Supporting Children with ADHD and Retained Primitive Reflexes Through Nature-Based Therapy

Supporting Children with ADHD and Retained Primitive Reflexes Through Nature-Based Therapy

At our practice, two of the most common challenges we support children with are ADHD and retained primitive reflexes. While these diagnoses may look very different on the surface, they often overlap in how they affect a child’s ability to regulate their body, focus on tasks, and thrive in everyday life. The good news? Research and our clinical experience show that engaging children in nature-based occupational therapy provides powerful opportunities to address these challenges in ways that feel natural, motivating, and fun.

Retained Primitive Reflexes: When Early Movements Don’t Fully Integrate

Primitive reflexes are automatic movement patterns that babies are born with to help them survive and develop. Normally, these reflexes integrate (or fade away) within the first year or so of life as higher-level brain functions take over. But sometimes, reflexes remain active—what we call “retained primitive reflexes.”

The most common retained reflexes we see include the Moro, ATNR (Asymmetrical Tonic Neck Reflex), STNR (Symmetrical Tonic Neck Reflex), TLR (Tonic Labyrinthine Reflex), and Landau Reflex. When these stay present beyond infancy, they can interfere with motor, sensory, and cognitive skills in very real ways. Children may struggle with:

  • Visual and ocular-motor skills – tracking words across a page, copying from the board, or shifting focus.
  • Core and postural strength – slouching, fatigue during seated work, or poor endurance.
  • Coordination and balance – clumsiness, frequent falls, or difficulty with sports.
  • Emotional regulation – heightened anxiety, frustration, or emotional outbursts.

Nature-based therapy gives us a perfect environment to work on reflex integration. Activities like climbing trees, rolling down hills, crawling under logs, balancing on uneven terrain, or swinging challenge the body in ways that mimic the developmental movements babies needed to integrate these reflexes in the first place. By embedding these patterns into play, children strengthen their core, refine their balance, and gradually reduce the impact of retained reflexes—all while having fun outdoors.

ADHD: Executive Functioning, Attention, and Regulation

Children with ADHD often experience difficulties in executive functioning, such as self-awareness, self-regulation, self-motivation and self-evaluation. They may struggle with attention, becoming easily distracted or overwhelmed, and face challenges with regulation—both sensory and emotional. This can show up in the classroom as difficulty sitting still, impulsivity, or frustration when tasks feel too hard.

Nature-based occupational therapy offers a unique way to target these areas. The natural environment naturally reduces overstimulation from screens and artificial settings, and instead provides rich, calming sensory input. Activities such as building a fort, fishing with a rope and bucket, or choosing a trail route require planning, sequencing, and decision-making. Climbing, balancing, and hiking challenge their attention, body awareness, and problem-solving skills in real time.

Even simple activities like listening to birdsong or grounding with bare feet on grass help regulate the nervous system, providing a calming foundation for children who otherwise live in a heightened state of alertness. With each outdoor session, children practice focus, persistence, and self-regulation in ways that directly carry over into their school and home lives.

Why Nature-Based Therapy Works for Both

What makes nature so effective is that it isn’t contrived or artificial. It provides authentic challenges that engage both body and mind. For children with retained reflexes, natural play mirrors the developmental movements they need for integration. For children with ADHD, the outdoors offers a sensory-rich but calming environment to strengthen executive functioning and self-regulation. We know that when any child is experiencing emotional dysregulation, they need time and space. This is especially true for children with ADHD. Time and space are best received outdoors whenever possible.

And for both, nature-based therapy restores something modern childhood often lacks: the chance to move freely, take safe risks, and learn through exploration. As occupational therapists, we see children not just “work” on their challenges, but truly grow into themselves—becoming more confident, coordinated, and resilient.

Parent Takeaway: Whether it’s climbing, crawling, balancing, or building, every moment of play outside can support your child’s brain and body in powerful ways. Nature doesn’t just set the stage for therapy; it’s the co-therapist, guiding children toward greater independence, regulation, and joy.

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