Viewing Demand Avoidance Through a Neuroimmune Lens
Research on neuroimmune reactive avoidance (NRA).
Updated June 21, 2025 | Reviewed by Margaret Foley
Many parents face challenges when trying to work collaboratively with their children. For families raising neurodivergent kids, even simple routines can become complex and emotionally fraught.
As a clinician—and a PANDAS /AE mom ( pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections /autoimmune encephalitis)—I deeply understand the exhaustion of parenting under pressure, especially when carrying the weight of advice that doesn’t quite fit: “Just be firmer" or "Kids need clear boundaries .” But for some children, even the simplest request can feel overwhelming—a real threat to their nervous system . When we begin to understand what’s truly driving these responses, everything can shift. We create space for connection, healing, and more peaceful days.
This post introduces a trauma - and biology-informed understanding of demand avoidance through the lens of neuroimmunity and offers the concept of neuroimmune reactive avoidance (NRA).
Two Roots of Demand Avoidance
Over the years, I’ve seen two distinct patterns that drive intense avoidance behaviors. These can look similar on the surface, but they arise from very different causes—and require very different kinds of support.
Pattern One: When Control Feels Like Survival. Pathological demand avoidance (PDA), coined by Elizabeth Newson in the 1980s, is a profile observed in some neurodivergent individuals. Children with PDA often appear socially adept—expressive, imaginative, even charismatic . But underneath, their nervous system is on constant alert.
What PDA can look like:
PDA isn’t about being defiant; it’s a nervous system reacting to perceived threat. Even gentle suggestions can trigger panic. One parent told me, “It’s like my daughter has an internal allergy to being told what to do.”
Understanding PDA in this way opens the door to compassionate, effective support built on trust and emotional safety, not control.
Pattern Two: When Your Child’s Brain Feels Under Siege. The second pattern is something I refer to as neuroimmune reactive avoidance (NRA) (Odelya Gertel Kraybill, 2025). This is a newer and evolving area of understanding, but for many families, recognizing it has brought much-needed clarity—and hope.
NRA emerges when a child’s immune system becomes dysregulated and starts affecting the brain. This can happen after infections like strep throat, Lyme disease, or even common viruses. You may have heard of related conditions such as PANS (pediatric acute-onset neuropsychiatric syndrome) or PANDAS .
What makes NRA different:
A father I worked with put it into words many parents will recognize: "One day my son woke up and couldn’t handle us asking him to come upstairs for dinner. This was a kid who used to help set the table every night. It felt like someone had swapped our child for a different version of him."
In cases of NRA, the child’s avoidance isn't rooted in choice or defiance; it’s a neurological and immunological reaction. Understanding that their brain is under stress , not misbehaving, can completely shift how we support them—with gentleness, patience, and appropriate medical care.
The Crucial Difference: PDA vs. NRA
Understanding the distinction truly matters.
PDA: A Nervous System in Defense, Not Defiance. Pathological demand avoidance isn’t about refusal or rebellion; it’s a nervous system reacting to perceived threat. For children with PDA, even everyday requests can feel overwhelming. The focus isn’t on gaining compliance, but on reducing pressure and creating a sense of safety and connection.
Supportive Strategies:
The goal is not control, but co-regulation and trust. When a child feels safe, connection becomes possible—and through connection, cooperation can gently follow.
For NRA: Treat the Inflammation, Then Support the Child. Neuroimmune reactive avoidance (NRA) is not behavioral, it’s biological. When the brain is inflamed, everything from emotions to executive functioning can become dysregulated. The most meaningful support begins with recognizing this as a medical issue, not a discipline problem.
Understanding Changes Everything
Understanding the “why” behind demand avoidance transforms how we parent and support our children. When we shift from asking “How do I get them to listen?” to “What is their nervous system trying to tell me?” everything changes.
I’ve lost count of how many parents have cried in my clinic—not out of despair, but relief. Relief that they weren’t failing. Relief that their child wasn’t broken or “just being difficult.” Relief that someone finally named what was happening.
Many had spent years pursuing therapies that didn’t help, and hearing from professionals that their child was manipulative or in need of stricter parenting. These messages often felt like gaslighting , leading parents to question their own instincts and sanity. (See more on the medical gaslighting of PANDAS/PANS/AE parents here .)
One mother, through tears, shared: “For the first time in three years, I felt like I could breathe. My child wasn’t broken—and neither was I. We just needed a different map.”
That moment—when blame gives way to understanding—is often the beginning of healing.
Moving Forward With Compassion
Your child isn’t giving you a hard time; they’re having a hard time. There’s a world of difference in that perspective, and it changes everything. When we begin to see challenging behaviors as signals of distress rather than defiance, we unlock new ways to connect, support, and heal. (See more on attunement framework here .)
With the right understanding, both you and your child can begin to move toward calmer days, deeper trust, and a relationship built not on control but on connection.
You don’t have to walk this path alone. There is hope. And there is help.
To find a therapist, visit the Psychology Today Therapy Directory .
Share this post Facebook Bluesky Linkedin Email
There was a problem adding your email address. Please try again.
By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy
Odelya Gertel Kraybill, PhD, LCPC, is a psychoneuroimmunology and trauma therapist, scholar, and neurodivergent parenting expert.
Get the help you need from a therapist near you–a FREE service from Psychology Today.
This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.