A nervous-system-based approach to demand sensitivity for kids, teens, adults, and the parents trying to help them.
If your child refuses everyday demands in ways that seem extreme, and reward charts, consequences, and gentle parenting scripts have all made things worse, you may be looking at Pathological Demand Avoidance (PDA). The reason the usual tools haven't worked is because they target behavior, and PDA isn't a behavior problem. It's a nervous system that reads demands as threat.
In a typical nervous system, a demand ("put on your shoes") registers as a neutral request. In a PDA nervous system, the same demand registers as a threat, neurologically. The child isn't choosing to refuse. Their body is doing what bodies do under threat: fight, flight, freeze, or fawn. Everything that follows — the tantrum, the bargaining, the shutdown, the bolt out of the room — is what a threat response looks like in a kid who doesn't have words for what just happened.
The confusing part is that the content of the demand doesn't matter much. A PDA nervous system can react the same way to "put on your shoes" as to "do your homework." It's not about how hard the demand is. It's about the demand itself being perceived as a loss of autonomy.
I co-developed the RELATE framework with Rachelle Manco, LCSW. It's a structured way of working with PDA that focuses on the nervous system mechanism directly instead of trying to reshape behavior from the outside. It's designed for clinicians to use with families, and it's also available as a parent book for parents who want to implement the approach at home. Both are at relatepda.com.
When I work with PDA families or demand-sensitive adults directly, RELATE is the underlying model I use in the room. It's not a set of scripts. It's a way of understanding and responding to the nervous system state that's driving the avoidance, and it works in ways that compliance-based approaches don't.
Book your first session through Tava Health. You can verify your insurance in about 30 seconds and see my real availability. If you want to read more first, the Your Child Refuses Everything and You Don't Know Why article on my blog goes deeper into how I think about this work. The specialties page covers everything else I work with.