Sarah Collins: 00:00:00.197
When I’m talking about primitive reflexes and being integrated, if your child’s reflexes are retained, that does not mean that their brain is broken or that something is wrong. We need to really– the only thing that gets broken and fixed is a bone. Other than that, there’s a lot of things that we can be doing to help to support our children. And that is an important distinction to remember, is that we want to be supporting their function, but not necessarily that we need to be fixing them. [music]

Gretchen Roe: 00:00:33.736
Good afternoon, everyone. This is Gretchen Roe for The Demme Learning Show, and I am so excited to welcome my sweet friend, Sarah Collins, today to have a conversation about primitive reflexes. I have been looking for someone to have this conversation with for over two years. So when I met Sarah back in February up in Pennsylvania, I knew it was a divine opportunity. And it’s taken us till now to make it happen, but I’m so excited to welcome her here today. In just a moment, I’m going to let Sarah introduce herself. I just want to say that we’re having this conversation today because this is information that is important to you as your journey with your students. So let’s begin. Sarah, will you tell our audience about you?

Sarah Collins: 00:01:19.662
I sure will. Well, thank you for having me, first of all. And yes, I agree. When we met in February and you and I were like, you’re coming into my sessions and I was into yours and we’re having conversations back-and-forth. Like so much of what we do overlaps. And I love that so much. So yes, I am Sarah Collins. I’m an occupational therapist. I’m also a fellow homeschool mom. We started homeschooling back in 2016. And it was primarily because of the timing of a move. And we said we’ll just give this a little try. And then here we are. And my daughter is now a sophomore in high school, and we have no plans of ever changing our homeschooling journey. And I think part of that also has to do with my son, who is my second born, Caleb. He is now 13 and is doing absolutely beautifully, but even this conversation that we’re talking about today of primitive reflexes, not only am I coming at this from an occupational therapist perspective, but also as a parent perspective, because it’s something that we’ve lived through and worked through in my own home. So you’re going to hear from both sides of this, OT, homeschool mom, and also kind of recognize within that that there is somewhat of a tension within this topic. It is very heady. It is very, no pun intended. Actually, I kind of do now that I said it. I’m like, yeah, it was. [laughter] But because there is so much neuroscience, that I want to go in and touch on pieces of that. But I know what really matters to you is how does this affect my child and what do I do about it?

Sarah Collins: 00:03:00.428
So I’m going to try to touch on both, not be too much on one side and too much on the other, but knowing that we don’t have that much time to get through everything. So we’re going to plunge forward or move forward and plunge forward, maybe. I don’t know. That’s the word I was looking for. But really knowing that there is going to be a little bit of both of those things.

Gretchen Roe: 00:03:22.545
Right. And this is like drinking from a fire hose. When I said I was looking for someone to have this conversation with, this was important in my homeschool journey for one of my children. And so I have a very personal invested interest in making this available. And I think Sarah and I connected in a conversation with another homeschool mom when I asked the question, “Does your student have retained primitive reflexes?” And Sarah looked at me and I looked at her and all of a sudden that moment. So now we’re bringing that moment to you all. So this is not going to be the end all conversation. This is the beginning of the conversation. And perhaps we’ll have Sarah back to dig a little bit deeper sometime later this year.

Sarah Collins: 00:04:04.949
I do want to make sure that we are answering the questions of what are primitive reflexes? Why are they potentially retained? And how would you know as a parent? And then, what do you do as a parent? So we’re going to try to go through all of those again briefly, but enough to give you a little bit of a background. So again, these are the questions that I’m going to try to answer as we go through. So we’re going to start with what exactly are primitive reflexes. So again, this requires a little bit of brain neuroanatomy. So we just want to say primitive means they start in the womb or they start in your uterus. So this is before kids are even born that they have these reflexes present. And the reflex is that a sensory stimuli comes in. So we’re getting that through our eyes, through our ears, through our mouth, through our muscles and our body, through movement, whatever, which leads to then an automatic motor response. So when we put them together, the function and why they’re there is actually to help with the birthing process somewhat. So things like the ATNR reflex, which we’ll talk more about that, about each one as we go on. But the ATNR reflex, which is if you turn your head, one arm flies out. But that’s actually designed to literally help with the birthing process.

Sarah Collins: 00:05:25.207
So when you’re coming out of a birth canal, right, your head has to turn, your shoulder has to go down and out to allow that to happen. So that’s why this reflex begins in utero and happens then. Then they are for more for survival. So at the beginning, there’s a rooting reflex, which is when you’re running your finger up to the side of the mouth or anything touching that a child would automatically want to start sucking. This is for survival to begin breastfeeding or bottle feeding at all. And sweetly, there’s another one that is the palmar reflex. So when you put your hand on or anything in the middle of a person’s palm, were they, a baby, where they will close in. And I was actually for the HomeschoolOT book club where reading, Hold on Oo Your Child by Gordon Neufeld. And he talks about that in forms of attachment in his book. And I was like, yes, yay, I’m glad you’re talking about that. These also lead then to further development. So things, again, if we go back to this ATNR, when your head is turned and your arm flies out, then you begin to start to see your hand and you’re like, oh, that’s exciting. There’s something in a hand, right? And so that begins the eye hand coordination. So all of these start, and then they have a purpose in their starting and a purpose as they’re progressing forward.

Gretchen Roe: 00:06:46.846
And every mother who’s had an infant has experienced that joy when that baby grasps your– when that baby turns its head toward you to nurse. But the challenge arises and that’s what you’re going to talk about. So let’s together.

Sarah Collins: 00:07:05.404
Right. So all of these are located here in the brainstem. So this is a nice picture from the Vision Help blog. I like it because it shows you the brain itself, but it also kind of talks about why and where things are. So when we’re talking about a sensory input, right? So that’s something that you’re taking in through anything. And in general, the motor input, right? It’s sending messages up your spinal cord. So from the inside up here and it’s going up and then within the brainstem and you can see how close that is to areas like the cerebellum, the amygdala, which is really important. Well, they’re all really important. And then your frontal lobe. So there’s something called a reflexive arc, which we have forever. And what that is, is when a sensory input comes in that is painful, dangerous, anything, without having to think through our cortex, we just have an automatic response. Things like if you put your hand on a burning oven or a burning stove top, you just pull it away. It’s not because your brain is like, “Oh, that might be hot. Let’s think about that for a second and decide what to do.” No, it just, it bypasses the brain. It’s reflexes straight in and out of the spinal cord on both sides, the input, the output. Where these reflexes are, these primitive ones are in the brain stem. So it’s before we have this cortical involvement of let me think about what is actually happening here. Later on, as time goes on and the reflexes get integrated, we can have that same sensory stimuli, something like a loud noise or something. And we would process and think through and say, “Hmm, is that dangerous? Is it not?” We would then, our frontal lobe would tell our amygdala to chill out. We don’t need to have like really fast heart or anything like that. It’s just a loud noise and we calm right back down. So when this is happening in the brainstem versus giving us a chance to actually think and we’re getting these automatic responses, that’s how it impacts function.

Sarah Collins: 00:09:13.139
Okay, so this is the list of primitive reflexes here. Now, I printed this and put it on here. This is actually from occupationaltherapy.com. It’s a published article by Samantha Hayden Reich, maybe Hidden Reich. I don’t know. Samantha, I’m sorry if you hear this and I’m butchered your name. That’s what I think it is. Anyway, so the reason that I wanted to pull these up here is for a few things that I want you to notice. One is that a lot of these are stimulated, like we talked about before, through the birthing process. I want you also to notice that there is a range and when they theoretically should be integrated, right? So most are before one year, with the exception of the tonic labyrinth, which is up to three and a half years. So can be earlier on. So should theoretically be happening developmentally before a child turns one, okay? So as we’re thinking about these moving forward, we want to recognize that, yes, there is a range, but it is still pretty early on.

Gretchen Roe: 00:10:18.068
Right. You know, it’s like that same range, Sarah, that we say children learn to crawl somewhere between 7 and 18 months– I mean, learn to walk between 7 and 18 months. But then we say all five-year-olds should be learning to read. And part of the reason we’re having this conversation is because every child is different.

Sarah Collins: 00:10:38.247
Right. And that’s a very important thing to be remembering as we’re going through this. When I’m talking about primitive reflexes and being integrated, if your child’s reflexes are retained, that does not mean that their brain is broken or that something is wrong. We need to really– the only thing that gets broken and fixed is a bone. Other than that, there’s a lot of things that we can be doing to help to support our children. And that is an important distinction to remember, is that we want to be supporting their function, but not necessarily that we need to be fixing them. If we are thinking about retention, though, what is happening is that reflex arc that I talked about, that’s within either the brainstem or the spinal cord, it stays in place. It can often look more subtle within children. So I’ve talked a lot about the ATNR where you turn your head and your arm flies out. It doesn’t necessarily happen in that whoa, huge thing as children get older, but you can still see it in different ways. So like when we test for reflexes, I can see based on positions that we put the children in or adults in, we can see this, it happened. We can see we provide the stimuli and then we can see the motor response. And because we are avoiding that cortical influence, right, in that development because it’s here in the brainstem, then that can affect children’s development within lots of different things. And we’re going to talk about that as we go on. So if we know what they are, then why are they retained in some children? Well, we know potential causes. We do not know a 100%. And this is why I want to back up and stop for one second because I’ve mentioned that my son had primitive reflexes retained. Now when I graduated with my Master’s of Science in Occupational Therapy, it was back in 2008 when I graduated. And I vividly remember during school going into the daycare at VCU. I went to MCV Medical College of Virginia, which is part of Virginia Commonwealth University. I remember going into the daycare there and we were testing all these kids’ reflexes so that we could see them in essence. But we did not know about them being retained, and we did not know what would really be happening and how that would influence development. And that was in 2008.

Sarah Collins: 00:13:05.180
So this research has been coming along since then, most in the past decade. And when I’m posting up or showing you some of these articles and things later on, you’ll notice like 2021, 2022. So much is happening now. And what we do not know is the exact reason why. So here are some potential causes. One is birth trauma, but not just meaning trauma like it’s traumatic to mom and baby, but also things that could be different throughout a birthing process. So cesarean sections fall into this because if you remember that a lot of the reason why babies– or why these reflexes are activated, some happen because of the birthing process. So if we change that, then that can be one of the reasons that these could potentially be retained. So this is a risk factor. It doesn’t mean if you have a C-section, your kid’s reflexes are going to be retained. It means it is a risk risk factor.

Gretchen Roe: 00:14:04.588
And I think Sarah, it’s also important for the moms who are listening to this to recognize this. We’re not trying to assign blame or consequence here. We just want you to be aware that this is how you get here.

Sarah Collins: 00:14:19.586
Yes, absolutely. Container kids is another one.

Gretchen Roe: 00:14:24.714
I mean, Sarah, explained this one to me last [crosstalk].

Sarah Collins: 00:14:27.125
She’s like, “What?” [laughter]

Gretchen Roe: 00:14:28.325
I don’t even know what this was, but…

Sarah Collins: 00:14:32.523
So many of the integration happens because of movement, specifically head movement, right? So if we know that you’re turning your head and something happens, we also know that if you’re turning your head the other way or you’re moving up and down, then our body starts to realize, “Wait, I don’t need to fly out here. I’m actually wanting to crawl right now, right? Or I wanna hold this ball in my hand, but I don’t want to squeeze all the way in,” right? So we have to have experience to be able to integrate the reflexes. So many of us, especially as kid two and three and four come along, right, we’re following along. This is totally me, right? My oldest was three and she was going to kids first swim school and whatever. And I had my son in that carrier that it’s your car seat and then you put him in your arm and you just carry it along and then you prop them down there. And when they are contained quite frequently without the freedom of movement, it can cause not to have enough experience to be able to integrate the reflexes.

Sarah Collins: 00:15:41.551
We have seen an uptick since 2020, and part of that likely being because people were afraid of germs. And so we’re not moving around nearly as much or allowing our kids the freedom of movement in other places to experience different sensations in their hands and their feet and their movement. So, again again, we are not forcing blame. We are saying these are some potential causes. Another is ear infections. And this is another one where my son fell right into it. And so many of these require head movement. And when our kids have several ear infections, they don’t tend to move their heads as much cause it can cause pain. So that can cause a retention.

Sarah Collins: 00:16:24.312
A lack of crawling– now Caleb, we called it the janky leg. He crawled with one leg back all the time. And then he rolled or scooted on his butt. So this lack of crawling was likely because of his ear infections and also now we know a lot of things are going on with his vision that we didn’t know at that time. Because he was little, right? But because of that, and his weird crawling, his head wasn’t moving in the same way as it would be, and as with a typical quadruped position. Another risk factor. Not saying yes one to the other, but another risk factor injury.

Sarah Collins: 00:17:04.765
So there’s more research coming out now about not just the retention of reflexes, but the return of reflexes. Specifically with concussion, and actually some new research coming out with Parkinson’s and even dementia. Where we are returning to that more primitive brain. And then exposure to toxins. And so that one has not been as clear like what exactly is a toxin. But that research is still forthcoming. So again, as we’re talking about all of these, as we’re kind of living in this tension of the right-now and the not-yet. We do know a lot but we don’t know it all. And so as I’m explaining to you as parents, we want you to be familiar and to know some of the risk factors. And to kind of know what the thought process can be. Not that you need to know it all because there’s not a person out there who knows it all.

Gretchen Roe: 00:18:00.290
All right. So why are they retained? Well, okay, we have some options. But how do you know? You might know the risk factors so that we should look for it, but how exactly do you know for sure? Well, we want to look at function, right? Because when we’re thinking of this input, the sensory input, and then the motor output, we also want to know, “Okay, is this really affecting my child and what they may want to do?” And this is where the majority of your questions are coming that you submitted to Gretchen. In fact, I went back and I was like, “Okay, I need to add in some things here because this is what people actually care about.” Because we all want our children to be successful in what they need and want to do during the day. That’s what it comes down to. And how do we define success? By their participation in what they specifically need and want to do. Not society’s success, but your children’s.

Sarah Collins: 00:18:53.720
So let’s kind of think through. Now I can’t go into every single one of them because of time. But I do want to explain a little bit about the Moro and hope that it’ll kind of help to understand some of this. So the Moro is when you would drop your child back as a baby or they would have a really loud noise or something. You would hear a “Huh.” So it’s a sharp intake of breath, and then their arms would fly out specifically like this. Now if you guys have little ones at home, you should do it. Just try it. They won’t remember, it’ll be fine. It’s a natural reflex, right? It’s also why a lot of times they wake up in the middle of the night with that startle. And so people are swaddling to help hold our babies together, to help so that that sort of reflex does not wake them up in the middle of the night.

Sarah Collins: 00:19:39.096
So if it is retained, or when it’s present, then we have this stimulus which can be a loud noise or a scary something coming at your face, or a load or a dropback, something like that. So you got the stimulus, and then you have that Moro reaction which is the arms and the deep inhale. It also starts a reaction within the body where that we release adrenaline and cortisol towards the brain. So if it’s integrated, what happens is that, again, that stimulus comes and the body does start to prepare by having some adrenaline, cortisol, the heart rate kind of speeds up a little bit, eyes can start to dilate, breathing goes faster. But then the amygdala kicks in, your frontal lobe is like, “Chill, relax.” We activate our sympathetic nervous system. We calm back down our parasympathetic and we regulate our bodies so that we recognize, “No, this wasn’t an emergency, just to knock at the door, not a big thing.” So that’s what it should look like theoretically as an integrated brain. When it is retained or stays, we get this hyper-arousal quite frequently. So if you think about– if you’re constantly with a faster heart rate, adrenaline and cortisol go into the brain continuously, we even see things like increased histamine responses, allergies, right, car sickness because of these chemicals going to the brain all the time.

Sarah Collins: 00:21:14.611
We can see excessive anxiety, decreased memory or ability to learn because if you are in this hyper state, hyper-aroused, how can you focus and have the attention to be able to take in information? You can, but it’s harder. We also see the hypersensitivity to different types of sensory input. Could be kiddos who are really struggling with different types of clothes or different visual stimuli. This is why OTs know a lot about this because we deal with this frequently. With kids, again, we want you to be able to participate in what you need and want to do. And if you’re in a hyper-aroused state, it’s really hard to participate in some of those things. So that’s kind of what it can look like. Now again, you can see the same chart. But now I put it up over here [laughter] on the right side so that you can see there’s a lot of signs to see, “Yep, this means that it’s retained.” Now I don’t expect you to be able to regurgitate all of this information, right? But I want you to know that it’s out there and that there are charts that can help. There are podcasts that can help. There’s me that can help. There’s lots of resources that are out there to really break down and say, “Okay, we’ve got this input and the motor output. What is that doing to our children to affect them?”

Sarah Collins: 00:22:35.550
It can affect things like– so I wanted to talk about ADLs. That’s our function here, our ADLs. So bedwetting, especially at night, well, when you’re bedwetting, you’re at nighttime, but can be a sign of the spinal galant that is when it’s triggered by moving your fingers up and down either side of the back. So that can cause bedwetting. Sequencing, interestingly, so when you think about motor planning, we always think about there’re three different things, right? You have to come up with an idea, then you act on it, and then you have to evaluate and say how things went. So all of these that are that continuously or should be influencing our motor planning also have a lot to do with sequencing. So if we have to think about, “All right, I need to get dressed. First, I have to put this over my head. Next, I put my arm through, might pull it down. What button? I need to hold this with one hand and then move into the other,” right? So that sequencing can be– if that is a struggle or motor planning is a struggle, that can be a sign that the TLR is still there. Fatigue, we talked about the morale already and how that histamine response. So that can affect our ability to do our ADLs, brushing our teeth, that low stamina, core strength, things like that. Sensitive to specific clothing could be the Moro, could also be the spinal gland. So again, this is where we would test to see specifically your screen to see if I give you this stimulus, does the motor response automatically happen? If so, how is that affecting your function?

Gretchen Roe: 00:24:19.447
Sure. And that makes such a tremendous amount of difference because sometimes as parents, we have a child who seems hypersensitive to their environment. They are reacting out of bounds of what we think is normal. And we don’t know how to define this. So understanding that this could be part of that process is huge.

Sarah Collins: 00:24:41.994
And one of the beginning pieces of it, so if we think about this as primitive reflexes, if we’re working on neurodevelopment, right? So together, your cognitive system, right, we have to start at a certain level to be able to build upon it. So this can be one of the very first things. If we’re trying to bypass, we’re going to be fighting it over and over. If these reflexes are still here and we’re trying to do all of this higher level thinking, how? We’re going to keep getting being stuck, basically. So we talked a little bit about the sequencing already, and I knew that piece of it. But then I was like, what else? How else would this be influenced or language development would be influenced by primitive reflex retention? So when it was talking about the motor patterns that are required for speech, so a few different things. One, we practice a lot of that. We have to get past the rooting reflex, right? So if that’s still there, then actual movement of the mouth is inhibited. Also things like bringing stuff to your mouth. If that AT&R is still present and your arm is here, right, you’re not bringing something to your mouth nearly as frequently. And that tactile stimulation helps with that motor, the actual movement or the, oh my goodness, oral motor development.

Sarah Collins: 00:26:04.214
And also the motor patterns themselves. So the cerebellum is a different part of the brain, also in the back, but not the brainstem, which helps to coordinate the fluidity of motor patterns. So if we’re getting this automatic response and we are not developing the cerebellum at the same pace, that affects the motor patterns of speech. The auditory processing, which also– we have to hear speech to be able to know what the words mean to and then be able to speak them. And that can be affected if the morrow is still present because the startle reflex, we’re hearing things that are coming in and we’re scared and then we’re again, heart rate up, chord is all going.

Sarah Collins: 00:26:51.418
The one other functional piece that was asked about before, so I wanted to make sure it was in here is reading and writing. I work with a vision therapist here and I live in Phoenixville, Pennsylvania, and I work with a vision therapist. In fact, you can hear her on the OT Is In podcast. It was, I think about a month ago. I don’t remember the exact episode, but she came on and spoke and I run a primitive reflex clinic with her because what she has noticed is if she’s working with children whose eyes are not separating from their head. So that visual scanning that we need without the primitive reflexes, it takes her so much longer to get through any of these the visual scanning, the convergence disorder, she can’t get to that level when the primitive reflexes are still there.

Gretchen Roe: 00:27:42.080
Interesting.

Sarah Collins: 00:27:42.600
So this really obviously affects your reading and your writing. The ocular motor skills themselves could be impacted if the TLR is there, the ATNR, sitting. If we want to sit down to read to hold some attention, yet we have the spinal [gland?], which is when you have anything near your spine and it makes you want to move and twist and get out. How on earth are you going to sit in your chair when the back of the chair is bothering you or the clothing is bothering you? You can’t, right? It really affects your attention. And again, that goes along with the Moro reflex as well. If you’re in a hyper aroused state, it is very difficult to ignore other distractions or things happening around you. That also affects your ability to learn, affects reading, affects writing. Your handwriting, the ATNR. So anytime that you’re moving your head from side to side, that would matter with your ATNR reflex. And if you’re trying to copy something and you’re looking even copy work here. So you can say from the board to your paper, which is one thing. But with my son, what we were noticing is I had to have things in front of him because he couldn’t look so far side to side or his ATNR would be activated. But the STNR, so if I’ve got something here written in front and then you’re having to look down at your paper to copy, that could be activating the STNR reflex, which would make that very difficult for our children. The other thing that I didn’t put on here that has to do with handwriting is that palmar reflex. So that is– we talked about like you have something in your hand and then you grasp right like this, right? If that reflex is still there, it’s really hard to hold your pencil in this manner. You might get a lot of this. So if these are things that you see in your children, then we should look towards screening for the reflexes. So what does that look like? Well, again, it’s that sensory stimuli, which then gives us that motor response. So what we do, if you have these reflexes, then we do the opposite. So I’m going to stop here actually for a second, because this would be how we help to get rid of them. How we screen for them is that we don’t do the opposite. We provide that sensory stimuli and we look to see if the motor response is there. Now, you can do this through a lot of different ways. You can do that through a functional neurologist can look. An occupational therapist can screen, can look, should be part of an occupational therapy evaluation. Some pediatricians do, especially with baby babies, although this, like we said, this research is new. And so there’s not always that every pediatrician will do it as children get older. Most developmental optometrists do it. I actually just talked to, I told you I do a vision clinic here in Phoenixville, Pennsylvania, but I just talked to another one here recently who called me because she heard I was doing this work and she was like, wait, we need this here too. Some chiropractors do. Also, there’s a whole lot of videos and things that you can find on good old Google. If you look up, how do I check to see if my child has the Moro reflex? You can watch a video on it. How can I check to see if my child has the ATNR reflex? You can watch a video on it. So because it’s not hard, because what we want to see is here’s your sensory stimuli. What’s the motor response? You can see them. When I do these screenings for people, it takes me about 15 minutes at the most to be able to check and see here. So it is very important when you are going to people to help. Like if you want a person to help you to find them, which I will never downplay the importance of building your team. I forever say that homeschooling is not alone schooling. I know that there are so many parents who are like, I’m going to figure this out and I’m going to figure this out and I’m going to figure this out. And I think that is absolutely commendable and fantastic. I also want you to remember that you are still in charge when you are building another team or adding people to your team. So–

Gretchen Roe: 00:32:13.702
I love that you have said that because I think sometimes when we take a homeschool journey, we think it’s a journey by ourselves. And it really shouldn’t be. It should be a collaborative effort between the people we surround ourselves with and our own intuition. So I think it’s important to make sure that we’re assessing our intuition in the process. Is something not feeling right here? Then we need to dig deeper.

Sarah Collins: 00:32:38.501
Yes, absolutely. And I will tell you, we did this for my own child, right, as we talked through what was going on with my son. Now, I did not recognize primitive reflexes at the beginning, because like I said before, that was not something that was covered and only recognized them in babies. The retention information was not there yet. And so as time went on, and we were seeing a lot of these reading struggles, and we were seeing writing struggles, and we were seeing for this kiddo, he was forever in a seeking mode. So he wasn’t in a hyperarousal. He was in a seeking. He continuously needed more and more sensory stimuli and then, then would get into the hyperarousal. So we were working– I could figure that out. I’m like, “All right, cool. I need to give you some more proprioception. You’re doing that on your own.” We had mattresses laid out and he’s diving on things all day. Great. But I didn’t recognize the retained primitive reflexes until I started doing my own research here. And then when I met with this vision therapist and we started working together and collaborating at that point. So it is really important to know you can build your team. And if it’s something that you want to handle on your own, go for it. Absolutely. There’s so many resources out there. If you want to build your team, it’s also important to ask, “What research do you know? Why would you think it’s this?” Ask the why. That’s okay. It’s important to question. Well, I say ask questions is different than questioning. My husband says that to my kids all the time. He’s like, are you asking me a question or are you questioning me? Forever, feel free to ask a question. That’s what we should be doing with the people who are on our team. I also would recommend that you look for people who are going to start with the play and exercise first. And we’re going to talk a little bit about that. But there’s a lot of things, other strategies that are out there. There’s different lasers, there’s different– it’s called cold laser or lead magnets that people are doing to help with this integration. And fantastic, but we can start with the exercise and with play to try that first. I just met with a family on Monday, and I was talking to them and she said, “Well, we–” I don’t want to go into what she was actually– the state or anything like that. But she was saying that they were evaluated and someone told her it would cost them $7,000 to have to work with them on getting their reflexes integrated. And I said–

Gretchen Roe: 00:35:20.486
The [crosstalk] German in me is going, “No, wait a minute.”

Sarah Collins: 00:35:23.962
No, that’s…I hope there was a whole lot more to that conversation. But what she got out of it was $7,000 to have primitive reflexes integrated. And we want to start– I am not saying that some kids will not need more assistance, but we want to start with exercise and with play. And again, so what that movement is, is instead of doing the– we’re working on the same sensory stimuli, but then we’re going to practice another movement. So for the moral reflex, what that would be is instead of being here, right, then we’re going to do the opposite movement and again, we can look at this through Google. There is a million on YouTube, a million videos out there of what are the primitive reflex exercises. So there was a person who sent in the question that was like, “Do you know what? What do we do if we feel really overwhelmed by having to add all of these extra things to the day, especially with exercises and things like that?” So there at Kokeb McDonald, she is doing fantastic work. She has put out books for every single primitive reflex, and they’re called Integrating Primitive Reflexes Through Play. And she has lots of different ways that you can set up your environment, lots of different activities that you can do so that you’re playing with your child but specifically working on integrating these reflexes. She is coming to the OTs in a podcast. I think, Gretchen, when you and I talked before, I was like, “I want to get a hold of her to get her on this podcast.” And it was literally the next day.

Gretchen Roe: 00:36:59.546
We finally got a hold of her.

Sarah Collins: 00:37:00.967
Yup, next day. And I was like, “Yes,” so. Because I want her to talk about her work because it is beautiful and fantastic to just have some guidance and some play with our children and how we can work with them without having to be like, “Okay. Well, now it’s time for this exercise, and now I need you to do this, and now I need you to do this.” You know what? You guys know your kids. Now for my son, he’s a hockey player. He’s exercise-oriented. That’s his jam. So I could tell him that we’re going to do this Starfish now is what it’s called to integrate the Moro Reflex. He’s like, “Cool.” So great, but you know your kid. And so if the doing it by a specific exercise works for your child, have at it. If not, then these books are really, really great. They’re free on Kindle. And they’re really–

Gretchen Roe: 00:37:56.331
I think one of the important things for us to also set for the audience is if you see a reaction in your child, it doesn’t necessarily mean that this is the answer. But don’t assume the ship has sailed because you have a teenager who is overreacting. I want parents to be able to understand that you can integrate these things regardless of their age. So [crosstalk].

Sarah Collins: 00:38:22.102
Absolutely.

Gretchen Roe: 00:38:22.977
Oh.

Sarah Collins: 00:38:22.836
Absolutely.

Gretchen Roe: 00:38:24.174
We’re just too late.

Sarah Collins: 00:38:25.129
Yeah. So my son was eight when we started his reflex integration. And what the research is showing is that for most children, if you are very specific with those exercises, within 30 days is when you’re going to get some integration. Now, what happens then is that, okay, so that we’re not stuck in this reflexive arc, but our brain here has not been our cortical brain, so has not been working in the same manner for this amount of time. So it still takes time for the brain then to start thinking of different patterns. So the sequencing, if we’ve got our TLR integrated, fantastic. Now we can start to focus more on sequencing of what comes first, what comes second, what comes third. But it’s not like, “Oh, magically, after 30 days, boom, I’m getting dressed. And now I can tell you how to do long division,” right?

Gretchen Roe: 00:39:19.715
Right. Right. And I think that’s an important thing to recognize is we’re not talking about waving a magic wand here and ta-da, everything is easy. That’s not the point. But we do want to make the journey easier where we can. I have a question for you from Kathleen. She says, “Is this something DMI, dynamic movement intervention, addresses through therapy?” Not familiar with what she’s asking so I’m just tossing it to you.

Sarah Collins: 00:39:49.147
I’m not familiar with that program with DMI. I’m not sure. So I did put up here a few within the homeschool world. The Equip program, I know that she really works on it, Carol Brown. She’s also fantastic. We’ve had several conversations specifically about primitive reflexes, but she kind of works through primitive reflexes, therapeutic listening, which again on the OTSN program, I just had advanced brain technologies come and talk about what that is. And then kind of working through from there starts more inner hemisphere, cross-hemisphere work. Diane Kraft, Gretchen, you’re the one who told me Diane Kraft, really, of some of the work that you’ve done with her.

Gretchen Roe: 00:40:37.788
I met Diane Kraft years and years ago when I was looking to help a child who needed some integration. And Diane was instrumental in helping me do that. And then when I came to work for Demme Learning, Demme Learning allowed me to get my certification through Diane. So this is why I’m familiar with some of this. But I also think it’s important to recognize there are resources out there. This is evolving as you and I are speaking. So there are resources out there that we’re not even aware of yet, but parents need to do some digging. You need to be a student of making this process work for your child.

Sarah Collins: 00:41:19.093
Brain Connex Therapy, I know is another one that really works through starting with primitive reflexes because again, a lot of times this is our starting point. That doesn’t mean this is our ending point, right? It’s our starting point. So they start by working with primitive reflexes and then moving through some other strategies to help again with cognitive development. So within our therapy world, most occupational therapists should know at this point about primitive reflexes. I can’t say every single one, but most should. And there’s continuing education out all the time. In fact, I’m actually taking another course on primitive reflexes on Friday from Sensational Brain. So just because the research is evolving, like we’ve been speaking. So I want to make sure that I’m up and that I’m understanding everything.

Sarah Collins: 00:42:11.982
When I work with families, frequently I provide the resources for, okay– so that you’re not having to search Google and search YouTube and do all of these things, but yet you’re building your team so that then I could do the research for you, right? And then let you help to implement it. I do not, as an occupational therapist, work specifically with children anymore. What I do is work with you as a parent, as kind of understanding the why and then providing the resources and recommendations to be able to figure out how to work this into your homeschool day, for sure.

Sarah Collins: 00:42:47.678
It’s important if you’re saying, hey, I think, yeah, that I’m seeing all of these things happening for my children. I’ve looked at that chart that you gave, Sarah. And again, we’re going to put this in the show notes, that chart. But I’m seeing every single one of those things. And I think my child has all of these reflexes. So am I going to spend nine hours a day doing exercises? No, no, you’re not. You for sure are not. What we do is typically start with one. And then as we get proficient with that exercise, then we move on to adding in others. But each one is like two or three minutes. It’s not a lot. We’re not doing the starfish all day long, where we’re having our arms out here and we’re bringing them in, but we’re doing it for two or three minutes. So once you again get proficient, then you move on to the next one and add that in. And so that your repertoire is not crazy and overwhelming to you or to your child because that’s not helpful.

Gretchen Roe: 00:43:48.551
Absolutely. It is not. I think the other thing that’s really important here is we are choosing to take a homeschool path because we didn’t want what a public private parochial education was going to provide for us. So we have the latitude to engage in a way that’s different from what a public-private parochial experience would provide for us. So it’s up to us to figure out how did we make this work within our environment to make learning easier for our kids.

Sarah Collins: 00:44:20.547
Right, right. So what we did in in our family is– my son is an early riser and so he would come downstairs. We would start our day typically with the– we started with the starfish and he still had even the palmar grasp. In fact, I put it in my Instagram at HomeschoolOT– I put up a picture today of his– you could see it. I ran a pen across his hand. I think I took the video when he was seven or eight. I don’t remember. I think he was eight. But I ran a pin across and you can see his fingers coming up like this right away, reflexive. And so we started with the exercises specifically for those two, because for him, handwriting was what was– handwriting and reading, it was the way that it really affected his day. And that’s what he was motivated for because other kids around him were reading.

Sarah Collins: 00:45:14.142
In fact, there was a club that you had to read the rules. It was in our neighborhood. You had to read the rules or you couldn’t come in and he couldn’t read the rules. And so they were like, “You can’t be in the club.” So for him, he was like, “Well, I better figure out how to read.” And it’s really hard to figure out how to read when your eyes do not separate from your head. And it’s really hard to learn to write when your hand is stuck around your pen because you have this reflex there. So with that being said, what works for in my home may not work in yours. You may not have an early riser who is so motivated by exercises themselves. That’s where some of those other things– the books of how to integrate through play may be really helpful for you.

Gretchen Roe: 00:46:02.859
Absolutely.

Sarah Collins: 00:46:03.339
So I think in summary, I threw so much information out at you and I’m hoping that you got pieces of, okay, so here’s where it is in the brain. I understand a little bit about that. I know a little bit about why. What do I do? Where do I start? And then we can progress from here, knowing that you are supported. So in summary, all babies are born with these reflexes. They should integrate to allow for higher-level thinking. But if they don’t, then we’ve got some of this retention, which can really affect functioning. So we want to assess them using those movements and then support using the resources around, within the homeschool world, other resources that you find on the internet or whatever. And we’re here for you.

Gretchen Roe: 00:46:52.897
I think it is important to say that Sarah is a resource in this process because she’s given you these resources here. This will also be included in the show notes. But this doesn’t mean this is a journey you have to take all by yourself. And sometimes having someone like Sarah to come alongside you can help you figure out what is really important in the process of having that conversation. We don’t have to do all the things all at once. Sarah is here to help you parse your priorities to figure out what’s [crosstalk] priority.

Sarah Collins: 00:47:28.856
That’s my favorite part.

Gretchen Roe: 00:47:31.634
And then sometimes this is a little bit like a domino effect. If you can figure out what the biggest challenge is and you can get that out of the way, you’d be amazed at the things that will fall in behind that as well.

Sarah Collins: 00:47:48.285
Yeah, for sure. So if these are the most primitive, then what comes next and what comes next and what comes next? And how can we help, yeah, to progress and make sure that we know– again, all of our kids, they are developing at their own rate. And it’s at that own peace, that doesn’t mean that we can’t support them in that to help. In fact, we can, and that’s part of what we should be doing as parents, is really coming alongside of our children to help support them to do what they need and want to do during the day.

Gretchen Roe: 00:48:17.555
Absolutely. And I love that because to support them to do what they need and want to do. Sometimes I have parents who will say to me, oh, well, this is my son, Owen – I’m going to use my own son as an example – this is my son, Owen, and he’s just lazy. And I want you to know as parents, there is no such thing as a lazy child. There is some sort of impediment to their learning, and it’s up to you to be the detective to figure out what that is.

Sarah Collins: 00:48:48.436
I love that, detective. I say frequently, we want to be students of our children. And we need to start that by observation. And even doing some of these screenings or finding, checking to see if primitive reflexes are there, that is being a student of your child. That’s really coming alongside of them looking at what it is that can be that hindrance, right, so that they can do what they need and want. That is that observation piece is so important.

Gretchen Roe: 00:49:15.505
I know that– now, my child who led me down this path is 25 years old. So I started this journey a long time ago, but at the age of five, after three years of preschool, he couldn’t recognize but about four letters of the alphabet. His kindergarten teacher said, well, he’s quite a different learner. And when I started looking at his production in his kindergarten class, I’m like, oh, no, he’s not a different learner; he has a learning disorder. And we need to figure this out. So that’s [inaudible] I started my journey, and that was 20 years ago. So I can tell you there’s value in doing this. When he was diagnosed with dyslexia at the age of eight, we were told he wasn’t college material. He holds a degree in computer science, and he’s a systems analyst now. I think you don’t have to receive every diagnosis that you’re given. I think it’s important to recognize that you have an enormous amount of control in helping your child be successful.

Sarah Collins: 00:50:23.490
And that’s what that function piece comes back to. I love that so much. So really thinking about what do you need and want to do now? And we want to support you with that. And also, what do you need and want to do long term? We’re going to continue to support you. And somebody else telling you that you’re not going to or that you can’t– yeah.

Gretchen Roe: 00:50:42.184
Yeah, no.

Sarah Collins: 00:50:43.024
We don’t need that.

Gretchen Roe: 00:50:46.714
Tell us a little bit about the OTs in community because I think that’s an important resource for parents going forward. If they have seen something in our conversation today and they’re sitting there going, great, now what do I do? Tell us how the OT is in community can help support them.

Sarah Collins: 00:51:02.303
Oh, I would love to. That’s my favorite. So there’s a lot of things that I do as part of HomeschoolOT, but the OT is in community is actually my favorite. Well, I don’t know. I also love the podcast, but the OTs and community, what that is, is there are people who are in there from all over the world, really. We’ve got somebody from the Bahamas, from the UK, and then lots of different places around the United States. And so all of my resources, including this will be in there too, but all of the resources that I make and create are in there in a free resource library. There every single week is an open question and answer for 30 minutes where people just come in and talk. But do you know what? I love that I host it and I’m there to answer questions. Absolutely. But I’ve also watched parents relate to each other and be like, this is what works; it worked for us, and here’s something interesting that didn’t work for us. Or what about this program? And wow, that is– it just makes me so happy happy to see others on this journey because again, homeschooling is not alone schooling [laughter], so to have other parents coming along and just really provide that community. Then there’s also a book club that we do once a month. It’s all optional. It’s not, “Wow, if you’re not– if you don’t show up to book club, you better get out [laughter],” but that is an option. We are reading right now Hold On to Your Children, which– wow. If you have not read that book, I highly recommend.

Gretchen Roe: 00:52:33.415
It’s an amazing book. Yeah. Well, I could run down that rabbit trail. But we have a couple of different comments here. Emily Carr says that Maria says you’re the best. [laughter]

Sarah Collins: 00:52:48.757
That’s funny. I just saw a message that came up that my friend Maria just texted me. It was like, “Hey, my friend Emily is on [laughter]. She’s watching you [laughter].” So hi, Maria. Hi, Emily and thank you.

Gretchen Roe: 00:53:00.118
And here’s another question. I think this is a good question for you. It says, “What do you do when you have successfully integrated and now the child is opposite? She needs to be in the middle, not opposite. For example, she wouldn’t even notice when she hit her head. But now, she’s extremely sensitive,” – read oversensitive – “When she hits her head.” So the pendulum has swung far the other direction.

Sarah Collins: 00:53:27.833
Okay. Interesting. Actually, it kind of points me to hyper-arousal, which is interesting to me. So what I would do is go see an OT or work on a sensory profile– would be coming next. So when we are focused or we’re talking to somebody back and forth or engaged in any activity, we are what we call the zone of optimal alertness. So that means that we need to be in this zone so that you’re taking in information and you’re processing it and integrating it. It’s another integration. All that word really means is that our brain is organizing it. So when we say these reflexes are integrated, it’s because our brain is able to organize all that stimuli and then we’re able to have the response that we need and want. Some kids, it takes a long time to get up into that zone, which it sounds like that’s where she was before, where she needed so much stimuli and maybe even wasn’t seeking it out, but it took a long time to get in there. There are some kids that once they’re in that zone, then you’re– I don’t know, something. Your brother comes in or you hit your head and [laughter] brother’s screaming, clicking this pin, whatever [laughter]. Things are happening. And then, you fly out of that zone through the roof and you get over, you’re hyper-aroused, you get overstimulated, we’ve got a meltdown or a breakdown. So what we want to help to teach her to do is– the strategy’s to get into that zone and to either make our zone bigger, which would be oftentimes working with an OT. Sometimes, it is with primitive reflex integration, although it sounds like you’ve already done that. So then, we need to work on some other things neurologically because again, as soon as these reflexes are integrated, it doesn’t mean that the rest of the brain is like, “Cool, I’m on board [laughter].” We have to work through the development here, so a therapist who either knows it’s called NDT, which would be neurodevelopmental therapy, or could be an occupational therapist who’s working on sensory processing, or could be that you are adding in throughout your day, what we call a sensory diet, meaning that we are providing a lot of that input that is calming throughout the day. So I’m hoping that that answered that question. [laughter]

Gretchen Roe: 00:55:50.424
And mom will let us know if we’re not on target here. But I think the other thing that would be helpful to know is how long ago did the integration occur, because the longer you are from the integration, the more smooth it is. If you’ve just finished the integration process, it’s a little bumpy. I know it was when we did that with my child, but I think it’s also good to remember there can be other factors. One of my children was born a drama queen, and she’s old enough not to be a drama queen [laughter]. She embraces that [laughter]. And so sometimes it’s hard to sort issue from personality, but if the personality is impeding success academically, emotionally, developmentally, then we want to be able to figure out what exactly is happening here. And it makes a tremendous amount of difference. Sarah, this has been just an amazing experience. I really appreciate you.

Sarah Collins: 00:57:02.626
Absolutely. I love doing this. It [crosstalk] makes me very happy.

Gretchen Roe: 00:57:06.979
Absolutely fantastic. I think you guys can see the benefit of spending some time with Sarah. I want to offer one tiny piece of promotion as we conclude here. Sarah has a podcast called The OT Is In. And I have to tell you all, I get to spend some time with Sarah every week listening to this podcast, and I do a lot of podcast listening, a lot of book reading, a lot of things to put these webinars together, and Sarah’s podcast is fantastic. If you have a child that you think learns differently, I want to encourage you to go find her podcast and spend a little time there because I think you’ll find it to be very virtuous. I’ll put it that way [laughter].

Sarah Collins: 00:57:48.238
Thank you. Thank you. It is a joy and a pleasure for sure. I’m really enjoying interviewing the people that I have coming on. And even my own– I did my son’s story the other day. He let us, pieces of it, share more about that. So that’s on there. I mentioned already I’m interviewing Kokib here in a couple of weeks, which will give more information on primitive reflexes there too, but it is…I love it.

Gretchen Roe: 00:58:12.957
I want you all to know today, I know we hosed you all down. This was like drinking from a fire hose. So I want you to know that we are going to be able to share a lot of these resources in the show notes. They’ll be there and available for you, so don’t panic that you missed something. One question, Sarah. What is the last book we mentioned? And that is Hold On To Your Children, and that is by Gordon Neufeld. And I realized I’m waiting for the book to come from Amazon. And he also has a byword by a physician that is a trauma-informed physician. His name is Dr. Gabor Mate–

Sarah Collins: 00:58:56.274
Yes.

Gretchen Roe: 00:58:57.172
–and his information is amazing. Absolutely amazing, so.

Sarah Collins: 00:59:03.091
Yeah [crosstalk] Gabor has quite a few since that time that he’s worked through or written, and yeah, absolutely fantastic.

Gretchen Roe: 00:59:12.051
Well, I have all of his books here in my office. I am a big fan. So [laughter] we’ll just call it at that. Sarah, thank you so much for your time today. This was just fantastic. And those of you who have enjoyed this, if there’s other things that you think you would like to have Sarah talk about, because she has three areas of specialty, and I dragged her into this one. This is not her area of specialty. So you can see how special she really is. Sarah, tell us what your particular emphasis is.

Sarah Collins: 00:59:44.631
I love, I mean, obviously, HomeschoolOT, so I’m working primarily with homeschool families. But I absolutely love sensory processing, which is where this does play in, but sensory processing and integration, executive functioning, and handwriting, and there are classes on my website for each of those, and that’s what the podcast is really focusing on too, is those areas. And yeah, I love it [laughter]. I [crosstalk] hope you hear my passion.

Gretchen Roe: 01:00:09.584
Can we hear the website one more time.

Sarah Collins: 01:00:11.405
HomeschoolOT.com.

Gretchen Roe: 01:00:13.767
Absolutely. All [crosstalk] right. Thank you [laughter]. This is Gretchen Roe for the Demme Learning Show. Thank you all so much for joining us today. You can access the show notes or watch a recording at demmelearning.com/show or on our YouTube channel. Be sure to rate, review, or follow wherever you may see this, and tell your friends, we’d love to help more families in their journey. Take care, everyone. Have a wonderful afternoon.

Sarah Collins: 01:00:37.943
Thank you.

[music]