The ATNR (Asymmetrical Tonic Neck Reflex): What It Is, Signs of Retention, and How to Support Coordination, Learning, and Nervous System Maturity
The Asymmetrical Tonic Neck Reflex (ATNR) is an early developmental reflex that supports hand–eye coordination and rolling in infancy. When retained beyond 4–6 months of age, it can contribute to poor posture, difficulty crossing the midline, handwriting fatigue, coordination challenges, and reduced focus. Nervous system-focused chiropractic care may help support improved motor control and regulation.
The Asymmetrical Tonic Neck Reflex (ATNR) is a crucial early-life reflex that supports hand–eye coordination, rolling, and early movement development. When it integrates on time, it allows the left and right sides of the body to work independently and efficiently—an essential foundation for crawling, walking, reading, writing, and sport.
When ATNR does not integrate, however, it can quietly interfere with coordination, posture, attention, learning, and daily tasks, often persisting into the teen and adult years.
At Nomad Chiropractic, we frequently assess retained ATNR patterns in babies, children, teens, and adults across Sydney’s North Shore and Northern Beaches, particularly in those with learning challenges, poor handwriting endurance, clumsiness, or postural asymmetry.
What Is the ATNR?
The ATNR appears around birth and is controlled by the brainstem. It is activated when the baby’s head turns to one side.
The classic ATNR response (often called the fencing posture) looks like this:
The arm and leg on the face side extend
The arm and leg on the skull side flex
This reflex plays an important role in early development by helping a baby:
Develop muscle tone
Coordinate eye and arm movement
Begin rolling and early reaching
Prepare the body for bilateral movement
When Should the ATNR Integrate?
The ATNR should integrate by approximately 4–6 months of age, as voluntary control and midline stability develop.
When integrated, the nervous system can:
Cross the midline easily
Use both sides of the body independently
Coordinate eyes and hands efficiently
Maintain symmetrical posture
If the reflex remains active, head movement can continue to drive limb movement reflexively—interfering with coordinated tasks.
Why a Retained ATNR Matters
A retained ATNR means the nervous system struggles to separate head movement from arm and leg movement.
This can lead to:
Difficulty crossing the midline
Poor bilateral coordination
Fatigue during desk or writing tasks
Postural asymmetry
Reduced efficiency in sport and movement
These challenges are often misinterpreted as clumsiness, lack of focus, or learning difficulty, rather than being recognised as a neurological integration issue.
Signs and Symptoms of a Retained ATNR
In Babies
Difficulty rolling both ways
Preference for turning the head to one side
Asymmetrical movement patterns
Challenges with tummy time
In Children
Poor handwriting or writing fatigue
Difficulty copying from the board
Trouble crossing the midline
Awkward pencil grip
Poor ball skills
Restlessness at a desk
In Teens
Neck and shoulder tension during study
Poor posture at a desk
Reduced coordination in sport
Difficulty multitasking
Fatigue with prolonged sitting
In Adults
Neck and upper back tension
Poor posture during desk work
Reduced coordination or balance
Difficulty with tasks requiring left–right integration
Chronic fatigue with fine motor tasks
Many adults are surprised to learn that long-standing posture or coordination issues may be linked to a retained ATNR.
How the ATNR Affects the Nervous System
When the ATNR remains active:
Turning the head reflexively changes muscle tone
The body struggles to stabilise at midline
Postural muscles fatigue quickly
Higher brain centres must work harder to override reflexive movement
This can interfere with:
Writing and reading efficiency
Eye-hand coordination
Postural endurance
Focus and learning
Over time, these inefficiencies increase physical and mental effort for everyday tasks.
Home Care Strategies to Support ATNR Integration
Professional assessment is essential, but consistent home support greatly improves outcomes.
1. Encourage Cross-Midline Movement
Crawling and bear crawls
Cross-body games (right hand to left knee)
Ball games that require tracking and reaching
2. Support Good Desk Posture
Feet flat on the floor
Paper positioned slightly angled
Regular movement breaks
3. Reduce Compensatory Patterns
Avoid sitting on one leg or twisting at a desk
Encourage symmetrical sitting and standing
4. Reflex-Based Movement Exercises
Specific ATNR-focused movements can help the nervous system learn to stabilise without reflexive responses. These exercises should be:
Slow
Controlled
Symmetrical
Practised consistently
(Always follow guidance from a trained professional.)
Chiropractic Care and the ATNR
Chiropractic care supports ATNR integration by optimising spinal, cervical, and nervous system communication.
At Nomad Chiropractic, our approach includes:
Gentle, nervous-system-focused chiropractic adjustments
Support for cervical spine and postural input to the brain
Movement and coordination assessment
Age-appropriate techniques for babies, children, teens, and adults
Integration of targeted home reflex exercises
This approach is particularly valuable for:
Children with learning or handwriting difficulties
Teens with postural fatigue or sporting challenges
Adults with desk-related neck tension and coordination issues
Families across Sydney’s North Shore and Northern Beaches often seek us out for this developmental and neurological focus.
Why Early Support Matters
When the ATNR remains active:
Learning tasks require more effort
Postural asymmetries become habitual
Coordination challenges persist
Early identification can:
Improve handwriting and learning efficiency
Support balanced posture
Enhance coordination and confidence
That said, integration is still possible later in life, and many adults experience meaningful improvements once this reflex is addressed.
Frequently Asked Questions
1. Can ATNR affect handwriting and learning?
Yes. Retained ATNR is commonly linked to handwriting fatigue, difficulty copying, and poor coordination at a desk.
2. Is poor coordination always caused by ATNR?
Not always—but ATNR is a frequently overlooked neurological contributor.
3. How long does integration take?
This varies by age and nervous system stress. Many people notice improvements within weeks to months or even longer for some with consistent care.
The ATNR is meant to help us move and learn—not hold us back.
If you or your child struggle with posture, coordination, learning tasks, or desk-based fatigue, a retained ATNR may be part of the picture.
At Nomad Chiropractic, we focus on nervous system-focused chiropractic care, supporting primitive reflex integration for families across Sydney’s North Shore and Northern Beaches, while educating families worldwide.
Homecare Movement Tips
We have a lot of homecare tips on our website here. But before you start doing every exercise under the sun we recommend getting checked and adjusted because some may integrate without the need of an extensive home-care regime with chiropractic care.
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A retained ATNR can quietly affect posture, coordination, handwriting endurance, and learning efficiency long after infancy. When head movement continues to drive reflexive limb responses, everyday tasks require more effort. Supporting neurological integration through targeted movement strategies and nervous system-focused chiropractic care may help improve stability, midline control, and resilience.
At Nomad Chiropractic, we focus on nervous system-based chiropractic care, supporting reflex integration for families across Sydney’s North Shore and Northern Beaches, and educating families worldwide.
Want to learn more? Book a FREE 15min discovery call with one of our North Shore Paediatric & Retained Primitive Reflex Chiropractors today: Book HERE
👉 Book a nervous system assessment today and take the first step toward calmer, more resilient living.
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Goddard Blythe, S. Attention, Balance and Coordination. Wiley-Blackwell.
Melillo, R. Disconnected Kids. Penguin Random House.
Ayres, A. J. Sensory Integration and the Child. Western Psychological Services.
Porges, S. The Polyvagal Theory. W. W. Norton & Company.
Schore, A. Affect Regulation and the Origin of the Self. Routledge.
Kolb, B., Gibb, R. “Brain plasticity and behaviour.” Annual Review of Psychology.
Teicher, M. H. et al. “The neurobiological consequences of early stress.” Biological Psychiatry.
Australian Spinal Research Foundation – Neurological development and posture resources.
Haavik, H. The Reality Check.
International Chiropractic Pediatric Association (ICPA) Developmental Guidelines.
Panksepp, J. Affective Neuroscience. Oxford University Press.
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The information provided by Nomad Chiropractic is intended for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
Chiropractic care, movement strategies, and nervous system–based approaches aim to support overall function and wellbeing. They do not diagnose or treat medical conditions, learning disorders, behavioural conditions, or developmental diagnoses.
Every child is unique, and responses to care may vary. Any concerns regarding your child’s health, development, learning, or behaviour should be discussed with a qualified healthcare professional. Always seek advice from your GP, paediatrician, or other appropriately registered health practitioner regarding specific medical concerns.
This content does not replace individual assessment or care. Decisions about your child’s health should be made in consultation with qualified professionals familiar with your child’s individual needs.
If posture, handwriting, or coordination feel harder than they should, a retained ATNR may be part of the picture—book a nervous system assessment to explore supportive next steps.