Movement disturbances in infancy were considered by Teitlebaum and colleagues [ 48 ] to be“ reflexes gone astray” serving as potential early indications of ASD. Their study indicated that some children exhibited RPRs beyond infancy, whereas others displayed the emergence of some RPRs significantly later than expected throughout infancy. They noted that the asymmetric tonic neck reflex may persist in individuals with ASD. Another reflex, head verticalization in response to body tilt, was found to be absent in a subgroup of infants identified as“ autistic-to-be.” They proposed that these reflexes may serve as ASD indicators and might be utilised by paediatricians to assess neurological impairment. Teitelbaum and associates [ 49 ] also demonstrated that infants who would later develop ASD exhibited a distinct set of movement pattern differences as early as 4 – 6 months of age.
Among the postnatal PRs that decrease as development progresses are the Galant and Moro reflexes. Konicova and Bob [ 50 ] examined school-aged children with ADHD( ages 8 – 11) presenting with Galant and Moro reflexes evaluated against a control group of the same age. Children with ADHD manifested a markedly greater prevalence of Moro and Galant responses in comparison to the control group.
Callcott [ 51 ] indicated that learning and cognitive difficulties in childhood are related to movement skills, including early academic preparedness. Callcott examined the prevalence of the Asymmetrical Tonic Neck Reflex( ATNR) and assessed the motor skills of pre-primary school Western Australian Indigenous children. She reported that 65 % of the Indigenous children studied exhibited moderate to high levels of ATNR, which correlated with academic achievement.
The United Kingdom ' s Millennium Cohort Study [ 52 ] found a correlation between delayed motor milestones at 9 months and significantly diminished cognitive function in five-year-olds. The
Australian Early Development Index [ 53 ] revealed that approximately 25 % of school-aged children are at‘ risk’ in their cognitive and physical development. A relationship was found by Williams and Holley [ 54 ] between cognition and motor development. They investigated how infant motor experiences in early life influence cognitive abilities essential for academic achievement. The standard progression of motor skills and gestures requires effective inhibition of PRs, particularly those associated with the mouth and hand.
Chinello and colleagues [ 20 ] explored the correlation between RPRs, motor repertoire, and autistic-like characteristics in parents of infants aged 12 – 17 months. Regardless of age, RPRs influenced the motor skills of infants and evidenced a strong correlation with autistic behaviours of the parents. A study conducted in Egypt [ 55 ] examined 206 students aged 9 – 10 years for dyslexia. The study employed comprehensive history-taking and neurological examinations, focusing on cerebellar indications, PRs, dyslexia, and apraxia assessments. Findings revealed that 22 students( 10.67 %) were identified as dyslexic. Dysdiadochokinesia, asymmetric tonic neck reflex, neck retraction, palmar reflexes, and apraxia were markedly elevated in individuals with dyslexia. The reversal of letters, the persistence of the ATNR, apraxia, and neck retraction were found to be strong predictors of dyslexia.
Numerous investigators have observed a correlation between incoordination and clumsiness, particularly in posture and gait, and ADD / ADHD, ASD, and other neurobehavioral disorders [ 56, 57 ]. Gait and motor disturbances were principally compared to those cerebellum-related [ 58 ]. The most frequent childhood neuro- behavioral disorder comorbidities are developmental coordination disorder( DCD),“ clumsiness,” or motor incoordination [ 59 ]. Incoordination typically pertains to the muscles responsible for posture, locomotion, or gross motor functions. Not infrequently, fine motor skills are also compromised [ 60 ]. Wisdom and associates [ 61 ] noted both distinctions and commonalities between ASD and DCD, indicating that the DCD cohort had superior emotion detection, theory of mind, and gross and fine motor coordination compared to the ASD cohort while demonstrating similar response inhibition capabilities. Wisdom and colleagues [ 61 ] observed that when categorised by symptom intensity, children with ASD deemed“ more able” exhibited no significant differences in any measures compared to children with DCD, in contrast to those classified as“ less able.”
3. Discussion
PRs provide a developmental function, enabling neonates to counteract gravity and facilitate voluntary movement through the integration of motor activity in the early months of life. Mature responses in a child ' s psychomotor development can only manifest when maturity has been obtained in the CNS. The process involves shifting from brainstem-based reflexes to cortically regulated responsivity. With impairment in the process of the development of integrated movement, the child may exhibit immature motor skills, evidenced by difficulties in maintaining balance, running, and cycling, oftentimes resulting in clumsiness. The child may experience difficulties with throwing and catching. Psychomotor abnormalities, sometimes referred to as minimal brain dysfunction can alter and impede a child ' s natural developmental trajectory. Initial indicators may manifest in early childhood; however, several signs become apparent later, such as learning and behavioural challenges during the preschool years. RPRs and the cognitive or behavioural challenges encountered by children upon reaching school age are correlated.
As a child develops, these PRs are supplanted by more advanced reflexes. The PRs that were once essential become inhibitory or redundant. The grasping reflex enables an infant ' s small hands to grasp objects as required; nevertheless, as the hands and fingers expand, this
220 | vol31 | no4 | AJNM