Have you ever been in class and been witness either to yourself, or someone else crooking their page with their arm over the side of the page and their neck mirroring on the opposite side? If the answer is yes this is more than a comfortable position for writing to occur and connects deeper with your CNS (Central Nervous System), and neurodivergence traits.
I know first hand that I personally just thought that this was a trait picked up out of comfort when putting pen to paper however, this is actually a reflux that has not been worked out between 6-8 months of age; and their is a connection with this, ADHD, learning disabilities, and autism called retained ATNR.
What is Retained ATNR?
The ATNR (Asymmetrical Tonic Neck Reflex), causes ones arm and leg on the side a baby is looking at to straighten out, while the opposite arm and leg remain bent. If this reflex persists, it indicates an underlying challenge in the central nervous system, cognitive or developmental delays.
Neurological Implications
In adults or older children, a retained ATNR is viewed by neurologists as a sign of upper motor neuron involvement, brainstem/corticospinal dysfunction, or structural brain damage.
- Adults: Often signals neurological conditions such as cerebral palsy, stroke, or other central nervous system (CNS) lesions.
- Children: Associated with delayed motor skill development, poor balance, difficulty crossing the body’s midline, and their hand-eye coordination challenges. It is also frequently observed in children with learning disabilities or conditions like autism and ADHD. Note that this also ca persist into adulthood, though initial sightings generally occur or are identified within childhood.
Diagnosis and Management
A neurologist or paediatrician will generally start the process to diagnose this through a clinical physical examination. Management focuses on addressing the underlying neurological issue and “integrating” the reflex. Other professionals that may be included in this diagnosis process include but are not limited to psychologist who will engage in psycho-educational assessments to connect with connecting challenges such as ADHD and learning disabilities
- Occupational Therapy (OT): Specialized therapies and targeted rhythmic movement exercises are often prescribed to help the brain learn to control voluntary movements.
- Vision Therapy: Can help with associated issues like poor eye tracking, focus, and visual processing deficits.
Connecting the Dots: Retained ATNR, Neurodivergence, and the Hidden Battle with Balance and Learning
When we talk about ADHD, Autism, and learning disabilities, we tend to focus heavily on cognitive behavioural strategies, accommodations, and executive dysfunctions. But what if a significant piece of the puzzle isn’t rooted in a lack of focus or willpower, but in a primitive physical reflex that simply refused to turn off?
This enters in ATNR—the Asymmetrical Tonic Neck Reflex.
Whether you are a parent watching your child struggle to sit still at a school desk or an adult trying to understand why you’ve felt clumsy and chronically overwhelmed your whole life, understanding this reflex can be an absolute game-changer!
Sooo, what is ATNR, Anyway?
The Asymmetrical Tonic Neck Reflex (say that 10 times fast) is a primitive survival reflex that develops while we are still in the womb and assists a baby through the birth canal. You’ve likely seen it in action: when an infant turns their head to one side, the arm and leg on that same side automatically extend straight out, while the limbs on the opposite side bend. It looks exactly like a fencing posture.
Under typical circumstances, this reflex should “integrate” (meaning the higher brain takes conscious control over these movements) by about 6-8 months of age.
However, in individuals with ADHD, Autism, and various learning disabilities, this integration often fails to happen. The reflex is well, retained. This means that every time the head turns, their nervous system tries to force the body into that infant fencing position, requiring immense conscious efforts in order to fight against it.
The Child’s Struggle: The Battle at the School Desk
For a neurodivergent child, a retained ATNR turns everyday tasks into an invisible physical marathon that those who’s brain do not register the same, simply will not see. As the brain is constantly fighting this physical reflex in which is triggered by head movements, children will experience severe neurological and motor symptoms:
- The Desktop Trap (Dysgraphia and Hand-Eye Coordination): When children look down at their paper to write, turning their head causes their arm to naturally want to extend straight and the fingers to open. To hold a pencil and pull it across the page, the child must force their muscles to oppose the reflex. The result? A white-knuckle grip, extreme hand fatigue, sloppily written text, and often immense frustration. Educators, parents, are we starting to see a connection?
- Severe Balance and Vestibular Issues: ATNR is closely tied to our range of motion and overall balancing system. Children with a retained reflex struggle with spatial awareness, tracking a ball, or walking in a straight line while looking to the side. They are often labeled “clumsy.”
- The “ADHD” Wiggle: Because sitting still forces the body to fight its own involuntary reflexes, these kids cannot sit still. They slouch, sit on their feet, wrap their legs around the chair legs, or constantly shift positions just to stabilize themselves.
The Adult Reality: Chronic Exhaustion and Clumsiness
A retained ATNR doesn’t magically disappear when you turn eighteen. If it wasn’t integrated in childhood, it persists into adulthood, often wearing masks that mimic adult ADHD, generalized anxiety, or sensory processing issues.
For neurodivergent adults, the daily presentation looks like:
- Subtle Movement Disorders: You might experience chronic muscle tension in the neck, shoulders, and back from a lifetime of overriding your body’s automatic movements. Stubbing your toe, bumping into door frames, or feeling slightly uncoordinated during workouts are absolutely normal.
- Visual Tracking and Dyslexia-Like Symptoms: Reading requires your eyes to track smoothly horizontally across a page. Because ATNR links head movements to eye movements, adults with this retained reflex may find that their eyes constantly jump or lose their place, turning reading into a chore that causes brain fog and chronic headaches.
- Driving Anxiety and Cognitive Fatigue: Think about what happens when you drive: you check your blind spot (turning your head), but your nervous system simultaneously tells your hand to extend, pulling the steering wheel slightly with it. Adults with ATNR spend massive amounts of background cognitive energy just to keep their vehicle straight when checking mirrors, leaving them drained after what are seemingly simple commutes.
Why ATNR, ADHD, and Autism Overlap
Our brains develop sequentially. If primitive reflexes i.e. the ATNR do not integrate properly, our higher-level processing centres—like the prefrontal cortex, which is responsible for our focus, impulse control, and emotional regulation—must work overtime to manage basic physical functions.
When a nervous system is locked in an immature physical loop, it stays in a consistent heightened state of stress. This exacerbates the sensory overloads found in Autism and amplifies behaviours such as the hyperactivity and distractibility associated with ADHD.
The Good News: Brain’s Can Rewire
The presence of a retained ATNR is not a strict life sentence towards clumsiness and learning barriers/challenges. Because of our brains neuroplasticity—the brain’s lifetime ability to consistently change by forming new neural pathways—it is possible to redirect these reflexes at any age.
Through targeted physical movements, often called Neuro-Developmental Movement Therapy or Reflex Integration Exercises, both children and adults can re-teach their nervous systems and the pathways it may have missed in their early infancy years. By spending just a few minutes a day doing simple, rhythmic tracking and cross-body exercises, you can effectively “unlock” your brain, alleviating the invisible physical strain that makes navigating life with ADHD, Autism, or a learning disability so uniquely exhausting.
Simple reflex integration exercises you can try at home
Integrating a retained ATNR requires practicing movements that force the brain to separate head rotation from limb extension. The goal is to build new neural pathways so turning the head no longer sends an involuntary “move your arm” signal down the spine.
For these exercises to work, slowness and precision matter far more than speed. Doing them quickly allows the old reflex to take over; doing them in a slow, controlled manner forces the higher brain to stay engaged.
1. The Lizard Crawl (Prone Position)
This classic reflex exercise simulates the exact developmental stage where ATNR should naturally integrate.
1.Starting Position:Lie flat on your stomach.
Lie face down on a comfortable mat or carpet, or bed with your arms at your sides and legs straight. Turn your head completely to the right.
2.Bring the Right Side Up:Slowly slide arm and leg.
While looking to the right, slowly slide your right arm up so your elbow is now bent at a 90-degree angle next to your head. At the same time, slide your right knee up along the floor toward your waist at a 90-degree angle. Leave your left arm and leg completely straight.
3.Hold and Breathe:Pause for 5-10 seconds.
Hold this static position. Take a deep, relaxing breath. Ensure your muscles are not tense or fighting the position.
4.The Slow Switch:The critical integration step.
Very slowly, straighten your right arm and right leg back to the starting position. Once flat, slowly turn your head all the way to the left.
5.Repeat on the Left Side:Balance the movement.
Now looking left, slowly slide your left arm and left knee up into that same 90-degree position. Hold for 5-10 seconds, then slowly return to straight.
Dosage: Repeat this cycle 5 times per side, once a day.
2. The Robot (Supine Position)
This exercise is excellent for both children and adults because it isolates eye-tracking and neck rotation while keeping the limbs completely still—directly opposing the ATNR pattern.
- Step 1: Lie flat on your back with your legs straight and your arms resting flat at your sides.
- Step 2: Look straight up at the ceiling. Keep your eyes fixed on a specific spot (or have a child look at a sticker on the ceiling).
- Step 3: Over the course of a slow 10-count, slowly rotate your head as far to the right as it will comfortably go. Crucial: Your arms and legs must remain completely still, heavy, and relaxed on the floor. If you feel an arm twitch or lift, stop, relax, and make the head movement even slower.
- Step 4: Hold for 5 seconds, then take 10 seconds to bring your head back to the centre.
- Step 5: Repeat the same slow movement to the left.
What to Watch For (Signs of Integration)
When you or your child first begin these exercises, you might notice clues that the reflex is heavily retained, such as:
- The opposite hand clenching into a fist automatically.
- Holding the breath during head turns.
- An inability to move the head without the rest of the torso trying to twist along with it.
As the weeks progress, these movements will transition from feeling jerky, exhausting, or frustrating to feeling entirely fluid and effortless. That shift is the physical sign of neuroplasticity in action—the brain has officially learned to separate the neck from the limbs.
I am not a medical professional and if this is a true medical concern, please advise a health care professional. These are some exercises to try with this new information to aid in something you have tried, and recognized that may help if/when connecting with a health care professional. As always if you have any concerns, questions, or challenges please reach out via my contact form!
Narissa