Autism Counselling in Leederville, WA

Photo of Danielle Zappavigna, PsyBA General, Psychologist
Danielle Zappavigna
Psychologist, PsyBA General
Verified Verified
Leederville, WA 6007
I work with: anxiety and depression, difficulty adjusting to a life challenge or a life change, traumatic life events, difficult events in childhood, recovery from bullying, workplace issues, relationship problems, adjustment to diagnosis of ADHD and/or Autism, parents of children with disabilities and medical conditions.
I love being a psychologist. It’s a genuine pleasure and joy to work with people, to be invited to hear about their lives, their challenges and what they want for themselves. In working with people, I’m interested in tailoring therapy to each individual client. I recognise that every person has their unique way of being in the world and way of looking at the world, and so will have their own needs and wants in how therapy will work for them.
I work with: anxiety and depression, difficulty adjusting to a life challenge or a life change, traumatic life events, difficult events in childhood, recovery from bullying, workplace issues, relationship problems, adjustment to diagnosis of ADHD and/or Autism, parents of children with disabilities and medical conditions.
I love being a psychologist. It’s a genuine pleasure and joy to work with people, to be invited to hear about their lives, their challenges and what they want for themselves. In working with people, I’m interested in tailoring therapy to each individual client. I recognise that every person has their unique way of being in the world and way of looking at the world, and so will have their own needs and wants in how therapy will work for them.
(08) 6490 9769 View (08) 6490 9769
Photo of Tarryn Lara Scher, PsyBA General, Psychologist
Tarryn Lara Scher
Psychologist, PsyBA General
Verified Verified
Leederville, WA 6007
We offer assessment for those aged 4-18 years for ADHD, Dyslexia, Dysgraphia, Dyscalculia, cognitive and educational assessment, Autism, Intellectual Disability and more.
At Exploring Minds Psychology we are passionate about providing services to support children, adolescents (and their families), and adults under 30 years of age.
We offer assessment for those aged 4-18 years for ADHD, Dyslexia, Dysgraphia, Dyscalculia, cognitive and educational assessment, Autism, Intellectual Disability and more.
At Exploring Minds Psychology we are passionate about providing services to support children, adolescents (and their families), and adults under 30 years of age.
(08) 6493 7795 View (08) 6493 7795
Photo of Andy Hall, PhD, PsyBA General, Psychologist
Andy Hall
Psychologist, PhD, PsyBA General
Verified Verified
Leederville, WA 6007
I specialise in ADHD Assessment and therapeutic intervention. I am a general psychologist and a sport's tragic, with a passion for Australian cricket and for the St. George-Illawarra Dragons NRL team. My work focuses on diagnostic assessment and treatment for neurodevelopmental conditions such as ADHD and Autism in school-aged children, teens, and adults. My assessments are not only informed by interviews but also by testing that makes comparisons with people of similar age and gender to help inform whether the behaviours represent "full" ADHD, autism, only traits of the condition, or are masking other areas of concern.
I specialise in ADHD Assessment and therapeutic intervention. I am a general psychologist and a sport's tragic, with a passion for Australian cricket and for the St. George-Illawarra Dragons NRL team. My work focuses on diagnostic assessment and treatment for neurodevelopmental conditions such as ADHD and Autism in school-aged children, teens, and adults. My assessments are not only informed by interviews but also by testing that makes comparisons with people of similar age and gender to help inform whether the behaviours represent "full" ADHD, autism, only traits of the condition, or are masking other areas of concern.
(08) 6490 9856 View (08) 6490 9856
Photo of Caroline Spiers, ACA-L1, Counsellor
Caroline Spiers
Counsellor, ACA-L1
Verified Verified
1 Endorsed
Leederville, WA 6007  (Online Only)
I have lived experience as an adoptee and work with ADHD and autism plus couples and/or poly families.
Are you struggling with your life and feel you might have unresolved issues, trauma, relationship or neurodiversity challenges or managing family dynamics/adoptee/grief and loss, bereavement or cultural issues? LGBTQIA+ needs that aren’t being seen or understood? A good counsellor will allow you space to talk, guide you gently along your journey and provide safety and non judgement to explore what can be achieved. This is the foundation of my practice - always from a trauma informed perspective.
I have lived experience as an adoptee and work with ADHD and autism plus couples and/or poly families.
Are you struggling with your life and feel you might have unresolved issues, trauma, relationship or neurodiversity challenges or managing family dynamics/adoptee/grief and loss, bereavement or cultural issues? LGBTQIA+ needs that aren’t being seen or understood? A good counsellor will allow you space to talk, guide you gently along your journey and provide safety and non judgement to explore what can be achieved. This is the foundation of my practice - always from a trauma informed perspective.
(03) 7003 2855 View (03) 7003 2855
Photo of Kylie Mathieson, MPsych, PsyBA General, Psychologist
Kylie Mathieson
Psychologist, MPsych, PsyBA General
Verified Verified
Leederville, WA 6007
Kylie is well known for her holistic, down-to-earth and non-judgemental style. She has worked with clients across the developmental spectrum, using evidence-based approaches to support those impacted by anxiety, depression, mood fluctuations, autism, and ADHD. She also enjoys supporting the LGBTQIA+ community. Kylie has particular interests in helping individuals navigate difficult life transitions, adapt following diagnosis/illness, manage professional pressures; improve performance, and embed healthy lifestyle habits (e.g. movement, mindful awareness, sleep). Kylie has further qualifications in fitness and executive coaching.
Kylie is well known for her holistic, down-to-earth and non-judgemental style. She has worked with clients across the developmental spectrum, using evidence-based approaches to support those impacted by anxiety, depression, mood fluctuations, autism, and ADHD. She also enjoys supporting the LGBTQIA+ community. Kylie has particular interests in helping individuals navigate difficult life transitions, adapt following diagnosis/illness, manage professional pressures; improve performance, and embed healthy lifestyle habits (e.g. movement, mindful awareness, sleep). Kylie has further qualifications in fitness and executive coaching.
(08) 6556 9594 View (08) 6556 9594
Photo of Nicholas Fares, PsychD, PsyBA General, Psychologist
Nicholas Fares
Psychologist, PsychD, PsyBA General
Verified Verified
1 Endorsed
Leederville, WA 6007
Deciding to seek support is a big step, and I'd like to make it easier for you. I have a wide range of experience across different life stages. I've worked as an NDIS psychologist and behaviour specialist, in schools within the Department of Education, delivered outreach psychological services in aged care, and offered private psychological services to adults. This experience enables me to tackle a wide range of issues, from anxiety and depression to more complex developmental and psychological conditions. Additionally, I have a special interest in working with men and couples.
Deciding to seek support is a big step, and I'd like to make it easier for you. I have a wide range of experience across different life stages. I've worked as an NDIS psychologist and behaviour specialist, in schools within the Department of Education, delivered outreach psychological services in aged care, and offered private psychological services to adults. This experience enables me to tackle a wide range of issues, from anxiety and depression to more complex developmental and psychological conditions. Additionally, I have a special interest in working with men and couples.
(08) 6109 8152 View (08) 6109 8152
Photo of Amanda Oliver, MA, PACFA, Psychotherapist
Amanda Oliver
Psychotherapist, MA, PACFA
Verified Verified
1 Endorsed
Leederville, WA 6007
I am a Psychoanalytic Psychotherapist specialising in adolescents & adults. Formerly a high school teacher, I have a natural ability to quickly develop relationships with teenagers and specialise in complex issues often affecting adolescents and their families. These issues often recur in adult relationships affecting daily life. By processing and understanding the past, it opens up a way to be able to move forward & improve current relations. I am passionate about not just alleviating symptoms but helping you to understand and resolve patterns of behaviour. Working together, we determine goals and the direction of your therapy.
I am a Psychoanalytic Psychotherapist specialising in adolescents & adults. Formerly a high school teacher, I have a natural ability to quickly develop relationships with teenagers and specialise in complex issues often affecting adolescents and their families. These issues often recur in adult relationships affecting daily life. By processing and understanding the past, it opens up a way to be able to move forward & improve current relations. I am passionate about not just alleviating symptoms but helping you to understand and resolve patterns of behaviour. Working together, we determine goals and the direction of your therapy.
(08) 7079 4452 View (08) 7079 4452
Photo of Simon MacLachlan, MPsych, PsyBA - Clin. Psych, Psychologist
Simon MacLachlan
Psychologist, MPsych, PsyBA - Clin. Psych
Verified Verified
Leederville, WA 6007
Simon is an endorsed Clinical Psychologist and accredited psychotherapist who provides a warm, open and collaborative space for healing and growth. Working with adults, children (6+) and adolescents from diverse backgrounds, Simon's treatment areas include: depression, anxiety, trauma, grief/loss, relationship difficulties, sleep issues, stress and adjustment issues, and more. Simon's interpersonal style is relaxed, gentle and non-judgemental, validating your here-and-now experience whilst collaborating with you to bring about positive change.
Simon is an endorsed Clinical Psychologist and accredited psychotherapist who provides a warm, open and collaborative space for healing and growth. Working with adults, children (6+) and adolescents from diverse backgrounds, Simon's treatment areas include: depression, anxiety, trauma, grief/loss, relationship difficulties, sleep issues, stress and adjustment issues, and more. Simon's interpersonal style is relaxed, gentle and non-judgemental, validating your here-and-now experience whilst collaborating with you to bring about positive change.
(08) 6219 3891 View (08) 6219 3891
Photo of Susan Woodworth, MPsych, PsyBA General, Psychologist
Susan Woodworth
Psychologist, MPsych, PsyBA General
Verified Verified
2 Endorsed
Leederville, WA 6007
Waitlist for new clients
At Walk and Talk Psychology we work with kids, teenagers and young adults in an outdoor space. Counselling takes place whilst walking along the beach or foreshore, or in a quiet playground with younger children. I am passionate about teaching young people how to recognise and to regulate their emotional responses, develop a positive sense of self, problem solve situations, and build their resilience for the future. The relaxed, calming environment and the light exercise enables more creative problem solving and and enhanced mental flexibility.
At Walk and Talk Psychology we work with kids, teenagers and young adults in an outdoor space. Counselling takes place whilst walking along the beach or foreshore, or in a quiet playground with younger children. I am passionate about teaching young people how to recognise and to regulate their emotional responses, develop a positive sense of self, problem solve situations, and build their resilience for the future. The relaxed, calming environment and the light exercise enables more creative problem solving and and enhanced mental flexibility.
(08) 6219 3806 View (08) 6219 3806
Photo of Tamara Jayne Boaden - Heart and Mind Society, Counsellor
Heart and Mind Society
Counsellor
Verified Verified
2 Endorsed
Leederville, WA 6007
With a focus on wellbeing, I tailor counselling services to the needs of each individuals’ requirements, whether you have goals of 1-3 sessions to uncover solutions, or if you prefer longer term therapy. From a person-centred approach I work with clients with tools and strategies to motivate and inspire personal and/or professional goals to achieve optimum wellbeing. I have been working in this capacity for over ten years and discover the needs from a holistic viewpoint. With clear direction, we work in collaboration to ensure that we meet goals that are in line with the personal and emotional growth and healing.
With a focus on wellbeing, I tailor counselling services to the needs of each individuals’ requirements, whether you have goals of 1-3 sessions to uncover solutions, or if you prefer longer term therapy. From a person-centred approach I work with clients with tools and strategies to motivate and inspire personal and/or professional goals to achieve optimum wellbeing. I have been working in this capacity for over ten years and discover the needs from a holistic viewpoint. With clear direction, we work in collaboration to ensure that we meet goals that are in line with the personal and emotional growth and healing.
(08) 6490 9271 View (08) 6490 9271
Photo of Stephanie Boyett, PsyBA General, Psychologist
Stephanie Boyett
Psychologist, PsyBA General
Verified Verified
Leederville, WA 6007
I love working with a range of people and believe there is nothing too small or big that we can work on. I believe in a person-centred approach - you drive the goals and we can work together to achieve them. I try my very best to provide a safe, welcoming environment for everyone that walks into my room so you can feel comfortable and accepted.
I love working with a range of people and believe there is nothing too small or big that we can work on. I believe in a person-centred approach - you drive the goals and we can work together to achieve them. I try my very best to provide a safe, welcoming environment for everyone that walks into my room so you can feel comfortable and accepted.
(08) 6171 3966 View (08) 6171 3966
Photo of Josephine Thien - Interconnect Therapy, MSc, AAFT, Psychotherapist
Interconnect Therapy
Psychotherapist, MSc, AAFT
Verified Verified
Leederville, WA 6007
Families, couples and individuals seek my services because they want help to express and explore difficult thoughts and emotions safely, they want to understand each other’s experiences and views, appreciate each other’s needs, build on strengths and make useful changes in their relationships and their lives. My clients often comment that my sessions have provided them an opportunity to reflect on themselves and how they interact in their relationships which helps them understand their own behaviours better, thus finding ways forward - either as an individual or as a couple and family.
Families, couples and individuals seek my services because they want help to express and explore difficult thoughts and emotions safely, they want to understand each other’s experiences and views, appreciate each other’s needs, build on strengths and make useful changes in their relationships and their lives. My clients often comment that my sessions have provided them an opportunity to reflect on themselves and how they interact in their relationships which helps them understand their own behaviours better, thus finding ways forward - either as an individual or as a couple and family.
(08) 7701 9554 View (08) 7701 9554
Photo of Naomi Terpsis, PsyBA General, Psychologist
Naomi Terpsis
Psychologist, PsyBA General
Verified Verified
Leederville, WA 6007
I am passionate about helping you become psychologically flexible. No, I won't try to fix you, because you're not broken! I won't try to challenge your thoughts or feelings, because they are valid! I will help you understand what motivates you and I will teach you how to live a life that is meaningful - to you! My lived experience with ADHD gives me special insight into how and why you have been struggling to master your ADHD Superpowers! I respect your needs and tailor sessions to suit your time and finances - and I am committed to providing you with meaningful therapy on your very first session!
I am passionate about helping you become psychologically flexible. No, I won't try to fix you, because you're not broken! I won't try to challenge your thoughts or feelings, because they are valid! I will help you understand what motivates you and I will teach you how to live a life that is meaningful - to you! My lived experience with ADHD gives me special insight into how and why you have been struggling to master your ADHD Superpowers! I respect your needs and tailor sessions to suit your time and finances - and I am committed to providing you with meaningful therapy on your very first session!
(08) 6118 6433 View (08) 6118 6433
Photo of Sam Khankhalili, PsyBA General, Psychologist
Sam Khankhalili
Psychologist, PsyBA General
Verified Verified
Leederville, WA 6007
Sam is the Clinical Director and Registered Psychologist at the South Perth Clear Health Psychology. Sam enjoys working with Adults, Children and athletes. He also takes pride in tackling a wide range of presentations including anxiety, depression, stress, grief, anger, interpersonal difficulties, drugs and alcohol challenges, relationship issues and sports related anxiety. Sam’s purpose is to drive and change people’s perspectives towards mental health as he believes that in order to have the best potential to be the finest version of ourselves, we should have techniques to channel our inner strengths and grow from challenges.
Sam is the Clinical Director and Registered Psychologist at the South Perth Clear Health Psychology. Sam enjoys working with Adults, Children and athletes. He also takes pride in tackling a wide range of presentations including anxiety, depression, stress, grief, anger, interpersonal difficulties, drugs and alcohol challenges, relationship issues and sports related anxiety. Sam’s purpose is to drive and change people’s perspectives towards mental health as he believes that in order to have the best potential to be the finest version of ourselves, we should have techniques to channel our inner strengths and grow from challenges.
(08) 6490 9995 View (08) 6490 9995

More Therapists Nearby

Photo of Brooke Clark - Brooke Clark Psychology, MPsych, PsyBA General, Psychologist
Brooke Clark Psychology
Psychologist, MPsych, PsyBA General
Verified Verified
1 Endorsed
Perth, WA 6000  (Online Only)
Not accepting new clients
I have a special interest in supporting people with Attention Deficit/Hyperactivity Disorder and Autism (any neurotype really) and trauma.
Hi! I am Brooke, a Neurodivergent and Neuro-affirming Registered Psychologist. My goal is empowering people to heal and uncover their true, authentic selves. I want to help clients build a life based on their unique values. My practice is: kink, LGBTQIA+, neurodivergent and gender non-conforming affirming. All people are welcome and celebrated. I work exclusively as a telehealth psychologist, Australia-wide referrals are welcome. I see clients with Medicare plans, NDIS plans and self-funded currently.
I have a special interest in supporting people with Attention Deficit/Hyperactivity Disorder and Autism (any neurotype really) and trauma.
Hi! I am Brooke, a Neurodivergent and Neuro-affirming Registered Psychologist. My goal is empowering people to heal and uncover their true, authentic selves. I want to help clients build a life based on their unique values. My practice is: kink, LGBTQIA+, neurodivergent and gender non-conforming affirming. All people are welcome and celebrated. I work exclusively as a telehealth psychologist, Australia-wide referrals are welcome. I see clients with Medicare plans, NDIS plans and self-funded currently.
Photo of Amit Londhe, MPsych, PsyBA General, Psychologist
Amit Londhe
Psychologist, MPsych, PsyBA General
Verified Verified
1 Endorsed
West Perth, WA 6005
I am a Culturally and Linguistically Diverse Psychologist specializing in NDIS clients with extensive experience in Autism, addressing challenging behavior, and enhancing self-esteem.
Seeking psychological support amid life's challenges can be tough. As a seasoned Psychologist with experience across the lifespan within the Medicare and the NDIS framework, I aim to offer a transformative journey to bridge these challenges. Imagine your mind as a room—I'm here to declutter and organize, making life's navigation smoother. I am here to provide understanding, personalised support, and tangible progress. Unlock the potential to a brighter future with a 15-minute free phone consultation. Let's connect, understand your goals, and embark on a journey to mental wellness together.
I am a Culturally and Linguistically Diverse Psychologist specializing in NDIS clients with extensive experience in Autism, addressing challenging behavior, and enhancing self-esteem.
Seeking psychological support amid life's challenges can be tough. As a seasoned Psychologist with experience across the lifespan within the Medicare and the NDIS framework, I aim to offer a transformative journey to bridge these challenges. Imagine your mind as a room—I'm here to declutter and organize, making life's navigation smoother. I am here to provide understanding, personalised support, and tangible progress. Unlock the potential to a brighter future with a 15-minute free phone consultation. Let's connect, understand your goals, and embark on a journey to mental wellness together.
(08) 6118 7713 View (08) 6118 7713
Photo of Thalia Koulas - Therapy Shmerapy, ACA-L2, Counsellor
Thalia Koulas - Therapy Shmerapy
Counsellor, ACA-L2
Verified Verified
3 Endorsed
Perth, WA 6000  (Online Only)
Therapy Shmerapy specialises in supporting the LGBTQIA+ and neurodivergent communities, with focus on autism, ADHD, LGBTQIA+ issues, and complex trauma. I have experience working with people aged 14 and above. I aim to create a non-judgmental space, ensuring inclusivity and genuineness in every session. I can work with people at all stages of life, from queer people out in the community, to people suspecting they may be autistic. I take particular interest in AFAB and neurodivergent people, and the entire LGBTQIA+ community. I am not suitable for people seeking CBT.
Therapy Shmerapy specialises in supporting the LGBTQIA+ and neurodivergent communities, with focus on autism, ADHD, LGBTQIA+ issues, and complex trauma. I have experience working with people aged 14 and above. I aim to create a non-judgmental space, ensuring inclusivity and genuineness in every session. I can work with people at all stages of life, from queer people out in the community, to people suspecting they may be autistic. I take particular interest in AFAB and neurodivergent people, and the entire LGBTQIA+ community. I am not suitable for people seeking CBT.
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Photo of Josip Vujica, PsyBA General, Psychologist
Josip Vujica
Psychologist, PsyBA General
Verified Verified
Perth, WA 6000
My areas of expertise encompass autism, ADHD, trauma, OCD, anxiety, depression, personality disorders, and concerns with self-esteem and self-worth.
I am a psychologist passionate about helping people. I work with adolescents and adults and have experience working with diverse cultural backgrounds. My role is to help you get to where you want to be and I work intimately to establish what it is you want to get out of therapy. I am a neuroaffirming and trauma-informed clinician, and I integrate a holistic approach that considers the interplay between thoughts, behaviours, bodily sensations, and emotions to foster overall well-being.
My areas of expertise encompass autism, ADHD, trauma, OCD, anxiety, depression, personality disorders, and concerns with self-esteem and self-worth.
I am a psychologist passionate about helping people. I work with adolescents and adults and have experience working with diverse cultural backgrounds. My role is to help you get to where you want to be and I work intimately to establish what it is you want to get out of therapy. I am a neuroaffirming and trauma-informed clinician, and I integrate a holistic approach that considers the interplay between thoughts, behaviours, bodily sensations, and emotions to foster overall well-being.
(08) 6120 1482 View (08) 6120 1482
Photo of Krysia Kostrz, MPsych, PsyBA General, Psychologist
Krysia Kostrz
Psychologist, MPsych, PsyBA General
Verified Verified
Perth, WA 6000  (Online Only)
Hi there! I love working with adults seeking to discover more about themselves. I'm lucky to be part of that moment of realisation, of clarity and understanding clients often experience - when everything finally makes sense! I provide ADHD and Autism assessments for adults via Telehealth, and therapy for adolescents and adults, with appointments available after hours and on weekends, and have immediate availability. My work is neurodiversity-affirming, and based on Community Psychology values and principles - my work is personal, relational and collective. I celebrate Neurodivergence, and I will celebrate you!
Hi there! I love working with adults seeking to discover more about themselves. I'm lucky to be part of that moment of realisation, of clarity and understanding clients often experience - when everything finally makes sense! I provide ADHD and Autism assessments for adults via Telehealth, and therapy for adolescents and adults, with appointments available after hours and on weekends, and have immediate availability. My work is neurodiversity-affirming, and based on Community Psychology values and principles - my work is personal, relational and collective. I celebrate Neurodivergence, and I will celebrate you!
(03) 4245 1035 View (03) 4245 1035
Photo of Jade Deglaitis, PsyBA General, Psychologist
Jade Deglaitis
Psychologist, PsyBA General
Verified Verified
Perth, WA 6000  (Online Only)
I am a generally registered psychologist who has experience working across the lifespan. I have a passion for working with children, adolescents, adults and families with neurodiversity, in particular the autism spectrum. However, I have experience working with a range of presentations and always welcome connecting with new clients to determine how I can support them in reaching their goals.
I am a generally registered psychologist who has experience working across the lifespan. I have a passion for working with children, adolescents, adults and families with neurodiversity, in particular the autism spectrum. However, I have experience working with a range of presentations and always welcome connecting with new clients to determine how I can support them in reaching their goals.
(08) 7078 8384 View (08) 7078 8384

See more therapy options for Leederville

Autism Counsellors

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.