
• Dyslexia

How does this look in daily life? When sitting up in a high chair to try a bite of a cereal puff, a retained ATNR can really get in the way. They turn their head toward the puff and the arm extends. Maybe they can close their hand around it but bringing it to their mouth and letting go can be so hard!

As they get older this may show up as they sit at their desk to write. Some kids with a retained ATNR turn their pages at an angle and keep their elbow straight (or straighter than usual). They scoot to the back of their seat to make room for their straighter arm. This child may struggle with copying from the chalk board as the head movements aren’t fluid. Poor visual skills add to this as well. Their teacher may be mentioning dyslexia. They get confused between b, d, p, and q and reverse letters. Filling out worksheets is so hard! Sports may be a little harder for them too, and they may walk and move awkwardly. Sometimes these traits are what makes them appear to have sensory processing disorder.

ATNR and sensory processing disorder

So how does a retained ATNR relate to sensory processing disorder (SPD)? Or do they relate at all? First, a retained ATNR (or any other primitive reflex) does not mean that someone has SPD or the other way around. The connection is much looser than that. It goes back to what happens in the developing brain.

Primitive reflexes are active while the baby is amassing a great amount of information about their world. Taking in sensory information is how that happens. They take in information from the world around them, react and respond to it and even take in sensory information from their own body from that reaction. It is a great loop of sensory and motor movements.

If sensory processing is a problem, the primitive reflex may remain active and will limit the motor skill development as well as additional sensory processing skills. Addressing the reflex will allow not only for higher motor functions but also improved sensory processing.

So what can you do to help someone with a retained ATNR?

Integrating the ATNR

When a reflex is retained past its useful time period there are some things that can be done to help. First off, I always recommend that you speak with your pediatrician and ask for an occupational or physical therapy referral to someone who specializes in primitive reflexes. They will be able to assess for retained reflexes and provide a plan to help these get integrated. 

A professional in primitive reflexes is useful because when one reflex is retained, often others remain as well. Helping these reflexes integrate helps the brain and body function more optimally.

The activities that you do to help integrate the Asymmetrical Tonic Neck Reflex often imitate parts of the reflex itself, but should not stimulate the actual reflex. A very easy way to work on the ATNR is by playing catch. Grab a ball and play for a few minutes a day! Be sure to add a challenge by “missing” and aiming the ball to one side and the other. If you need to make it a little easier, bounce the ball on the ground before they catch it.

Looking for more? One of the most effective ways to work on the ATNR is called the lizard.

The lizard

It has many steps that are important to keep in order, but once learned is great to address a retained ATNR! First, start off in this position:

• Lay on stomach with head turned to right
• Right arm extended out from body
• Right leg straight down
• Left elbow bent with hand pointing towards back of head
• Left knee bent with foot touching opposite knee

Now for the movement:

1. Straighten left arm
2. Straighten left knee
3. Bend right knee
4. Turn head to left

Repeat this sequence with the opposite side to return to the starting position. Continue this sequence, being sure to keep movements in order and not turn head prior to completing the arm and leg movements.

Doing activities like these every day to integrate the ATNR can usually help integrate it in 4-6 weeks. Totally worth 5 minutes a day! You will likely be making really great changes for the ATNR and their sensory processing at the same time.