Is Your Child Suffering From Anxiety? Here’s How to Attack It at Its Root

connection between child anxiety and sensory and reflex integration issues

Let’s take a poll:

Rate your feeling after the following events on a scale of 1-5, with 1 being completely relaxed and 5 being totally on edge.

  • Your neighbor is doing construction, and the sounds of jackhammering have been going on all day – for the past three days.

  • You walk into your friend’s house because you agreed to watch her toddler for a few hours… and stop, because there isn’t really anywhere to walk. Toys, books, crayons, clothes and cookies are strewn ALL over the floor.

  • You’re trying to get out of a sports stadium after a big game, and all the people pushed up against you are a head taller than you… and really need deodorant.

overcrowded stadium makes you anxious

Add up your score. Did you score 12 or above?

I did. You probably did as well. And so did most normal adults taking this poll. Intense sensory stimulation causes us to be overwhelmed by our environment. Dopamine levels go down, cortisol levels go up, and our physical and mental selves experience that state as anxiety. We are totally on edge, and can’t wait to get home (or for the construction workers to go home) so we can dig directly into a bowl of chocolate-chip-cookie-dough ice cream.

Let’s pretend for a moment we’re in the shoes of a child (or an adult) with Sensory Processing Disorder.

The noise of children having a good time in the playground? It sounds like jackhammering.

two jackhammers at full blast

Your brother left a few Legos in the middle of your room? It feels like your entire toy closet was dumped out on the carpet.

Walking down the aisle in the supermarket? All the people passing by two feet away feel like they’re right next to you – and the food smells wafting out of their carts and off the shelves smell worse than an athlete after a summertime game.

And this might be happening all day, every day. Who wouldn’t be anxious?

Anxiety with a psychological basis usually appears only after a child has reached a certain age and stage of cognition. It also usually has some preceding cause, like bullying or trauma. For many, the event or situation can invoke feelings of anxiety that are recognized initially only by the subconscious, yet, upon further reflection and investigation the cause stems from a triggering source. In contrast, anxiety with a physiological basis can and does appear much younger, and without an apparent cause.

When children with Sensory Processing Disorder have everyday interactions with their environment, everyday stimuli are felt as uncomfortable and/or overwhelming. Dopamine levels go down, cortisol and adrenaline levels go up, and our children are anxious and on-edge.

Knee-Jerk Reaction?

Sensory integration issues aren’t the only physiological cause of anxiety. Sometimes reflex integration issues play a part.

Infants are born with certain reflexes, uncontrolled reactions to environmental stimuli. Any mother has seen these in action. Stroke your infant’s cheek – he turns and opens his mouth, trying to find something to suck. Slam a door – her arms fly wide open. (The bane of any mother trying to get her infant to sleep is when the infant suddenly flings her arms open and wakes herself up.)

baby startle moro reflex

That last reflex is known as the Moro reflex, or startle reflex. A sudden change in the infant’s environment, most notably loss of physical support, causes the infant to fling her arms open, then retract them, often accompanied by crying. The Moro reflex – like all primitive reflexes – serves a purpose in infanthood (assisting in starting the breathing process when the newborn first emerges, clinging to and alerting the mother should she inadvertently lose her hold on the infant, keeping the baby alert to potential threats). It is, however, supposed to be integrated by 4 months, replaced with the adult startle reflex.

Sometimes, however, it sticks around. And like all guests who outstay their welcome, the Moro reflex starts to cause trouble. Sudden changes in a child’s environment trigger this Moro reflex and cause cortisol to cascade through their body, accompanied by the feeling of stress.

Imagine you’re working on a project. You have 10 co-workers. Every time a co-worker says your name from outside your range of vision, you jump as if they had snuck up behind you and yelled BOO! straight into your ear. How productive will your day be? How will you feel after that day? Can anyone say “bowl of chocolate-chip-cookie-dough-ice-cream?”

While some children and adults with an unintegrated Moro reflex do actually physically startle, flinging their arms wide, most have learned to compensate. The startle still occurs, but it’s mainly internal.

child with unintegrated moro reflex

These are the children who can’t cope well when things don’t go as expected. You’re a minute late to pick up your child in preschool, and he’s already started to lose it. Your 6 year old daughter has all her dolls lined up in a particular order on her bed, and Heaven help us if her little brother moves one half an inch out of place. Your 9 year old son needs to wear his Superman baseball cap on math test days. If it’s a test day and he can’t find it, he’ll burst out crying and refuse to go to school.

“All in the Body,” Not “All in the Mind”

We’ve seen many of these children who have been to psychological therapies for their clear and present anxiety. The therapies usually worked to some extent, but the anxiety kept re-manifesting in different behaviors.


Because when anxiety is caused by a sensory integration issue or a reflex integration issue, the cause is physiological. Treating it as a psychological or behavioral issue will often help to minimize one particular manifestation of it. But the physiological response, having lost an outlet of expression, will look for a different outlet of expression. Your anxious, thumb-sucking child stops sucking her thumb – but then she turns into an anxious, nail-biting child. Her unintegrated Moro reflex is looking for an outlet. And it will find one.

nailbiting because of child anxiety

Once these children integrate these primitive reflexes – a process accomplished by a combination of physical exercises tailored to the child’s particular combination of unintegrated physical reflexes – the anxiety is solved at the root. No longer does the child feel so threatened in the face of a sudden change. No longer do they startle internally and feel the need to control their environment in order to protect themselves.

They are able to acclimate appropriately to changes in their environment, actively engage in the dynamics of the relationships around them, look forward to new experiences with a sense of “I can handle this; bring it on” and all the while their personality and joy of life comes shining through.

In February 2018, we ran a live teleconference on Child Anxiety + Sleeping and Feeding Red Flags. To find out more about the causes of child anxiety, learn what you can do about it, and hear the long Q&A session that followed the presentation, purchase access to the recording in our Store. Don’t miss it!


  1. Dana Noack on April 13, 2021 at 10:59 am

    Wow! Fantastic article.
    A few months ago I found out about Primitive Reflexes. After reading quite a few articles and blog posts, this explains it so well. Plus, I’m at the fork in the road for my 9 yr old son. He’s about to take his PR assessment. I was not sure about how much additional help; occupational therapy, behavioral therapy, he is in vision therapy. He is on the waiting list for a neuropsychologist. Your article makes me feel better about the wait.

    • Amy and Evelyn Guttmann on May 13, 2021 at 9:15 am

      So happy it was helpful, Dana! 🙂
      We hope you find the right resources and therapy for your son. Dealing with these challenges is not an easy road for anyone, but your son is very fortunate to have a parent who is putting so much time and thought into helping him progress and grow.
      It might be worthwhile checking into an evaluation of his vestibular system. Almost all kids that end up in our practice – especially when they have multiple challenges – have some kind of vestibular component as well. And because the vestibular system is so foundational, when it is out of whack it can have an impact on a wide range of emotional and behavioral areas.
      Wishing you the best of luck,
      Amy and Evelyn

      • Kay on September 1, 2021 at 11:33 pm

        This is a fabulous article. Thank you so much for this great concise information! I’m just starting my 14-year-old son in OT and wish I done it years ago. Why does OT seem to exclusively work with younger children when It’s OK it comes to sensory integration and primative reflex integration? Have y’all seen success and working with teens and adults in integrating reflexes?

        • Amy and Evelyn Guttmann on September 10, 2021 at 2:45 am

          Thanks so much, Kay! We’re happy you found it informative.
          Targeted sensory integration therapy and primitive reflex integration DO work effectively for children of all ages. While it is true that addressing any issue is easier when a child is younger, as there are less demands on them from a physical, social, academic and behavioral perspective, if a teenager is looking to help themselves and willing to engage in the movements and exercises that target the areas of concern, the changes may take a little longer, but they are definitely achievable.
          In addition to the targeted therapy to remediate the issues (which, as just mentioned, is a process that can take a little while), there are almost always compensatory techniques and coping skills that can be provided to the young adult to help them more immediately manage with their symptoms and provide them with a repertoire of coping mechanisms.
          If you have any specific questions you want to ask about your son, you’re welcome to join our Live Clubhouse chat every Friday from 10:15AM – 11:15AM EST. We discuss topics on Neuroscience in Parenting and do 1:1 sessions upon request.
          Wishing you and your son a successful OT process,
          Amy and Evelyn

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