The Assymmetric Tonic Neck Response (ATNR) and Vertical Midline Barrier (VMB)

An Immature Movement Response which interferes with Reading:

The Vertical Midline Barrier (VMB)


Dee J. Coulter

It has been found that many children with learning difficulties over the age of seven or eight still exhibit signs of incomplete maturation of movement responses.  These responses should have been “integrated” into their central nervous system as part of their normal maturation in the first seven years.  The Asymmetric Tonic Neck Response (ATNR) which can interfere with reading and writing is described in this article.



Original Function

In newborns/early infants, the head and outstretched arm move as a ‘pair’.  As the outstretched arm is drawn in toward the head, the opposite arm is drawn in toward the head, the opposite arm extends out and the head turns to face the extended arm.  This helps the child learn the range of his or her body’s territory and the child begins to learn to coordinate the grasp ad to master the linkage of eye with hand that will be so important in life. 

Normal Maturation

Crawling on hands and knees integrates this movement response, since the head must turn toward each arm as it reaches forward.  This serves to neutralize the ATNR or ‘erase’ it.  If the child doesn’t crawl, other movements can also help in the maturation process, but it is more likely that the child will not have overcome the automatic movement response as fully. ‘Crawls’ that are a seated scooting movement also fail to address the maturation of this response.

Signs of ATNR Presence

When the child is jumping on a trampoline or rebounder, rolling hula hoops along the ground or reaching out to move something, the unused arm will reach upward toward the side of the head and the fingers of that hand will curl together.


When the child is on hands and knees and turning the head to one side to see an object placed in that visual field, the other arm will buckle and the fingers of that hand will curl. It is also possible to have a retention of the ATNR on one side of the body, but to have it fully matured on the other side.  In this case, to compensate for the problematic side, a child will favor one side of the body over the other in athletic maneuvers and may assume unusual postures while studying.

This movement response (ATNR) can return with whiplash accidents, even in adults, and it will then need to be worked through again with rehabilitation exercises.

Handicapping condition of ATNR retention

When the child (or adult) is reading, in the typical reading posture with the book centered, the retention of this movement response will cause fatigue within 15 or 20 minutes at the most.  Extended seat work or reading will often cause headaches in people with severe ATNR problems.  It is very common to have this problem after a closed head injury.


In athletics, the presence of the ATNR may cause ‘tennis elbow’ from the subtle resistance, by this movement response, to bringing the racket toward the body.  The retention of the ATNR may also cause a hook or slice in golf from the tendency to lift the head away from the bent arm, it may lead to erratic breath patterns in swimming from the arm ‘violating’ the movement response (ATNR) when a breath is to be taken. In basketball, this movement response may interfere with the ability to do front cross dribbling.  Finally, a retention of the ATNR may be one cause of ‘fender bender’ car accidents: the driver has to make a sudden stop, reaches out with the right hand (left hand when car is driven on the left side of the road) to avoid the falling forward of loose items on the front right seat, the head accordingly responds by turning to the right (left) and the left (right) arm by bending.  The steering wheel thereby is turned to the right (left) and the car hits another car on the right (left).

Corrective activities for the ATNR

 Begin with activities that are in the horizontal plane, since these are developmentally earlier and simpler exercises.  Log rolling games (where the child rolls across the floor or down a small hill with arms either to the sides or stretched above the head) and rolling in a barrel are good beginning exercises.  Then, progress to children’s games that involve arms swinging across the body; for example, ‘London Bridge’ (where partners sway arms to toss the captured child back and forth) and any ‘tunnel’ games where outstretched arms form a tunnel against the wall or with a partner.  Always try to create a game out of the activity to preoccupy the mind, so the body can do the motor activity without cognitive controls.  The goal is to have the movement practice occur in an automating way.  If the child always does it under ‘cortical’ or conscious brain control, it will only create a ‘splinter skill’ that disappears once the mind attends to something else.  Then, the immature movement response (ATNR) will continue to interfere with learning tasks.  Your goal is to have the mature motor activity become automatic.


Game suggestions

1.       Do log rolls with children lying on the floor and saying words, “Roly poly, pickery pack, go see what you can see, roly, poly, pickery pack and now come back to me.”

2.       Stand perpendicular to a wall and lean against it with one extended arm; bend the other arm, placing the hand on the hip, and turn the head towards this bent arm.

3.       Roll in a cardboard box or barrel, a barrel with old carpeting inside gives an added tactile experience.

4.       Play the game of ‘London Bridge’ in the verse “take the key and lock her up” tossle the ‘captured person’ back and forth, thus creating shoulder rolls.

Causes of ATNR retention

                Failure to crawl or do other movements that could ‘erase’ this movement response is thought to contribute to the persistence of the ATNR. Also, there is some indication that yeast allergies, which can arise from overuse of antibiotics, may be a contributing factor.  The ATNR can also reappear following a whiplash accident, even in adults.  Some bodywork practice work directly with immature movement response maturation as well.  The Feldenkrais approach is a good example and might be especially effective with victims of whiplash or older individuals for whom children’s games are less appropriate.


Original function

Originally, the vertical midline barrier creates a useful barrier which makes it difficult or impossible for the infant and very young child to use either hand to do tasks on the opposite hand’s side of the body.  This forces the child to use both hands. Without this barrier, children might grow to rely so heavily on their chosen hand that the other side of the body would not grow into full functioning.  The barrier also enhances the capacities of the body to behave in symmetrical ways.

Normal Maturation

This barrier remains active until about age six or seven.  It is at this time that handedness is firmly established, and the brain is undergoing a growth spurt that triggers the transformations leading to concrete thinking. The body is readying itself for the vast array of asymmetrical tasks that lie ahead.

Nearly all organized sports activities are basically asymmetrical practices.  What one does on one side of the body is not then done of the other side – one learn to kick, throw, catch, or turn one’s body emphasizing one side of the body over the other.  For that reason, it is inappropriate to introduce these activities until after the vertical midline barrier has been integrated.

Signs of Vertical Midline Barrier Presence

When asked to touch with both hands “head, shoulders, knees, toes, elbows, waist,” the child will perform well except for the cue “elbows”. At this cue (s)he will either attempt to curl each hand back toward its own elbow (sign of full presence of the midline barrier) or touch one elbow at a time with the opposite hand (sign of a residual midline barrier which may be fading).

When handprints are placed on the floor in pairs so that alternate pairs are laid out left hand on left side and right hand on right side, and the other pairs are laid out in a crossed pattern, where left hand is on right side and right hand is on left side, the child with a vertical midline barrier will be unable to crawl along the trail of handprints by placing the hands on the proper places across the midline. When encountering the crossed pattern, the child will either turn the hand over so the palm is facing up to match the hand pattern without crossing the midline at all (sign of full presence of the midline barrier) or will do one hand at a time, leaning way over wit the body to lessen the crossover (sign of residual midline).

When writing or drawing, the child will lean on one arm and reach out with the other in order to work on the paper which is pushed over to the side, away from the midline. When asked to stand and make small, medium and large arm circles, the large circles won’t overlap in front of the body as they should.  When doing jigsaw puzzles, the child avoids searching for or selecting pieces that are on the opposite side of the puzzle from where they are to be places, since that involves crossing the midline.

Handicapping Condition of Midline Barriers

Children who still retain a vertical midline barrier will lose their place easily when reading and when copying from the board or from another piece of paper.  This makes them very slow at copying tasks.  They will often forget to borrow in arithmetic and to cross t’s or dot i’s since these tasks usually involve crossing the midline.

Silent reading comprehension will be poor because the eyes will jerk at the midline causing them to miss those words.  With oral reading, however, they may be excellent, because their brains ca compensate for this problem by comparing what they say with what makes sense.

They will use visual cues heavily in figuring out words, since phonics decoding strategies demand too much cortically, and they are already very challenged.  They will not want to read for pleasure.  They will also be poor at dressing themselves since that involves many midline tasks (zippers, buttons, tying shoes, etc.).  Later, adult tasks like sawing wood, shuffling cards and striking matches will be difficult as well.

Corrective activities

All two-handed tasks are excellent practices.  Weaving, working with clay, craft work, playing recorder or xylophone or doing mundane tasks like sweeping, raking or pouring are all valuable exercises.  May game activities are helpful – juggling, blowing party blowers, riding on platter swings with a center rope, playing tether ball, or playing flashlight tag in the dark (while lying on their backs on the floor).

It is also helpful to stimulate the extremities so they become more conscious for the child – wheelbarrow walking, hand or foot massages, going barefoot, wearing wristbands, and Marbles Between Toes Exercise from the Extra Lesson.

Causes of Retention of Immature Midline Barrier

Oxygen deprivation at or near birth, poor prenatal diet and birthing that didn’t involve pressure to the head (breech births and some C-sections) are thought to be causes.  Many hospitals send C-section babies home with skull caps to wear for the first 3 months to compensate for this lack of organizing pressure.

Dee Coulter, Ed.D. Ph.D., is on the faculty at the Naropa Insitute, Boulder, Colorado and received her degree I Neurological Studies from the University of Northern Colorado.  Dr. Coulter is a nationally know neuro-science educator.  She freelances as a consultant and has CDs available on subjects such as : Music Education and Cognitive Development.  She also directs her correspondence course Neurology and Learning, through the University of Northern Colorado.  She may be addressed at Kindling Touch Insitutes, 4850 Niwot Road, Longmont, Colorado 80503, USA.