Persisting primitive reflexes and motor and cognitive development in children: A systematic review

The early childhood is critical for developing fundamental movement skills (FMS) and cognitive functions. Primitive reflexes (PRs) are involuntary motor responses essential for early survival and brain development. Persisting primitive reflexes (PPRs) beyond infancy appear to be associated with deficits in motor and cognitive development. Emerging evidence suggests movement programs targeting persisting PRs could be beneficial, but findings remain inconsistent.

This systematic review followed PRISMA 2020 guidelines and was registered with PROSPERO and OSF. PubMed, Web of Science, and Scopus were searched to identify studies examining PPRs in children aged 3-11 without neurodevelopmental disorders. Fourteen studies published between 2004 and 2023 were included and categorised into three clusters.

Six studies examined the relationship between PPRs and motor development; all reported negative associations, particularly affecting locomotion, balance and manual dexterity. Six studies linked PPRs to lower cognitive performance, especially in reading, spelling, and mathematics. Five studies evaluated interventions aimed at reducing PPRs; most showed improved developmental outcomes, with effect sizes ranging from small to large.

PPRs appear to be associated with delays in motor and cognitive development. The most frequently observed reflexes were the Asymmetrical Tonic Neck Reflex, Symmetrical Tonic Neck Reflex, and Tonic Labyrinthine Reflex. Early identification and targeted movement-based interventions may be promising approaches to mitigating these developmental challenges. However, the available evidence remains limited and heterogeneous and should be taken into account when interpreting the results.