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Prevalence of primitive reflexes and or frontal release sign in the substance abuse populations

Oeyvind Andreassen1*, Sverre M. Nesvåg2 and Anne-Lill M. Nja2
  • 1 Salvation Army Treatment Center Stavanger (FAB), FAB, Norway
  • 2 Regionalt kompetansesenter for rusmiddelforskning i Helse Vest, KORFOR, Norway

Abstract: Substance abuse populations have demonstrated a higher occurrence of Attention Deficit Hyperactive Disorder (ADHD) related symptoms than the general population. Recently, a link has been observed between ADHD, primitive reflexes [1] and Developmental Coordination Disorder (DCD) [2]. However, an underlying question is whether there a higher incident of primitive reflexes or frontal releasing among people with substance abuse. This work focuses on the asymmetrical tonic neck reflex (ATNR) and the Moro reflex to investigate a possible link between primitive reflexes and SUD populations. Results from this study demonstrate a prevalence of 84.6% and 61.5% among the SUD population for the ATNR and Moro reflexes, respectively, indicating a strong link between substance abuse and primitive reflexes. Introduction: People with substance abuse diagnosis (SUD), in general, have reduced their cognitive function both during and after substance use. Current knowledge indicates that it can take up to a year post substance abuse to recover cognitive function [3], [4]. The presence of primitive reflexes are linked to ADHD and other neurological disorders, and learning disorders such as functional disconnection. Literature has suggested that this is due to a maturational delay [5]. The prevalence of ADHD among the average population is 2-4.4% [6], while among the Swedish Penal System, the prevalence of ADHD is substantially higher at 40% [7]. Method: The study was conducted at a pretreatment facility before rehabilitation and directly after detox that is a part of the Norwegian Public Specialist Healthcare System. Candidates was include within two weeks after detoxing in a state run and controlled detox facility. 13 inpatients to the pretreatment facility consented to participate in the study. From the 13 participants, 11 were male and 2 were female. Measurement of primitive reflexes The asymmetrical tonic neck reflex was assessed using the Schilder Test [8]. The test position was demonstrated and explained to each participant as follows: «Stand upright with feet together and arms held straight out front at shoulder level, with wrists relaxed. The patient was asked to close their eyes and keep there hands in the same position, only moving the head 70 to 80 degrees, or the chin touches the shoulder. The practitioner stands behind the patient and turns the patient head to the left, holding the position for five-seconds and then returning to the starting position. Then the same was performed on the right side. ». The procedure was performed twice. Positive signs of the test are; the movement of the extended arms in the same direction as the head turns, dropping of the arms or swaying and loss of balance [9], [10]. Moro reflex or Erect test for Vestibular-activated Moro [11], [12]. Test position: The subject stands with feet together, arms and body at a 45-degree angle with hands flexed at the wrists. Test procedure: The examiner stands behind the subject and instructs the patient to bend their head back as if looking in the ceiling, and closes their eyes. Note that any arm movements or loss of balance, as a result of putting the head in extension, indicates a positive finding. Once the subject has stabilized in this position, the practitioner instructs the patient to stand still and fall backwards when an audio cue is given. The practitioner must be prepared to catch the full weight of the subject. Positive signs: abductions of arms, falling back, inhaling, or crying when losing center of gravity [13], [14]. The study was approved by the regional ethics comity (REK) helse Vest and performed with the Helsinki deceleration. Results: Results from the study size of 13 people with SUD, 11 (84.6%) tested positive for asymmetrical tonic neck reflex and 8 out of 13 (61.5%) tested positive for the Moro reflex. The Medcalc.org program was used for ATNR with the study finding contradicting literature values with a prevalence of 40%. Significance level P=0.0010 with 95%CI of observed proportion 55% to 98% Discussion: Primitive reflexes are movement patterns that emerge during fetal life and are critical for the survival of the newborn infant. These reflexes are readily elicited during the first six months of life. As the nervous system develops, primitive reflexes are inhibited or transformed. The persistence of primitive reflexes beyond their normal time span of 1-2 months, interfere with subsequent development and indicates neurological impairment [15]. The occurrence of primitive reflexes varies from 0% to 30-40% in the general population for ATNR [11] and up to 84.6% in the SUD population. The study with a prevalence of 0% ATNR by Vreeling et al.[16], [17] used the Schiler test on 30 medical students. The presence of primitive reflexes is considered a soft sign (NSS) and a part of DCD in literature [15]. In literature there are treatment protocols for reintegration of primitive reflexes [18], and combined with vestibular rehabilitation, the therapy is more effective [19]–[22], [12], [23] . In this study, a primitive reflex prevalence of 84.6% (ATNR) and 61.5% (Moro reflex) was observed. The results indicate that primitive reflexes should be investigated in the treatment regime of SUD patients. A protocol based on literature should be tested to see whether SUD patients can benefit from this form of therapy, as other patient groups with similar issues have like children with DCD [20]. Weakness and conflict of interest. There was only one practitioner testing for the primitive reflex and the testing was not filmed to prevent tester bias and more control. The literature on primitive reflexes contains a mix of old and recent data. Primitive reflex tests performed in previous studies are not identical in all studies in the literature. Conclusion and further work: This study indicates that there is a significant higher prevalence of primitive reflex (also called frontal release signs) 84.6% (ATNR) and 61.5% (Moro reflex) in the SUD population than in the general population from literature (0-40%). Further studies should be conducted with ADHD prevalence among SUD population, primitive reflexes and treatment regime for such populations.

Acknowledgements

The Norwegian ministry of health and Social Affairs, and the Salvation army of Norway

References

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Keywords: frontal release sign, Primitive reflex, ADHD, SUD, ATNR, Moro reflex, DCD

Conference: International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.

Presentation Type: Poster

Topic: Clinical Applications in health, disease, and injury to the nervous system

Citation: Andreassen O, Nesvåg SM and Nja AM (2018). Prevalence of primitive reflexes and or frontal release sign in the substance abuse populations. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience 2018. doi: 10.3389/conf.fneur.2018.60.00031

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Received: 26 Mar 2018; Published Online: 14 Dec 2018.

* Correspondence: Dr. Oeyvind Andreassen, Salvation Army Treatment Center Stavanger (FAB), FAB, Stavanger, Rogaland, 4017, Norway, oyandreassen@gmail.com