Spotlight on the ATNR: Asymmetrical Tonic Neck Reflex
Primitive reflexes are automatic movements that are present from birth and play an important role in early infant development. As a child's nervous system matures, these reflexes are typically integrated, allowing more voluntary movement patterns to develop.
The Asymmetrical Tonic Neck Reflex (ATNR) is one of several primitive reflexes that supports early movement and coordination. Researchers and clinicians continue to explore how retained primitive reflexes may be associated with movement and developmental patterns in some children, although this remains an evolving area of research.
In some children, primitive reflexes may persist beyond the age they are commonly expected to integrate. If there are concerns about movement, coordination or development, an assessment by an appropriately qualified healthcare professional may help determine whether further evaluation is appropriate.
What is the ATNR?
The ATNR is typically present at birth and is generally expected to integrate by around 4 to 6 months of age.
When a baby's head turns to one side, the arm and leg on that side naturally extend while the opposite arm and leg bend. This normal reflex helps support early hand-eye coordination, visual tracking and movement during infancy.
As voluntary movement develops, the ATNR usually becomes less noticeable as the nervous system matures.
Signs That May Be Associated With a Retained ATNR
Some practitioners consider that a retained ATNR may be associated with challenges such as:
Hand-eye coordination difficulties
Visual tracking challenges
Handwriting difficulties
Difficulty crossing the body's midline
Balance and coordination challenges
Reduced body awareness
Attention or concentration difficulties
Neck or shoulder discomfort during certain activities
These signs can have many different causes and should always be considered as part of a comprehensive clinical assessment rather than being attributed to a single factor.
Movement Activities That May Support Motor Development
Some practitioners use movement-based activities as part of a broader management approach aimed at supporting coordination, motor control and body awareness.
Examples may include:
Marching on the spot while turning the head from side to side
"Lizard" crawling movements
Crawling with gentle head turns
Bear crawling activities
Other age-appropriate movement exercises recommended by a healthcare professional
The suitability of these activities depends on the individual's age, development and clinical presentation.
When Should You Seek an Assessment?
If you have concerns about your child's movement, coordination, posture or developmental milestones, consider discussing these concerns with an appropriately qualified healthcare professional.
Following an individual assessment, recommendations may include observation, movement-based activities, referral to another health professional where appropriate, or other management options based on your child's needs.
Every child develops differently, and not all movement or learning challenges are related to primitive reflexes.
This article is intended for general educational purposes only. It should not be considered medical advice or used as a substitute for an individual assessment by an appropriately qualified healthcare professional.