Larvae are found in leaf beds of quieter waters which provide cover and foraging sites.

Adults create retreats by shoveling sand and gravel with their snouts, forming a cavity beneath cover objects.

A pair of Neuse River waterdogs crawl slowly, with the male trailing the female by 2–4 cm.

After several slow circles are made, the males moves parallel to the female and places his limbs over her back.

[citation needed] Adults feed from the mouths of their retreats or move about in search of prey at night.

Adults mainly prey on snails, earthworms, isopods, amphipods, mayflies, stoneflies, caddisflies, true flies, and fish.

Other prey include: slugs, leeches, spiders, crayfish, centipedes, millipedes, odonates, hellgrammites, beetles, caterpillars, and salamanders.

Other prey items of larva include: earthworms, caldocerans, isopods, amphipods, collembolans, odonates, and stoneflies along with other insects.

Mainly preyed on by fish, Neuse River waterdogs produce chemical defenses to ward off these predators.

While the Neuse River waterdog is overall ranked of least concern by the International Union for Conservation of Nature, they are assessed as having a decreasing population trend.

[1] Predominant threats to the species are habitat degradation and destruction due to agricultural pollution, development and humans' modification of streams by channelization and impoundment.