Autism Therapists in Acton, MA

Photo of Adrian Rivera, LICSW, LCSW, Clinical Social Work/Therapist
Adrian Rivera
Clinical Social Work/Therapist, LICSW, LCSW
Verified Verified
Acton, MA 01720
I support people of all ages with personal or relationship challenges, mood/anxiety disorders, neuro-developmental differences (ADHD/ Autism) and provide educational counseling and advocacy.
Some people struggle for weeks, months, or even years before considering psychotherapy. And it makes sense — it's hard to confide in a stranger and can take a while to find the right fit. We want authenticity and experience in a therapist but also someone relatable and easy to talk with. When couples counseling, family therapy, or child/adolescent support is needed, the search may seem even more daunting. We need a clinician with the interpersonal skills, temperament, and adaptability to forge a meaningful connection with our partners, children, and the networks who support them.
I support people of all ages with personal or relationship challenges, mood/anxiety disorders, neuro-developmental differences (ADHD/ Autism) and provide educational counseling and advocacy.
Some people struggle for weeks, months, or even years before considering psychotherapy. And it makes sense — it's hard to confide in a stranger and can take a while to find the right fit. We want authenticity and experience in a therapist but also someone relatable and easy to talk with. When couples counseling, family therapy, or child/adolescent support is needed, the search may seem even more daunting. We need a clinician with the interpersonal skills, temperament, and adaptability to forge a meaningful connection with our partners, children, and the networks who support them.
(978) 938-9017 View (978) 938-9017
Photo of Emily Hogan, MA, LMFT, PMH-C, Marriage & Family Therapist
Emily Hogan
Marriage & Family Therapist, MA, LMFT, PMH-C
Verified Verified
1 Endorsed
Acton, MA 01720  (Online Only)
Hello! I’m glad you’re here. We all face challenges in life, and you are worth the support you're seeking. I am a unique fit for you if you identify as LGBTQIA+, neurodivergent, and/or chronically ill (these often overlap, especially EDS, POTS, MCAS, ME/CFS, long COVID, autoimmune). Perhaps you are here because you are facing medical trauma, new or ongoing disability, adult diagnosis of ADHD/ autism, or sexuality/gender identity questions. If you would like support with trauma, I am fully EMDR trained. I am also a certified perinatal therapist and can support you in all aspects of your fertility, pregnancy, or parenthood journey.
Hello! I’m glad you’re here. We all face challenges in life, and you are worth the support you're seeking. I am a unique fit for you if you identify as LGBTQIA+, neurodivergent, and/or chronically ill (these often overlap, especially EDS, POTS, MCAS, ME/CFS, long COVID, autoimmune). Perhaps you are here because you are facing medical trauma, new or ongoing disability, adult diagnosis of ADHD/ autism, or sexuality/gender identity questions. If you would like support with trauma, I am fully EMDR trained. I am also a certified perinatal therapist and can support you in all aspects of your fertility, pregnancy, or parenthood journey.
(978) 485-4824 View (978) 485-4824
Photo of Shanna R Kraai, LICSW, Clinical Social Work/Therapist
Shanna R Kraai
Clinical Social Work/Therapist, LICSW
Verified Verified
Acton, MA 01720
I specialize in overcontrolled personality challenges including anxiety, autism, learning difficulties, and emotional regulation challenges.
I bring over 15 years of experience as a clinician, with expertise in the areas of research, child welfare, juvenile justice, domestic and international school systems, and private practice therapy and assessment. I am passionate about mental health and aspire to create a climate of empathy, creativity, and understanding with families. I am a skilled clinician who strives to build resilience and adaptability in all my clients.
I specialize in overcontrolled personality challenges including anxiety, autism, learning difficulties, and emotional regulation challenges.
I bring over 15 years of experience as a clinician, with expertise in the areas of research, child welfare, juvenile justice, domestic and international school systems, and private practice therapy and assessment. I am passionate about mental health and aspire to create a climate of empathy, creativity, and understanding with families. I am a skilled clinician who strives to build resilience and adaptability in all my clients.
(978) 295-2967 View (978) 295-2967
Photo of Lara Buchanan, MSW, LICSW, Clinical Social Work/Therapist
Lara Buchanan
Clinical Social Work/Therapist, MSW, LICSW
Verified Verified
1 Endorsed
Acton, MA 01718
I have been a clinical social worker in practice for almost 20 years, working with children, adolescents, and parents. My practice focuses on supporting children in developing the tools, strategies, and self-awareness to navigate life's inevitable stresses and challenges. I have particular training and experience in treating anxiety and depression and helping children cope with divorce, loss, and other challenges. I also have worked extensively with children and adolescents on the Autism Spectrum. My work with parents focuses on supporting their child's growth and development.
I have been a clinical social worker in practice for almost 20 years, working with children, adolescents, and parents. My practice focuses on supporting children in developing the tools, strategies, and self-awareness to navigate life's inevitable stresses and challenges. I have particular training and experience in treating anxiety and depression and helping children cope with divorce, loss, and other challenges. I also have worked extensively with children and adolescents on the Autism Spectrum. My work with parents focuses on supporting their child's growth and development.
(978) 231-9723 View (978) 231-9723
Photo of Elise Jacobson, LICSW, Clinical Social Work/Therapist
Elise Jacobson
Clinical Social Work/Therapist, LICSW
Verified Verified
Acton, MA 01720  (Online Only)
Waitlist for new clients
I’ve helped many adults and children seeking support during times of transition, emotional confusion or family stress. Practice members are looking to understand themselves, improve relationships and their parenting. Some struggle to explain themselves clearly and effectively. Many of my clients are seeking a PDA affirming and trained practitioner.
I’ve helped many adults and children seeking support during times of transition, emotional confusion or family stress. Practice members are looking to understand themselves, improve relationships and their parenting. Some struggle to explain themselves clearly and effectively. Many of my clients are seeking a PDA affirming and trained practitioner.
(508) 444-8739 View (508) 444-8739
Photo of Zucel Leiva Lopez, MEd, LMHC, Counselor
Zucel Leiva Lopez
Counselor, MEd, LMHC
Verified Verified
Acton, MA 01720
The complexity of life can affect our everyday functioning, and how we choose to deal with conflict. We are all affected by conflict. Sometimes we need support to regulate our emotions and make authentic decisions. We all deserve to live fulfilling lives and access the tools we need. I enjoy helping people find their path to emotional well-being. I provide a safe, nurturing, and positive therapeutic space. I honor the client’s experiences and strengths.
The complexity of life can affect our everyday functioning, and how we choose to deal with conflict. We are all affected by conflict. Sometimes we need support to regulate our emotions and make authentic decisions. We all deserve to live fulfilling lives and access the tools we need. I enjoy helping people find their path to emotional well-being. I provide a safe, nurturing, and positive therapeutic space. I honor the client’s experiences and strengths.
(978) 396-4243 View (978) 396-4243
Photo of Betsy Wilk Katz, LMHC, LPC, RDMT, MA, CT, Licensed Professional Counselor
Betsy Wilk Katz
Licensed Professional Counselor, LMHC, LPC, RDMT, MA, CT
Verified Verified
1 Endorsed
Acton, MA 01720  (Online Only)
My therapeutic style is warm, open and supportive; and my hope is to create a safe, non-judgmental space. I am an eclectic clinician, but tend to borrow heavily from humanistic, person-centered, strengths-based work. I share these styles through the expressive art therapies. It is my fundamental ethic and value to view my clients as whole, and who are made up of a multitude of gifts, talents and strengths. I have many years experience working with adults, young adults and teens.. Is your child having difficulty with self-esteem, mental health, and coping abilities? I am here to help you.
My therapeutic style is warm, open and supportive; and my hope is to create a safe, non-judgmental space. I am an eclectic clinician, but tend to borrow heavily from humanistic, person-centered, strengths-based work. I share these styles through the expressive art therapies. It is my fundamental ethic and value to view my clients as whole, and who are made up of a multitude of gifts, talents and strengths. I have many years experience working with adults, young adults and teens.. Is your child having difficulty with self-esteem, mental health, and coping abilities? I am here to help you.
(475) 405-2905 View (475) 405-2905
Photo of Susan Hunter-Jones, MSW, LICSW, Clinical Social Work/Therapist
Susan Hunter-Jones
Clinical Social Work/Therapist, MSW, LICSW
Verified Verified
Acton, MA 01720
Using a holistic approach I provide a safe and trusting space for you to share, reflect, and learn. If you are feeling anxious, depressed, or facing challenges in your life, I can help. As we work together through the therapeutic process it is my goal to help you discover renewed strength and energy to make healthy decisions and change negative patterns of thinking, behaving, and interacting. You will learn coping strategies that enable you to view yourself through a new and gentler lens and find happiness in the simple joys of daily living.
Using a holistic approach I provide a safe and trusting space for you to share, reflect, and learn. If you are feeling anxious, depressed, or facing challenges in your life, I can help. As we work together through the therapeutic process it is my goal to help you discover renewed strength and energy to make healthy decisions and change negative patterns of thinking, behaving, and interacting. You will learn coping strategies that enable you to view yourself through a new and gentler lens and find happiness in the simple joys of daily living.
(508) 433-7051 View (508) 433-7051
Photo of Errika Gravlin, MAT
Errika Gravlin
MAT
Verified Verified
Acton, MA 01720
I am a CTI-trained Transformational Coach with a deep appreciation for the inherent creativity, resourcefulness, and wholeness within each individual. I believe in the power of personal transformation and spiritual growth to create profound change in our lives. As a professionally trained and experienced transformational coach, I have the tools and understanding to help you create the life you imagine and regain a renewed sense of self.
I am a CTI-trained Transformational Coach with a deep appreciation for the inherent creativity, resourcefulness, and wholeness within each individual. I believe in the power of personal transformation and spiritual growth to create profound change in our lives. As a professionally trained and experienced transformational coach, I have the tools and understanding to help you create the life you imagine and regain a renewed sense of self.
(978) 486-7246 View (978) 486-7246
Photo of Heather Veague, PhD, Psychologist
Heather Veague
Psychologist, PhD
Verified Verified
Acton, MA 01720
Many young people who come to meet with me are apprehensive about therapy. They might worry that I will be silent, expecting them to fill the space with what's difficult to express. Alternatively, they might have encountered therapists who speak more than listen, resulting in a session that feels like a class. Therapy is an investment of time and resources. If you're willing to open yourself up to me, I can promise you that you will be heard, and I will engage authentically. My job is to help you grow to weather emotional storms and build the life you want.
Many young people who come to meet with me are apprehensive about therapy. They might worry that I will be silent, expecting them to fill the space with what's difficult to express. Alternatively, they might have encountered therapists who speak more than listen, resulting in a session that feels like a class. Therapy is an investment of time and resources. If you're willing to open yourself up to me, I can promise you that you will be heard, and I will engage authentically. My job is to help you grow to weather emotional storms and build the life you want.
(508) 545-7491 View (508) 545-7491
Photo of Alexandra Lee Barbar, LICSW, Clinical Social Work/Therapist
Alexandra Lee Barbar
Clinical Social Work/Therapist, LICSW
Verified Verified
Acton, MA 01720
Always coming from a place of respect, warmth and authenticity I provide psychotherapy to children, adolescents and adults. It is my belief and has been my experience that individuals are resilient and have a wealth of resources within. Drawing from 27 years of training and experience in a variety of settings, we will use a collaborative approach to unearth and/or to build on strengths that develop insight and that foster healing and growth.
Always coming from a place of respect, warmth and authenticity I provide psychotherapy to children, adolescents and adults. It is my belief and has been my experience that individuals are resilient and have a wealth of resources within. Drawing from 27 years of training and experience in a variety of settings, we will use a collaborative approach to unearth and/or to build on strengths that develop insight and that foster healing and growth.
(978) 234-2314 View (978) 234-2314
Photo of Rosanna M Casavecchia, OTR/L, MT, CEAS, Occupational Therapist
Rosanna M Casavecchia
Occupational Therapist, OTR/L, MT, CEAS
Verified Verified
1 Endorsed
Acton, MA 01720
To establish a relationship with a therapist takes time and can be rewarding when you are able to build trust, knowing you are able to confide and share your perspective, your story. This process allows the individual the opportunity to gain clarity in a setting that is confidential and accepting. All too often emotional/physical pain can have a significant impact on our ability to remain independent, self-reliant, engaged in everyday tasks and life roles at level of independence that is rewarding to oneself and those they care for. As an Occupational Therapist with a background in behavioral health, I take a holistic approach.
To establish a relationship with a therapist takes time and can be rewarding when you are able to build trust, knowing you are able to confide and share your perspective, your story. This process allows the individual the opportunity to gain clarity in a setting that is confidential and accepting. All too often emotional/physical pain can have a significant impact on our ability to remain independent, self-reliant, engaged in everyday tasks and life roles at level of independence that is rewarding to oneself and those they care for. As an Occupational Therapist with a background in behavioral health, I take a holistic approach.
(978) 733-2586 View (978) 733-2586

More Therapists Nearby

Photo of Lisa Burke, LICSW, Clinical Social Work/Therapist
Lisa Burke
Clinical Social Work/Therapist, LICSW
Verified Verified
Concord, MA 01742
Waitlist for new clients
***My caseload is currently full, please contact me to be added to my waitlist.*** I left my job as a Program Director, at McLean Hospital to bring my clinical knowledge and training to the suburbs. I work with children, adolescents and young adults, who struggle with depression, anxiety, difficulties regulating emotions, self-harm, suicidal ideation and borderline personality disorder (BPD). I also have experience treating those with mild intellectual disability, Autism and behavioral disorders. I'm certified in Cognitive Behavioral Therapy Interventions from Boston University and I am trained in DBT, from Behavioral Tech, LLC
***My caseload is currently full, please contact me to be added to my waitlist.*** I left my job as a Program Director, at McLean Hospital to bring my clinical knowledge and training to the suburbs. I work with children, adolescents and young adults, who struggle with depression, anxiety, difficulties regulating emotions, self-harm, suicidal ideation and borderline personality disorder (BPD). I also have experience treating those with mild intellectual disability, Autism and behavioral disorders. I'm certified in Cognitive Behavioral Therapy Interventions from Boston University and I am trained in DBT, from Behavioral Tech, LLC
(617) 981-6522 View (617) 981-6522
Photo of Sophia Sgarlat, LCSW, Clinical Social Work/Therapist
Sophia Sgarlat
Clinical Social Work/Therapist, LCSW
Verified Verified
Sudbury, MA 01776
I specialize in ADHD, Autism, Depression, SI, and Anxiety, with experience in art & garden therapies.
Do you think you may have ADHD or Autism? Have you struggled to assert boundaries at work, with family, & partners? Have you felt curious about exploring different pronouns and gender identity? Do you feel bad that you have a disability and don't know how to tell your friends that you can't do certain activities? You may have goals to tell your friends your preferred pronouns. Goals to get a diagnosis for your disability & curious about medication, goals to reevaluate your relationship with cannabis/alcohol. You may feel shame & anger about your childhood & the way your parents handled your behavior.
I specialize in ADHD, Autism, Depression, SI, and Anxiety, with experience in art & garden therapies.
Do you think you may have ADHD or Autism? Have you struggled to assert boundaries at work, with family, & partners? Have you felt curious about exploring different pronouns and gender identity? Do you feel bad that you have a disability and don't know how to tell your friends that you can't do certain activities? You may have goals to tell your friends your preferred pronouns. Goals to get a diagnosis for your disability & curious about medication, goals to reevaluate your relationship with cannabis/alcohol. You may feel shame & anger about your childhood & the way your parents handled your behavior.
(339) 237-4320 View (339) 237-4320
Photo of Francesca Rinaldi, MS, BCBA, LABA
Francesca Rinaldi
MS, BCBA, LABA
Verified Verified
Westford, MA 01886  (Online Only)
I am accepting new clients for immediate virtual openings. I am a board certified licensed behavior analyst (BCBA/LABA) and work with adults and adolescents who have a diagnosis of Autism Spectrum Disorder looking to improve their wellbeing and change behavior to live their best lives. As a behavior analyst I aim to promote positive behavior change in the home, at school, at work, and in the community for the individuals I serve. My goal is to offer effective therapy that is person centered and focuses on all of the goals that my clients hope to accomplish.
I am accepting new clients for immediate virtual openings. I am a board certified licensed behavior analyst (BCBA/LABA) and work with adults and adolescents who have a diagnosis of Autism Spectrum Disorder looking to improve their wellbeing and change behavior to live their best lives. As a behavior analyst I aim to promote positive behavior change in the home, at school, at work, and in the community for the individuals I serve. My goal is to offer effective therapy that is person centered and focuses on all of the goals that my clients hope to accomplish.
(978) 991-9078 View (978) 991-9078
Photo of Sue Schmitz, LMHC, ATR, Counselor
Sue Schmitz
Counselor, LMHC, ATR
Verified Verified
Hudson, MA 01749
Sue is a Licensed Mental Health Counselor and registered Art Therapist. After studying psychology and studio art at Dartmouth College, Sue attended Lesley University’s Mental Health Counseling and Art Therapy program, graduating in 2012. Sue has worked with adults and children with depression, anxiety, trauma, thought disorders, and substance use, as well as oncology patients, homeless and low-income women, and youth on the autism spectrum.
Sue is a Licensed Mental Health Counselor and registered Art Therapist. After studying psychology and studio art at Dartmouth College, Sue attended Lesley University’s Mental Health Counseling and Art Therapy program, graduating in 2012. Sue has worked with adults and children with depression, anxiety, trauma, thought disorders, and substance use, as well as oncology patients, homeless and low-income women, and youth on the autism spectrum.
(351) 200-5926 View (351) 200-5926
Photo of Greg O'Rourke, MA, Counselor
Greg O'Rourke
Counselor, MA
Verified Verified
1 Endorsed
Concord, MA 01742  (Online Only)
I specialize in helping individuals dealing with relationship issues, despression, grief, autism (including what used to be called Asperger's Syndrome), OCD, bipolar disorder, and mood disorders.
Are you feeling overwhelmed by anxiety, depression, ADHD or perhaps the stress from significant life changes? You're not alone. We often face these challenges and search for effective ways to cope and seek a life where we can feel truly at peace and fulfilled. Together, we'll explore strategies to manage your emotions and daily stresses, aiming to unlock deep self-compassion and resilience. This journey is about empowering you to live confidently and realize your dreams, providing the support you need every step of the way.
I specialize in helping individuals dealing with relationship issues, despression, grief, autism (including what used to be called Asperger's Syndrome), OCD, bipolar disorder, and mood disorders.
Are you feeling overwhelmed by anxiety, depression, ADHD or perhaps the stress from significant life changes? You're not alone. We often face these challenges and search for effective ways to cope and seek a life where we can feel truly at peace and fulfilled. Together, we'll explore strategies to manage your emotions and daily stresses, aiming to unlock deep self-compassion and resilience. This journey is about empowering you to live confidently and realize your dreams, providing the support you need every step of the way.
(508) 290-8354 View (508) 290-8354
Photo of Hannah Gilbert, MSW, LCSW, Clinical Social Work/Therapist
Hannah Gilbert
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
2 Endorsed
Chelmsford, MA 01824
Hannah earned her Master’s Degree in Social Work at Simmons University in Boston, and her Bachelor’s Degree in Psychology from Rivier University, in Nashua New Hampshire. Hannah enjoys working with children, adolescents, college aged individuals, and adults. She has experience in anxiety and depression, adjustment disorders, Autism Spectrum Disorders, Intellectual Disabilities, as well as Schizophrenia in addition to normal life stressors.
Hannah earned her Master’s Degree in Social Work at Simmons University in Boston, and her Bachelor’s Degree in Psychology from Rivier University, in Nashua New Hampshire. Hannah enjoys working with children, adolescents, college aged individuals, and adults. She has experience in anxiety and depression, adjustment disorders, Autism Spectrum Disorders, Intellectual Disabilities, as well as Schizophrenia in addition to normal life stressors.
(978) 330-1277 View (978) 330-1277
Photo of Meredith Cohen, MA, PhD, Psychologist
Meredith Cohen
Psychologist, MA, PhD
Verified Verified
Bedford, MA 01730
My neuropsychological evaluation expertise includes ADHD, learning disorders, autism, anxiety, and mood disorders.
My practice is divided between therapy and neuropsychological evaluations. I draw from several therapeutic approaches, including cognitive behavioral therapy (CBT), relational theory, family systems therapy, and other researched-based techniques, including mindfulness. My neuropsychological evaluations are comprehensive, and I provide detailed and relevant recommendations that target clients' daily life activities and settings (school, workplace, home, community). I aim to emphasize strengths and affirm all identities, including neurodiversity. Please see my website for more information-drmeredithcohen.com.
My neuropsychological evaluation expertise includes ADHD, learning disorders, autism, anxiety, and mood disorders.
My practice is divided between therapy and neuropsychological evaluations. I draw from several therapeutic approaches, including cognitive behavioral therapy (CBT), relational theory, family systems therapy, and other researched-based techniques, including mindfulness. My neuropsychological evaluations are comprehensive, and I provide detailed and relevant recommendations that target clients' daily life activities and settings (school, workplace, home, community). I aim to emphasize strengths and affirm all identities, including neurodiversity. Please see my website for more information-drmeredithcohen.com.
(781) 519-4731 View (781) 519-4731
Photo of Jesse Lowe, CLC, MA, AAMFT, APFM
Jesse Lowe
CLC, MA, AAMFT, APFM
Verified Verified
Devens, MA 01434  (Online Only)
Whether navigating special education, developing a unique rhythm at home, figuring out how to practice self care with Autism, PANS/PANDAS, PDA, or chronic illness, or simply creating a homeschool plan, my clients often need specialized support and encouragement.
In my 20+ years of working with young people and their caregivers, I have been guided by a deep respect for my clients and their unique experiences, perspectives, and needs. My coaching centers around supporting youth and caregivers to find their best path forward by holding space for them as they uncover what works best. As a parent/caregiver consultant and educator, I seek to situate young people's unique needs in the context of the secure base caregivers can provide. I draw from my extensive experience with a wide range of neurodiverse clients to provide support and resources.
Whether navigating special education, developing a unique rhythm at home, figuring out how to practice self care with Autism, PANS/PANDAS, PDA, or chronic illness, or simply creating a homeschool plan, my clients often need specialized support and encouragement.
In my 20+ years of working with young people and their caregivers, I have been guided by a deep respect for my clients and their unique experiences, perspectives, and needs. My coaching centers around supporting youth and caregivers to find their best path forward by holding space for them as they uncover what works best. As a parent/caregiver consultant and educator, I seek to situate young people's unique needs in the context of the secure base caregivers can provide. I draw from my extensive experience with a wide range of neurodiverse clients to provide support and resources.
(978) 310-3840 View (978) 310-3840
Autism Therapists

What is the most effective treatment for autism?

Applied Behavior Analysis (ABA) has come to be considered the standard treatment for children with autism spectrum disorder, and research has confirmed its effectiveness for many children. Therapists trained in ABA techniques work with children (and their parents) on developing social skills, communication and learning abilities, and everyday habits of hygiene and grooming. The clinician will tailor their program to the child’s particular need but the overarching goal will be to help them advance as far as possible toward independence based on their level of symptoms and decrease the need for additional special services. Families should seek a mental health professional specifically trained in ABA, and holding special certification in the technique, who has extensive experience not only with the approach but in using it with children with the same level of symptoms as the child who needs care.

How does ABA work?

Applied Behavior Analysis (ABA) sessions, which typically focus on positive reinforcement, can be intensive, lasting two or more hours several times a week, and continuing for two years or more. Therapists can also be expected to ask parents to take an active role in reinforcing lessons. Research has found that the technique can lead to major improvements that decrease the need for additional special services.

How does treatment for autism work?

Therapy sessions based on Applied Behavior Analysis will likely be frequent, intensive, and highly structured. After a thorough assessment, a therapist will help a child understand and develop skills in a range of areas, including communication, motor skills, social skills, self-care, play, and academic skills, as well as routines of daily living like hygiene. Typically, the therapist will help a child break down the components of a behavior—often referred to as the antecedent (what prompts an action), the behavior, and the consequence(what immediately follows)—and then reward the child at every step, while also asking parents to reinforce the lessons, and the rewards, throughout the day. This core therapy may be supplemented by occupational or speech therapy, and antidepressants, antipsychotics, and anticonvulsants may be prescribed to address specific severe symptoms.

How long does therapy for autism take?

Some people with autism spectrum disorder may be engaged in some level of therapy for many years, but research shows that treatment will be most effective if it is begun early and delivered intensively. When therapy begins by age 3, children tend to be better able to grasp and adopt the skills needed to manage everyday life, including attending school and establishing social relationships. This type of early-intervention treatment regimen is highly structured, typically involving 20 to 40 hours of one-on-one therapy per week, along with additional hours of engagement managed by parents, for a period of two years or more, although the duration of treatment is dependent on the child’s level of symptoms and pace of progress.