Early screening for learning difficulties
News about the escalating number of children suffering with learning difficulties and various diagnoses are a common depressing read in the Australian press. The economic burden on society is often mentioned, highlighting that this is a problem that affects us all. Figures from USA estimates the combined annual national cost of learning disabilities, autism and ADHD to be US$ 193 billion!(1) Although we can’t extrapolate these figures to Australia, the fact is: it’s costly. More importantly though, is the worry, pain and stress the individual child and their families suffer when they are not performing at optimum.
To ensure the best outcomes for these children, an early diagnosis is essential. Health professionals’ ability to diagnose learning problems, ASD and ADHD have improved significantly over the recent years and this helps the child receive the support she/he requires.
A recent study (2) draws our attention to the possibility of early screening to pick up the potential strugglers before actual challenges manifest in the child. In this study they used the presence of three primitive reflexes in pre-school aged children to measure psycho-motor function of the child and compared this to a standardised assessment for this age group called MOT 4-6.
Primitive reflexes are commonly used by many health professionals to assess integrity of a baby’s nervous system and track the baby’s development as the reflexes normally integrate. The reflexes are replaced over the first year of life by more mature motor responses: postural reflexes and voluntary movements in gravity. Zafeiriou (3) mentions that babies with 5 or more abnormal postural reactions, as in non-integrated primitive reflexes, have either developed cerebral palsy or developmental retardation. Sally Goddard and many others have demonstrated that retained primitive reflexes beyond the first 12 months of life is indicative of decreased brain efficiency in processing sensory information. This will interfere with gross motor function, balance, coordination, learning and behaviour – ‘minimal brain disorder’ (2).
The physiotherapists who conducted this study assessed the presence of the asymmetrical tonic neck reflex (ATNR), symmetrical tonic neck reflex (STNR) and tonic labyrinthine reflex (TLR) in 35 healthy, typically developing pre-schoolers (4-6 yrs old). They then conducted a Motor Proficiency Test for children between 4 and 6 years old, MOT 4-6, a validated test for stability, locomotion, object control and fine movement skills in this age group. The 18 standardised movements included jumping sideways, throwing at a target and standing on 1 leg.
The researchers then compared their results, and they were very interesting! Out of the 35 normal, healthy, well-functioning children 89% had at least one retained primitive reflex, although most at a very residual level. 69% of the girls and 63 % of boys had good or complete integration. The MOT 4-6 showed 63% of the girls and 60% of the boys showed very good or normal development. The results of the two tests correlated: The children who had better motor function also had fewer retained primitive reflexes. So as a screening method the 3 reflex tests showed the same results as the 18 motor proficiency tests. This could save significant time and effort in highlighting children who may benefit from a little extra attention.
So what does all this mean for us? It is obviously a very small study group, and I don’t know much about the lifestyle of families living in Gdansk. However – if we generalise – about 40% of preschool kids, who have not been flagged as needing special attention, are actually functioning below their potential. Given Heidi Haavik’s research on the effect of the adjustment on sensory motor integration and pre-frontal cortex function, does chiropractic have a role to play here? Research has shown that sequential brain-based movement patterns can help stimulate reflex integration and improve brain function (4). And we know how to asses a child for primitive reflexes and provide appropriate exercises, don’t we? If not, maybe it’s time to learn so we can play an active role in children living healthier, happier (and cheaper) lives.
- Persistence of primitive reflexes and associated motor problems in healthy preschool children Ewa Z. Gieysztor Arch Med Sci. 2018 Jan; 14(1): 167–173.
- Primitive Reflexes and Postural Reactions in the Neurodevelopmental Examination Dimitrios I. Zafeiriou, Pediatr Neurol. 2004 Jul;31(1):1-8.
- Prevalence of Persistent Primary Reflexes and Motor Problems in Children with Reading Difficulties M. McPhillips and N. Sheehy Dyslexia. 2004 Nov;10(4):316-38.