Autism Therapists in Grapevine, TX
![Photo of Scott Hickman - Texas Autism Assessment & Advocacy Group, PsyD, Psychologist](https://photos.psychologytoday.com/8033ca2d-ad96-49e4-add8-108f97847dbc/2/320x400.jpeg)
Due to the complexity of Autism Spectrum Disorders, Texas Autism Assessment and Advocacy Group feels that a multidisciplinary approach to assessment is imperative in determining an appropriate and accurate diagnosis. In our practice, each evaluation is conducted by a Licensed Psychology Associate with over 15 years experience as a Licensed Specialist in School Psychology, along with a licensed Speech-Language Pathologist. The knowledge and expertise of each discipline allows for a unique and collaborative approach to assessment in order to address the varied aspects of functioning affected and to determine an appropriate diagnosis.
Due to the complexity of Autism Spectrum Disorders, Texas Autism Assessment and Advocacy Group feels that a multidisciplinary approach to assessment is imperative in determining an appropriate and accurate diagnosis. In our practice, each evaluation is conducted by a Licensed Psychology Associate with over 15 years experience as a Licensed Specialist in School Psychology, along with a licensed Speech-Language Pathologist. The knowledge and expertise of each discipline allows for a unique and collaborative approach to assessment in order to address the varied aspects of functioning affected and to determine an appropriate diagnosis.
![Photo of Dr. Rozemarijn (Rosie) Staal - Ardent Psychological Services, PLLC, PsyD, Psychologist](https://photos.psychologytoday.com/47540d00-5f70-431c-9b7e-64f680133ca6/1/320x400.jpeg)
Common reasons for referral include ADHD, autism, intellectual disability, academic concerns, mood disorders, and behavior problems at home or at school.
Dr. Rozemarijn (Rosie) Staal is a warm and caring clinical psychologist who has been trained to use cognitive-behavioral therapy (CBT) and interpersonal therapy to help individuals improve their overall emotional well-being. In clinical practice, Dr. Staal focuses on delivering evidence-based treatments, and she has experience working with children, adolescents, and adults with a wide variety of emotional and behavioral concerns, in inpatient, residential, and outpatient settings.
Common reasons for referral include ADHD, autism, intellectual disability, academic concerns, mood disorders, and behavior problems at home or at school.
Dr. Rozemarijn (Rosie) Staal is a warm and caring clinical psychologist who has been trained to use cognitive-behavioral therapy (CBT) and interpersonal therapy to help individuals improve their overall emotional well-being. In clinical practice, Dr. Staal focuses on delivering evidence-based treatments, and she has experience working with children, adolescents, and adults with a wide variety of emotional and behavioral concerns, in inpatient, residential, and outpatient settings.
![Photo of Apree Clicque - Assessments by Dallas Therapeutic Services, PsyD, LPC, LCDC, Psychologist](https://photos.psychologytoday.com/e47c6287-cb6f-4a53-ac4b-8dee7773f86e/2/320x400.jpeg)
Assessments by Dallas Therapeutic Services
Psychologist, PsyD, LPC, LCDC
Verified Verified
1 Endorsed
Grapevine, TX 76051
To assess for Autism, we administer the ADOS-2 and ADI-R.
Psychological testing is a method of gathering and analyzing individualized data in order to better understand an individual’s personality, including diagnostic criteria and how the brain functions across a variety of tasks, such as attention or problem solving. Currently, DTS is able to offer in-depth diagnosis testing (including ADHD testing) as well as Autism testing, learning disorders, and IQ testing. The cost varies for each testing, starting at $1500. While we are in network with insurance (Aetna, BCBS, Cigna and Tricare), they do not always cover the cost of testing.
To assess for Autism, we administer the ADOS-2 and ADI-R.
Psychological testing is a method of gathering and analyzing individualized data in order to better understand an individual’s personality, including diagnostic criteria and how the brain functions across a variety of tasks, such as attention or problem solving. Currently, DTS is able to offer in-depth diagnosis testing (including ADHD testing) as well as Autism testing, learning disorders, and IQ testing. The cost varies for each testing, starting at $1500. While we are in network with insurance (Aetna, BCBS, Cigna and Tricare), they do not always cover the cost of testing.
![Photo of Kristy S Hagar, PhD, Psychologist](https://photos.psychologytoday.com/3c169e81-46cd-11ea-a6ad-06142c356176/3/320x400.jpeg)
I have extensive experience working with a wide range of developmental disorders including ADHD, Autism-spectrum disorders, learning disabilities, anxiety disorders, pediatric pain (including headaches, stomachaches), and other medical conditions impacting cognitive, academic, psychosocial, and emotional functioning.
I provide assessment and consultation services to meet the needs of children, adolescents, and young adults. My goal is to provide a continuum of support as children grow and develop from preschool to young adulthood/college-age. If you or your child is experiencing learning or achievement difficulties, social or adjustment problems, or fears and worries that are disrupting daily life, we can develop a plan of action to address these concerns.
I have extensive experience working with a wide range of developmental disorders including ADHD, Autism-spectrum disorders, learning disabilities, anxiety disorders, pediatric pain (including headaches, stomachaches), and other medical conditions impacting cognitive, academic, psychosocial, and emotional functioning.
I provide assessment and consultation services to meet the needs of children, adolescents, and young adults. My goal is to provide a continuum of support as children grow and develop from preschool to young adulthood/college-age. If you or your child is experiencing learning or achievement difficulties, social or adjustment problems, or fears and worries that are disrupting daily life, we can develop a plan of action to address these concerns.
![Photo of Miles O'Brien, LPCA, MA](https://photos.psychologytoday.com/08322276-13f6-4d27-8adb-a9ca82781ee4/2/320x400.png)
Miles O'Brien
Licensed Professional Counselor Associate, LPCA, MA
Verified Verified
Grapevine, TX 76051
I also focus on: Trauma, Feeling lost, Helping helpers, Emotional balance, Reaching goals, Bipolar 1 and 2, Depression, Borderline, Anxiety, Autism.
My approach is to meet you where you are with empathy and caring. To support you in life regardless of what you have been through. Regardless of if you hate yourself or love yourself or how stuck you feel. I hope to support you to reach your goals, and if I can't, to help you find someone who can. This space is for you. What do you want to do? Who do you want to become? Whether all hope is lost or you just can't figure something out. Whether you have been diagnosed with a disorder, you just don't feel happy where you are, or you want to learn how to be healthier. My approach helps you become more of who you are and be whole again.
I also focus on: Trauma, Feeling lost, Helping helpers, Emotional balance, Reaching goals, Bipolar 1 and 2, Depression, Borderline, Anxiety, Autism.
My approach is to meet you where you are with empathy and caring. To support you in life regardless of what you have been through. Regardless of if you hate yourself or love yourself or how stuck you feel. I hope to support you to reach your goals, and if I can't, to help you find someone who can. This space is for you. What do you want to do? Who do you want to become? Whether all hope is lost or you just can't figure something out. Whether you have been diagnosed with a disorder, you just don't feel happy where you are, or you want to learn how to be healthier. My approach helps you become more of who you are and be whole again.
![Photo of Miles O'Brien - Met Where You Are, LPCA, MA](https://photos.psychologytoday.com/fbc57a97-4798-44be-bd08-bd38fab54a6f/1/320x400.jpeg)
Met Where You Are
Licensed Professional Counselor Associate, LPCA, MA
Verified Verified
Grapevine, TX 76051
I also focus on: Trauma, Feeling lost, Helping helpers, Emotional balance, Reaching goals, Bipolar 1 and 2, Depression, Borderline, Anxiety, Autism.
My approach is to meet you where you are with empathy and caring. To support you in life regardless of what you have been through. Regardless of if you hate yourself or love yourself or how stuck you feel. I hope to support you to reach your goals, and if I can't, to help you find someone who can. This space is for you. What do you want to do? Who do you want to become? Whether all hope is lost or you just can't figure something out. Whether you have been diagnosed with a disorder, you just don't feel happy where you are, or you want to learn how to be healthier. My approach helps you become more of who you are and be whole again.
I also focus on: Trauma, Feeling lost, Helping helpers, Emotional balance, Reaching goals, Bipolar 1 and 2, Depression, Borderline, Anxiety, Autism.
My approach is to meet you where you are with empathy and caring. To support you in life regardless of what you have been through. Regardless of if you hate yourself or love yourself or how stuck you feel. I hope to support you to reach your goals, and if I can't, to help you find someone who can. This space is for you. What do you want to do? Who do you want to become? Whether all hope is lost or you just can't figure something out. Whether you have been diagnosed with a disorder, you just don't feel happy where you are, or you want to learn how to be healthier. My approach helps you become more of who you are and be whole again.
![Photo of Chelsea Apree Clicque - Dallas Therapeutic Services, PsyD, LPC, LCDC, Psychologist](https://photos.psychologytoday.com/200d0de2-3bfa-4072-8a13-4bdf15eb6baf/2/320x400.jpeg)
Dallas Therapeutic Services is a group practice uniquely managed to fit the needs of most clients! When the group formed, care was taken to choose clinicians with a variety of backgrounds and specialities. We want to provide an environment, where we can match clients with their best fit therapist. Additionally, we are able to psychological testing for ADHD, Autism, IQ (processing speed, working memory, comprehension and perceptual reasoning as well IQ score) and personality (diagnosis) - all of which can help with differentiating diagnoses and planning treatment accordingly.
Dallas Therapeutic Services is a group practice uniquely managed to fit the needs of most clients! When the group formed, care was taken to choose clinicians with a variety of backgrounds and specialities. We want to provide an environment, where we can match clients with their best fit therapist. Additionally, we are able to psychological testing for ADHD, Autism, IQ (processing speed, working memory, comprehension and perceptual reasoning as well IQ score) and personality (diagnosis) - all of which can help with differentiating diagnoses and planning treatment accordingly.
![Photo of Kristen Diou, MS, LPC, RPT, Licensed Professional Counselor](https://photos.psychologytoday.com/4a4ac208-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
Kristen Diou
Licensed Professional Counselor, MS, LPC, RPT
Verified Verified
4 Endorsed
Grapevine, TX 76051
I love helping kids, teens and young adults find confidence and joy in how they show up in the world. My clients have felt misunderstood for much of their lives and struggle with expressing themselves in a healthy way. Together, I help my clients express themselves without judgment and learn new coping skills.
I love helping kids, teens and young adults find confidence and joy in how they show up in the world. My clients have felt misunderstood for much of their lives and struggle with expressing themselves in a healthy way. Together, I help my clients express themselves without judgment and learn new coping skills.
![Photo of Madeline Blue, LPC, Licensed Professional Counselor](https://photos.psychologytoday.com/857f4c23-f50b-40de-ab80-6e78ad338b07/2/320x400.jpeg)
I am a child and teen therapist that specializes in helping kids and teens manage their feelings, anxieties and impulses. I support my clients to understand and verbalize their feelings as well improve social skills. I use both talk therapy and play therapy depending on the developmental level of my client. I view parents and myself as a team working together to help your child become the best version of themselves. I am an AutPlay Certified provider, I am currently working towards my certification to become a Registered Play Therapist and I am EMDR trained.
I am a child and teen therapist that specializes in helping kids and teens manage their feelings, anxieties and impulses. I support my clients to understand and verbalize their feelings as well improve social skills. I use both talk therapy and play therapy depending on the developmental level of my client. I view parents and myself as a team working together to help your child become the best version of themselves. I am an AutPlay Certified provider, I am currently working towards my certification to become a Registered Play Therapist and I am EMDR trained.
![Photo of Susan E Melton, MA, LPC-A](https://photos.psychologytoday.com/d88e8ab3-8d24-4441-a26e-d0d33b5aa639/3/320x400.jpeg)
Susan E Melton
Licensed Professional Counselor Associate, MA, LPC-A
Verified Verified
1 Endorsed
Grapevine, TX 76051
Most of us find ourselves needing support and encouragement when life struggles begin to feel overwhelming. We all are looking to find balance and achieve to our best ability through these struggles. I believe this is the role of therapy. In my experience, therapy is best when individualized not only to the situation that is overwhelming but also to our unique problem-solving abilities. I am a compassionate and understanding therapist that specializes in clients with unique challenges, ADHD, learning disabilities, Deaf, or hard of hearing, and caregiving. Together, we will achieve balance and insight using your unique abilities.
Most of us find ourselves needing support and encouragement when life struggles begin to feel overwhelming. We all are looking to find balance and achieve to our best ability through these struggles. I believe this is the role of therapy. In my experience, therapy is best when individualized not only to the situation that is overwhelming but also to our unique problem-solving abilities. I am a compassionate and understanding therapist that specializes in clients with unique challenges, ADHD, learning disabilities, Deaf, or hard of hearing, and caregiving. Together, we will achieve balance and insight using your unique abilities.
![Photo of Mylie Greenbach, LPC, PhD, Licensed Professional Counselor](https://photos.psychologytoday.com/6cda5760-afc9-4211-9a46-53d1d04049a7/2/320x400.jpeg)
I am a licensed professional counselor and a Ph.D. candidate with clinical experience starting in 2005. I assist individuals, couples, and families in resolving issues such as ADHD, Anger Management, Anxiety, Coping Skills, Behavioral Issues, Aging, Bipolar Disorder, Borderline Personality, Career Counseling, Codependency, Depression, Domestic Abuse/Violence, Life Coaching, Family Conflict, Emotional Disturbance, Life Transitions, Job Stress, Grief, and many more. I use a mix of Couples ACT, EFT, EMDR, DBT, CBT, MBCT, and many more. I believe in building on my client's strengths to attain the growth and changes they want to achieve.
I am a licensed professional counselor and a Ph.D. candidate with clinical experience starting in 2005. I assist individuals, couples, and families in resolving issues such as ADHD, Anger Management, Anxiety, Coping Skills, Behavioral Issues, Aging, Bipolar Disorder, Borderline Personality, Career Counseling, Codependency, Depression, Domestic Abuse/Violence, Life Coaching, Family Conflict, Emotional Disturbance, Life Transitions, Job Stress, Grief, and many more. I use a mix of Couples ACT, EFT, EMDR, DBT, CBT, MBCT, and many more. I believe in building on my client's strengths to attain the growth and changes they want to achieve.
15 Second Videos
Miles O'Brien
Met Where You Are
Katrina Will Colwick
Terah Harrison
Ann Marie Leist
![Photo of Marla Klein, MS, LPC, Licensed Professional Counselor](https://photos.psychologytoday.com/02012b1e-d654-41ac-b6d3-ec3ee36f1573/2/320x400.jpeg)
Marla Klein
Licensed Professional Counselor, MS, LPC
Verified Verified
3 Endorsed
Grapevine, TX 76051
Life stressors can contribute to feelings of anxiety, depression, loneliness, and even hopelessness. If you are feeling any of these, know that you are not alone. I work with clients to re-examine stressful situations in a safe, judgement free environment. Together we can identify goals and solutions to problems that cause pain and confusion and work to improve communication, coping skills and self-esteem.
Life stressors can contribute to feelings of anxiety, depression, loneliness, and even hopelessness. If you are feeling any of these, know that you are not alone. I work with clients to re-examine stressful situations in a safe, judgement free environment. Together we can identify goals and solutions to problems that cause pain and confusion and work to improve communication, coping skills and self-esteem.
![Photo of Katrina Will Colwick, MA, LMFT, Marriage & Family Therapist](https://photos.psychologytoday.com/3cb1d45c-46cd-11ea-a6ad-06142c356176/3/320x400.jpeg)
Katrina Will Colwick
Marriage & Family Therapist, MA, LMFT
Verified Verified
10 Endorsed
Grapevine, TX 76051
Our lives are filled with both joy and sadness, comforts and fears, strengths and weaknesses. At times we may feel that the negativity in our lives is more than we can handle. Those are times when seeking out counseling can provide a great benefit. It is my great pleasure to work with many people to help them achieve their goals, find comfort and peace, and live well adjusted, fulfilling lives. I am blessed to have provided services to those needing help with: childhood disorders, grief, abuse, marriage and family conflict, bullying, stress management, parenting, faith crises, premarital and many more.
Our lives are filled with both joy and sadness, comforts and fears, strengths and weaknesses. At times we may feel that the negativity in our lives is more than we can handle. Those are times when seeking out counseling can provide a great benefit. It is my great pleasure to work with many people to help them achieve their goals, find comfort and peace, and live well adjusted, fulfilling lives. I am blessed to have provided services to those needing help with: childhood disorders, grief, abuse, marriage and family conflict, bullying, stress management, parenting, faith crises, premarital and many more.
![Photo of Tamra White, MA, LPC-S, Licensed Professional Counselor](https://photos.psychologytoday.com/449a2a48-a0d4-437d-a739-9ca0a704e3b2/1/320x400.jpeg)
It takes courage to reach out for assistance. I acknowledge that, and welcome you to an environment that asks questions, and promotes change! In my practice, I strive to make the client feel safe, comfortable, and understood from the moment we meet. The quality of the connection between the client and the therapist is fundamental to emotional growth and genuine change. I understand that there are certain feelings, problems, relationship dynamics and behaviors that one would like to feel better about as soon as possible. My practice does not ignore one's need for change in the here and now!
It takes courage to reach out for assistance. I acknowledge that, and welcome you to an environment that asks questions, and promotes change! In my practice, I strive to make the client feel safe, comfortable, and understood from the moment we meet. The quality of the connection between the client and the therapist is fundamental to emotional growth and genuine change. I understand that there are certain feelings, problems, relationship dynamics and behaviors that one would like to feel better about as soon as possible. My practice does not ignore one's need for change in the here and now!
![Photo of Terah Harrison, MA, LPC, NC, Licensed Professional Counselor](https://photos.psychologytoday.com/4fcefbc9-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
Terah Harrison
Licensed Professional Counselor, MA, LPC, NC
Verified Verified
1 Endorsed
Grapevine, TX 76051
My primary focus is working with clients who want to create healthier relationships and have more fulfilling connections. This can be for couples, families or individuals. Issues related to family of origin, friendships, intimate relationships, and relationships within families are often addressed in sessions. I also have experience with those struggling with anxiety, worry, and stress. In therapy I believe it is my role to be with clients on their journey of self discovery and acceptance and to build a healthy client-therapist relationship that they can take out into the world and use to build strong connections with others.
My primary focus is working with clients who want to create healthier relationships and have more fulfilling connections. This can be for couples, families or individuals. Issues related to family of origin, friendships, intimate relationships, and relationships within families are often addressed in sessions. I also have experience with those struggling with anxiety, worry, and stress. In therapy I believe it is my role to be with clients on their journey of self discovery and acceptance and to build a healthy client-therapist relationship that they can take out into the world and use to build strong connections with others.
![Photo of Ann Marie Leist, PsyD, Psychologist](https://photos.psychologytoday.com/3d8ba38a-46cd-11ea-a6ad-06142c356176/3/320x400.jpeg)
All individuals experience difficult times or crises in their lives. As an experienced, licensed psychologist, I would like to help you work through life's challenges. I am committed to helping my clients overcome obstacles and meet goals that will lead to lasting and meaningful changes in their lives. I have extensive training in treating children, adolescents, individuals, couples, and families in therapy.
All individuals experience difficult times or crises in their lives. As an experienced, licensed psychologist, I would like to help you work through life's challenges. I am committed to helping my clients overcome obstacles and meet goals that will lead to lasting and meaningful changes in their lives. I have extensive training in treating children, adolescents, individuals, couples, and families in therapy.
![Photo of Beth Lusby, PhD, Psychologist](https://photos.psychologytoday.com/3b80a61e-46cd-11ea-a6ad-06142c356176/6/320x400.jpeg)
Dr. Lusby focuses on the assessment and treatment of children and adolescents. Services available include psychological testing, neuropsychological testing, parent coaching, school consultation, and psychotherapy. We also provide behavioral plans based on school/home observation.
Dr. Lusby focuses on the assessment and treatment of children and adolescents. Services available include psychological testing, neuropsychological testing, parent coaching, school consultation, and psychotherapy. We also provide behavioral plans based on school/home observation.
![Photo of Megan M Shelton, LPC-S, Licensed Professional Counselor](https://photos.psychologytoday.com/4528e73f-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
Children and adolescents often struggle with the same difficult feelings and emotions that adults do, but they have limited ways of expressing themselves. Similarly, parents can find themselves at a loss to reach their child, often leading to stress, anxiety, and disconnection. I have spent years working with children, teens, and their families in order to create healthy coping skills and foster healing, growth, and connection. I am passionate about helping children reach their full potential in a safe environment to explore their thoughts and feelings and develop necessary skills to thrive.
Children and adolescents often struggle with the same difficult feelings and emotions that adults do, but they have limited ways of expressing themselves. Similarly, parents can find themselves at a loss to reach their child, often leading to stress, anxiety, and disconnection. I have spent years working with children, teens, and their families in order to create healthy coping skills and foster healing, growth, and connection. I am passionate about helping children reach their full potential in a safe environment to explore their thoughts and feelings and develop necessary skills to thrive.
![Photo of Mitchell Shane Hill - Mitch Hill, LCSW-S, LCSW-S, BA-Psyc, Clinical Social Work/Therapist](https://photos.psychologytoday.com/1ed53094-668e-4cdf-911c-824558414ba1/1/320x400.jpeg)
Mitch Hill, LCSW-S
Clinical Social Work/Therapist, LCSW-S, BA-Psyc
Verified Verified
Grapevine, TX 76051 (Online Only)
My practice is all about improving self-awareness, self-control, and resiliency. I also focus on strengthening overall family connection and support. I use an eclectic blend of evidence-based theories and experiential practice. That means using the best of science in ways that are real, relevant and in-the-moment.
My practice is all about improving self-awareness, self-control, and resiliency. I also focus on strengthening overall family connection and support. I use an eclectic blend of evidence-based theories and experiential practice. That means using the best of science in ways that are real, relevant and in-the-moment.
![Photo of Melanie A Burman, LCSW, Clinical Social Work/Therapist](https://photos.psychologytoday.com/3ccccdf8-46cd-11ea-a6ad-06142c356176/3/320x400.jpeg)
I have been in private practice in the Grapevine area for over 30 years. I treat adults, adolescents and couples in both individual and group therapy. I address issues such as anxiety, depression, parent/teen relationships, family relations, alcohol and drug abuse recovery and marital counseling.
I have been in private practice in the Grapevine area for over 30 years. I treat adults, adolescents and couples in both individual and group therapy. I address issues such as anxiety, depression, parent/teen relationships, family relations, alcohol and drug abuse recovery and marital counseling.
See more therapy options for Grapevine
Nearby Autism Therapists Searches for Grapevine
See More Autism TherapistsAutism 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.