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Asymmetrical Tonic Neck Reflex

The asymmetrical tonic neck reflex (ATNR) is triggered as the head turns to one side. As the head turns, the arm and leg on the same side will extend and the arm and leg on the opposite side bend. It plays an important role in the birth process and in the development of hand-eye coordination.  The reflex should be inhibited by around six months of age and, if the ATNR remains in an older child, it can impact on - 


- Control of automatic balance

- Difficulty crossing the midline

- Hand-eye coordination leading to problems with the arm and hand movements necessary for writing

- Mismatch between written and oral performance

- Mixed laterality of hand, leg or ear dominance over 8 years of age

- Lateral eye movements, such as visual tracking, which is necessary for reading and writing

- Bilateral integration


Other associated long term effects and indications can be


- Homolateral movement patterns 

- Poor handwriting

- Pencil grip hard to maintain or immature

- Rotation of the page when writing

- Difficulty expressing ideas in writing

- Visual-perception problems, especially symmetrical figures

- Child did not commando crawl on tummy as a baby






from "Reflexes, Learning and Behaviour: A Window into the Child's Mind"  by Sally Goddard (2005) Fern Ridge Press, Eugene

Page rotation can indicate a retained ATNR
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