One of the biggest lessons I’ve learned in my work with neurodevelopment is this: just because a milestone wasn’t fully integrated in the first few years of life doesn’t mean it’s too late. The brain is plastic and is capable of great change. Development is a continuum. And the patterns we see in older children and teenagers often have deep roots in the earliest years.

We spend a lot of time talking about reflex and sensory motor integration along with cerebellar function that are both necessary and interdependent for proper development and praxis. It makes sense to discuss these issues in terms of a newborn to understand how things emerge and integrate. But, what about our older children, teens, and young adults? It may be clear to us now that critical pieces were not integrated or missed when they were developing, but what can we do now?

When thinking about our older children and teens, we need to ask: What pieces of early development didn’t fully integrate? Primitive reflexes, incomplete or absent sensorimotor foundations, and faulty midline orientation don’t just disappear if they weren’t addressed in infancy—they linger, often in ways that are subtle but impactful.

Revisiting the Foundations and Recognizing their Impacts

The first years of life are all about sequential development—one skill lays the groundwork for the next. Reflexes emerge, integrate, and dissapear in concert with higher levels of integration. This in turn pushes development. For better and for worse.

When something in that sequence was skipped, done inefficiently, or never fully refined, it shows up later in ways we don’t always recognize as neurodevelopmental gaps.

It is also important to recognize patterns. It is no coincidence that babies begin babbling during lower levels of organization. This integration is what sets the foundation for more complex praxis of motor and speech development. Incoming sensory information needs to be accurately and completely relayed to the cortex for processing…and the cerebellum also plays a massive role in coordinating all the functions. As baby begins to 4 pt creep properly and begin transitioning to stand, we hear changes in speech and see differences in fine motor and processing skills. This continues on throughout development because praxis depends on developmental integration – it does not matter whether we are talking about first steps or first words.

What Incomplete Integration Might Look Like in Teens

In two words: Problem List.

• Struggles with coordination? Might be lingering asymmetrical tonic neck reflex (ATNR) or weak cross-body movement.

• Poor posture and core strength? Could stem from an unintegrated Tonic Labyrinthine Reflex (TLR), weak vestibular processing, poor integration with cerebellum.

• Difficulty focusing or sitting still? Possibly a retained Moro reflex or an underdeveloped proprioceptive system might be at play.

• Avoidance of certain movements or exercises? May indicate gaps in vestibular integration or sensory processing.

Bringing Integration Into the Teen Years

The good news? We can revisit these early developmental stages and integrate them—at any age. The key is to work with the nervous system in a way that respects where the brain is now while addressing those earlier gaps.

Let’s be real. Our teens have their own self concepts and desires. Bringing up “programs” or “activities” sends the message that something is “wrong” with them. It can set up a contentious environment as well. The beauty of having a teenager is that there can be partnership. My teen needs ways to keep his brain growing and learning – and so do I. My son needs a daily routine of exercise, and so do I. My teen resents being “controlled” with tasks lists…and so do I.

We have a beautiful opportunity to change our mindsets from problem-based thinking, to dreaming of what we can create together. When we do these things together, we allow ourselves to be vulnerable. It’s good to let our sons and daughters see us make mistakes and struggle with something. It’s even better when they can teach or help us. Before we can talk about building neurodevelopmental routines for neuroplacticity, we must focus on our own mindsets and relationships.

Lucas isn’t going to do “therapy,” or contrived activities. But he enjoys our walks and runs. He loves challenging himself to complete 5K’s on the interactive treadmill. He loves the challenge of layering things and the novelty of experiencing new things. Most of all, he love achieving a new thing and being proud of himself. I will not disrespect him by giving him an activity I would give a baby. I would also not disrepect him by telling him what to do and not rolling up my sleeves and doing it with him.

He may be on the verge of adulthood, but I am in my 50’s. Continuing to grow my brain, laying down new circuits, keeping my body strong and healthy are all goals we share.

So, how do we revisit neurodevelopment and create system integration in our teens?

Here are some Ideas:

1. Midline Work – Many teens with Down syndrome still struggle with cross-body coordination. Drumming, dancing, martial arts, proper swimming technique, walking, running, and hiking are some ways to strengthen these pathways.

2. Reflex Integration Exercises – If you have identified specific reflexes that are persistent, targeted movements that mirror early reflex patterns can help integrate retained reflexes. There are many resources out there that teaches how to do this. A favorite resource of mine in The Symphony of Reflexes, by Bonnie L. Brandes MEd. There are also tons of videos and blogs online. Reflex Integration is having a moment. Unfortunately, it is mostly happening in application to other diagnoses such as autism and ADHD. (extra points if you can identify your own retained reflexes..hello Moro for me!)

3. Vestibular & Proprioceptive Input – Pilates, yoga, trampoline work, weight training, and rock climbing are some examples of ways to help refine balance, posture, and sensory organization.

4. Core Strength & Stability – Unintegrated reflexes often show up in poor posture and weak core engagement—functional strength training can help. Add a metronome or a balance challenge to these workouts to effectively target the cerebellum as well.

5. Regulation & Breathwork – Mindfulness, controlled breathing, and sensory input (like weighted blankets or compression work) can regulate an overactive nervous system. Humming, chanting, or listening to low bass tones calms the vagal nerve plexus that shifts the system out of flight/fight/freeze. Always layer components for maximim impact. Lucas and I love doing simple mindfullness activities while we walk…”What is everything that you see? Now, what is everything that you smell? and so on., then after a couple minutes, we run, or high knees, or cross march, or do jumping jacks… as fast as we possibly can for 15-20 seconds. (High intensity intervals specifically targets BDNF which downregulates certain over-expressed genes. It also has been proven to increase neuronal and dendritic growth.)

It’s Never Too Late for the Brain to Learn

There is nothing as a mother, OT, and advocate, that angers me more than when the traditional world writes off our children’ ‘s ability to develop, learn, and change, after a certain age. This tendency to write off difficulties with speech as “Apraxia,” difficulties with math and reading as “learning plateaus,” – not to mention challenges with health as “That’s just DS,” – and worst of all, the outdated and disproven idea that there is a “Critical window of time,” and when than window is closed we must focus on compensation and modification.

Let’s Create Something Amazing for our Teens and Young Adults

Change our mindset to ppossibility. Create a strong and mutually respectful relationship with our sons and daughters standing on the scary precipice of adulthood. Create novel experiences that allow us to learn and grow together. And always ambrace a healthy dose of being unapologetically unrealistic.

It’s not about going backward; it’s about finding and integrating the missing pieces so our sons and daughters can move forward in the strongest way possible.