Symmetric Tonic Neck Reflex (STNR)

Updated: Feb 23, 2019



Symmetric Tonic Neck Reflex

Does your child or anyone you know display the following behaviors?


* Squirming

* Getting up frequently

* Losing attention quickly

* Daydreaming frequently

* Writing poorly

* Writing laboriously

* Reversing letters or numbers

* Moving awkwardly or clumsily

* Avoiding athletics

* Developing athletic skills slowly


A major contributing cause of these ADHD symptoms in at least 75% of the cases is a specific reflex--the Symmetric Tonic Neck Reflex (STNR). The behaviors caused by an interfering STNR are the same as most of the behaviors that are classified as ADHD symptoms.


The Main Problem: There are many children and adults, at least 10% of the total population, who cannot seem to sit still comfortably for more than a few minutes. They are often classified as ADD or ADHD. The mechanical aspect of writing, just getting the words down on paper, becomes an incredibly difficult task. Many of these difficulties can be traced to an immature Symmetric Tonic Neck Reflex.


The Cause: Although the Symmetric Tonic Neck Reflex (STNR) occurs naturally in the normal development of children, if this reflex stays at an immature level, it can greatly interfere with specific and general coordination tasks. The STNR will stay at an immature level if the child does not crawl enough or properly in infancy. Individuals with an immature STNR will be extremely uncomfortable in what is generally considered the “proper” sitting position: sitting up straight and sitting still.


The incidence of an immature STNR is increasing in recent years because many babies are being kept on their backs to sleep to help prevent Sudden Infant Death Syndrome (SIDS), but then they are not being put on their tummies when they are awake. If they are never on their tummies, they are never going to crawl. If they don't crawl for at least 6 months and crawl properly, the STNR will remain at an interfering or immature level.


At the age of six months, when the STNR is designed to be in control of the child’s body, the STNR functions in response to the position of the head in relation to the body: when the neck is straightened, tension is increased in the muscles which straighten the elbows and those which bend the hips and knees. The baby will pull up into a “cat sit” to prepare for crawling. Essentially, the three body units - neck, arms, legs - are “tied together” by the reflex, so that movement in one area automatically produces a change in the muscular tension of the other two areas. The STNR will remain immature (in control) if the child does not crawl properly for at least six months.


The Effect: The important thing to remember is that the immature STNR makes the top half of the body want to be “opposite” that of the lower part of the body. A person with an immature STNR is very uncomfortable with all parts bent or with all parts straight.


The immature STNR generally hampers the production of rhythmic, coordinated movement and specifically interferes with the postures generally required for reading and writing. An immature STNR makes it very difficult for a child to sit at a desk in the “correct” sitting position, with elbows and hips bent at the same time.


STNR children will get up and down from their chairs when they write or will just try to stand up while they are writing. STNR children who are tall enough will often assume the “slouched” position, with legs stretched out in front. Children in this position are considered by many teachers to be “lazy” or “disrespectful,” or “unable to do your work sitting like that.” What many teachers do not realize is that these positions are actually comfortable to the STNR child because the child’s arms and head are not fighting with the position of the legs.


When not allowed to stand or sit in a slouched position, STNR children may frequently become “foot sitters,” sitting in the chair with feet and legs tucked under the body in order to keep the legs bent while the arms and neck are bent in reading or writing activities. Another favorite posture is the hooking of the feet around the legs of the chair to help hold the legs in position while the arms and neck are bent.


It needs to be emphasized that STNR children do not know why they are assuming these positions, nor are they even aware of their positions. They only know that these positions are more comfortable for them.


Many children and adults with an immature STNR give evidence of ADD/ ADHD because of the difficulty in sitting still for long periods of time in the “proper” sitting position. They may get up and down from their chairs constantly in order to relieve the muscular tension caused by the immature reflex, or they may just lose attention.


STNR children usually have poor penmanship: laboriously produced, with poor letter formation, and with the pencil held in a rigid and awkward manner. Every shift in the arm movement while writing also elicits a change in the muscular tension of the neck and legs. Consequently, these STNR children usually write in a constricted, restricted, and cramped style and position in order to avoid muscular changes.


Copying from the board to a paper is an especially difficult task, as the children must contend with the positional changes in the neck and arms, and the effects of these changes. Sometimes, STNR children can produce well-written papers, but this is usually at the expense of much time and effort, often with “homework wars” as a result. Writing is a chore for these children. Their writing is usually sloppy, covered with erasures, and almost illegible. Frequently a child will “lock in,” get a death grip on the pencil and practically draw the letters, so that at least the work is neat, but at great expense of time and energy. Research suggests that STNR children expend ten times the effort of those without an immature STNR to complete the same task. While three pages of homework may not seem like much, the equivalent of 10 X 3, THIRTY pages seems overwhelming. It is no wonder that STNR children resist writing.



The Cure: In time and with the proper exercises an immature STNR can disappear. Through research and years of designing the program, the IPM team has created the proper activities to improve a child’s ability to sit in a chair for extended periods of time. There is no need to purchase the high desks that many schools are reverting to.

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