How the Asymmetrical Tonic Neck Reflex affects handwriting and learning

Does your child struggle with handwriting? There is an often overlooked reason why: children that have difficulties with handwriting frequently have a retained Asymmetrical Tonic Reflex (ATNR).


The ATNR is a primitive reflex that babies exhibit and is part of the development of muscle tone, consistent one-side movements with their body, and even proper hand-eye coordination. This reflex should have been inhibited by the time a child reaches around eight months. However, when it is retained, it manifests as handwriting and learning issues such as dyslexia.


Indicators your child could have ATNR:


Normally, when a child turns their head to look at a page, the active ATNR will automatically cause the arm to extend and the fingers to open. However if a child has a retained ATNR, using a pen or pencil will require more effort for the student, and they may compensate by using excessive pressure.


Further indicators your child may have ATNR:


  • Difficulty keeping to the left hand margin when writing

  • Handwriting that trails off to a slant towards the right hand side of the page

  • Difficulty with planning and may run out of room towards the right hand edge of the paper


Girl struggling with handwriting
A retained Asymmetrical Tonic Reflex (ATNR) can cause handwriting difficulties


The ATNR and learning difficulties


The ATNR and subsequent handwriting issues also have a bigger impact on learning for the child. Their energy will be significantly diverted into heavily focusing on the physical process of writing, which distracts them from what they are actually writing about. Using a pen or pencil will require a huge amount of effort, leading to a very tight pencil grip and tension in the body. An overly tight grip can cause cramping and fatigue to set in rapidly, especially in the arm and hand. The frequent “shaking out” of a cramped hand is often an indicator of an active ATNR.


There may also be a big difference between their expression of ideas in written form versus their ability to express themselves orally.


When it comes to reading, a child with ATNR will experience eye tracking difficulties: their eyes do not move smoothly from one side of the page to the other and frequently jump. This can result in losing their place, loss of accuracy and loss of comprehension.


They may also experience what’s called mixed laterality. This is when a child uses their left foot and right hand, or they may use left and right hands interchangeably for the same task. The effect of mixed laterality can be the failure to send information to the most efficient centre of the brain for that skill.


All of this requires intense concentration that occurs at the expense of cognitive processing: their handwriting will suffer in terms of quality and quantity.



Children Children with ATNR often have an overly tight grip when handwriting
Children with ATNR often have an overly tight grip when handwriting


Neurodevelopmental therapy and ATNR


At The Key Clinic, we help children to develop and mature their handwriting. Anna Trundle is our Neurodevelopment and Auditory Supervisor and Occupational Therapist. Anna is a HCPC Registered Occupational Therapist with 30 years’ experience. She has a specialism in Paediatrics and Neurological Rehabilitation. Anna is also a National Handwriting Association Tutor and trained in Auditory Therapy.

Anna oversees our Key Neurodevelopmental Therapy practice which helps children mature their handwriting skills, as well as overcome labels such as dyslexia.


Crucially, 90% of children that are diagnosed with dyslexia have a retained ATNR. As mentioned above, the ATNR affects the eyes’ ability to track smoothly across a line of writing, causing the eyes to jump at the midline. This means words appear to move and lines and words are frequently skipped over.


Dyslexia can be successfully treated through a series of neuro-developmental movements, which give the nervous system a second chance to develop. Key Neurodevelopmental Therapy uses simple, precise exercises to inhibit primitive reflexes, overcoming blockages and creating new neural pathways in the brain by maturing the nervous system.


These need to be carried out for up to 20-25 minutes a day over a few weeks/months, until any remaining primitive reflexes have fully inhibited and the system becomes fully matured.


The child is left with significantly improved ability to learn and are then able to fulfil their true potential.


“We brought our eldest son to The Key Clinic at the start of his GCSE year, as he had recently flunked some really important exams. He had previously been diagnosed with Dyslexia and suffered from great anxiety and constant tummy aches/indigestion. After an in-depth assessment, he was prescribed exercises and some Key Auditory Therapy. On his return to boarding school, he achieved an instant 20% increase in his exam results across the board.”


- The Phelps family


Contact us today if your child is having difficulties with

their handwriting or reading.




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