Autism Therapists in Aurora County, SD

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Online Therapists

Photo of Caitlin Borges, MSW, CSW-PIP, Clinical Social Work/Therapist
Caitlin Borges
Clinical Social Work/Therapist, MSW, CSW-PIP
Verified Verified
1 Endorsed
Sioux Falls, SD 57108
Some of my specializations include autism, FASDs, neurodevelopmental difficulties, anxiety & trauma.
I am passionate and committed to serving children ages 4-12 experiencing a variety of mental health needs. My goal is to help children and their parents make connections between difficult behaviors and their underlying causes, and help them implement interventions that fit and work well for the family. I work from a person centered approach, providing strength-based care to help children and families address challenges in a way that meets each person’s unique needs. I also believe that play is the language of children, and use both directive and non-directive play therapy techniques to address struggles and difficult topics.
Some of my specializations include autism, FASDs, neurodevelopmental difficulties, anxiety & trauma.
I am passionate and committed to serving children ages 4-12 experiencing a variety of mental health needs. My goal is to help children and their parents make connections between difficult behaviors and their underlying causes, and help them implement interventions that fit and work well for the family. I work from a person centered approach, providing strength-based care to help children and families address challenges in a way that meets each person’s unique needs. I also believe that play is the language of children, and use both directive and non-directive play therapy techniques to address struggles and difficult topics.
(605) 205-8704 View (605) 205-8704
Photo of Tina (Christina) M Gunn (Johnson-Gunn), LIMHP, Mrs, LPC, LMHP, LMHC, Counselor
Tina (Christina) M Gunn (Johnson-Gunn)
Counselor, LIMHP, Mrs, LPC, LMHP, LMHC
Verified Verified
Sioux Falls, SD 57104
I have extensive expertise in autism (ASD), neurodiversity (ND), anxiety, and trauma.
Mission: Specializing in ASD and Neurodiversity, I assist and guide to relieve mental discomfort & improve well-being. I provide support in a safe environment for individuals to gain the skills that allow them to interact in the world surrounding them. I specialize in autism, trauma, sexual behaviors, anxiety, adoption and families affected by these. I want you to succeed. My experience is professional and personal. I understand how frustrating and difficult life gets. I mostly work with adults, assisting them in navigating the daily life. I've helped adults work through anxiety, depression, & trauma.
I have extensive expertise in autism (ASD), neurodiversity (ND), anxiety, and trauma.
Mission: Specializing in ASD and Neurodiversity, I assist and guide to relieve mental discomfort & improve well-being. I provide support in a safe environment for individuals to gain the skills that allow them to interact in the world surrounding them. I specialize in autism, trauma, sexual behaviors, anxiety, adoption and families affected by these. I want you to succeed. My experience is professional and personal. I understand how frustrating and difficult life gets. I mostly work with adults, assisting them in navigating the daily life. I've helped adults work through anxiety, depression, & trauma.
(605) 540-1102 View (605) 540-1102
Photo of Anne Dilenschneider, PhD, LPC-MH, QMHP, Licensed Professional Counselor
Anne Dilenschneider
Licensed Professional Counselor, PhD, LPC-MH, QMHP
Verified Verified
3 Endorsed
Sioux Falls, SD 57108  (Online Only)
After earning a PhD in clinical psychology, I completed a post-doctoral residency focused on assessing & treating high functioning Autism (Asperger's) and ADHD.
My intention is to work collaboratively with you to affirm your strengths, identify your challenges, and find ways to support your growth into the unique human being you are created to be. My areas of specialty training are related to developing greater integrity between who we are and how we live our daily lives. One specialty area is the assessment and care of persons who experience gender dysphoria and incongruence. My other specialty is assessing, treating, and accommodating high functioning Autism, especially in girls and women because, due to estrogen, the symptoms appear very differently than in boys & men.
After earning a PhD in clinical psychology, I completed a post-doctoral residency focused on assessing & treating high functioning Autism (Asperger's) and ADHD.
My intention is to work collaboratively with you to affirm your strengths, identify your challenges, and find ways to support your growth into the unique human being you are created to be. My areas of specialty training are related to developing greater integrity between who we are and how we live our daily lives. One specialty area is the assessment and care of persons who experience gender dysphoria and incongruence. My other specialty is assessing, treating, and accommodating high functioning Autism, especially in girls and women because, due to estrogen, the symptoms appear very differently than in boys & men.
(605) 865-1003 View (605) 865-1003
Photo of Michelle Ruesink, LPC, LPC-MH, QMHP, Licensed Professional Counselor
Michelle Ruesink
Licensed Professional Counselor, LPC, LPC-MH, QMHP
Verified Verified
Brookings, SD 57006
I am a Certified Autism Specialist who supports children across the spectrum.
My goal as a therapist is to help you find the very best aspects of yourself. I work to help you create healthy and dynamic relationships and to generate meaningful change. I offer specialized mental health services for adults, couples, children, and families. My practice combines a client-centered approach with effective psychotherapy interventions to treat a wide range of issues. Building a strong therapeutic relationship is key to each client's therapeutic journey, and I make this a priority to ensure a trusting and warm experience for my clients. My private practice office is located in Brookings, South Dakota.
I am a Certified Autism Specialist who supports children across the spectrum.
My goal as a therapist is to help you find the very best aspects of yourself. I work to help you create healthy and dynamic relationships and to generate meaningful change. I offer specialized mental health services for adults, couples, children, and families. My practice combines a client-centered approach with effective psychotherapy interventions to treat a wide range of issues. Building a strong therapeutic relationship is key to each client's therapeutic journey, and I make this a priority to ensure a trusting and warm experience for my clients. My private practice office is located in Brookings, South Dakota.
(605) 250-3745 View (605) 250-3745
Photo of Kelsey Borchard, MS, LPC, Counselor
Kelsey Borchard
Counselor, MS, LPC
Verified Verified
Brookings, SD 57006
My journey has been deeply informed by working daily with children. First as a 3rd grade teacher, and then more recently as a school counselor. Being a part of the public education system for eight years, I learned countless lessons about children and family systems. Most importantly, I have learned that children are able to learn well if their needs are met both physiological needs as well as their feelings of safety, love/belonging, and connection.
My journey has been deeply informed by working daily with children. First as a 3rd grade teacher, and then more recently as a school counselor. Being a part of the public education system for eight years, I learned countless lessons about children and family systems. Most importantly, I have learned that children are able to learn well if their needs are met both physiological needs as well as their feelings of safety, love/belonging, and connection.
(605) 702-6019 View (605) 702-6019
Photo of Irina Nicholas Goubanova, MS, LPC, QMHP, Licensed Professional Counselor
Irina Nicholas Goubanova
Licensed Professional Counselor, MS, LPC, QMHP
Verified Verified
Sioux Falls, SD 57105
Life is a journey, not a destination.We need strength & resiliency during that journey. We all occasionally stumble and face pitfalls. I am an experienced and intuitive mental health professional, who will help you heal during the times of emotional distress and life crises. My training and professional experience focus on helping clients during the time of transition.I have been successful in the treatment of Anxiety, Depression, Trauma, Chronic pain. I include therapeutic hypnosis Do not face your struggles alone. Help is within reach. You will know after your first visit, if you made the right choice.
Life is a journey, not a destination.We need strength & resiliency during that journey. We all occasionally stumble and face pitfalls. I am an experienced and intuitive mental health professional, who will help you heal during the times of emotional distress and life crises. My training and professional experience focus on helping clients during the time of transition.I have been successful in the treatment of Anxiety, Depression, Trauma, Chronic pain. I include therapeutic hypnosis Do not face your struggles alone. Help is within reach. You will know after your first visit, if you made the right choice.
(605) 250-3971 View (605) 250-3971
Photo of Tyson Wiggers, CSW, QMHP, MDiv, Clinical Social Work/Therapist
Tyson Wiggers
Clinical Social Work/Therapist, CSW, QMHP, MDiv
Verified Verified
Sioux Falls, SD 57110
It is a gift to listen and lean in to each of my client’s unique stories as we navigate the difficulties and joys of life. Working with individuals, couples, and families, I seek to offer an accepting, warm, and encouraging space where people learn about, and understand themselves, in light of the world around them. Though I primarily work with teens and families, I do enjoy working with adults and couples as well. I especially enjoy counseling those who have difficulties with depression, anxiety, neurodivergence, Christian/spiritual difficulties, and behavioral issues.
It is a gift to listen and lean in to each of my client’s unique stories as we navigate the difficulties and joys of life. Working with individuals, couples, and families, I seek to offer an accepting, warm, and encouraging space where people learn about, and understand themselves, in light of the world around them. Though I primarily work with teens and families, I do enjoy working with adults and couples as well. I especially enjoy counseling those who have difficulties with depression, anxiety, neurodivergence, Christian/spiritual difficulties, and behavioral issues.
(605) 453-4413 View (605) 453-4413
Photo of undefined - J Brockhoff Therapy Services, MSW, CSW-PIP, ACT, Clinical Social Work/Therapist
J Brockhoff Therapy Services
Clinical Social Work/Therapist, MSW, CSW-PIP, ACT
Verified Verified
1 Endorsed
Sioux Falls, SD 57104
Many clients come to therapy with a fear they will be judged and misunderstood. I believe in the social work value of upholding the dignity and worth of my clients. I approach therapy by balancing validation and change; it is essential that a client feels both affirmed and challenged. I believe all people are doing the best they can and can do better. My vocation is to help people find their own life worth living.
Many clients come to therapy with a fear they will be judged and misunderstood. I believe in the social work value of upholding the dignity and worth of my clients. I approach therapy by balancing validation and change; it is essential that a client feels both affirmed and challenged. I believe all people are doing the best they can and can do better. My vocation is to help people find their own life worth living.
(605) 674-6681 View (605) 674-6681
Photo of Lesley Atkins, MSW, CSW, PIP, Clinical Social Work/Therapist
Lesley Atkins
Clinical Social Work/Therapist, MSW, CSW, PIP
Verified Verified
1 Endorsed
Burke, SD 57523
Life to me is an adventure of ups and downs where everyone has the potential to expand their emotional well-being. Through collaboration with the client, and often times a significant other or family, the therapeutic work done in session can promote a better quality of life. My experience in the social work field over the past 14 years includes working with client populations in medical social work, homeless and near homeless housing placement, and treatment for at risk client populations on the Rosbeud Reservation to develop skills and flexibility for working with most ages and client needs.
Life to me is an adventure of ups and downs where everyone has the potential to expand their emotional well-being. Through collaboration with the client, and often times a significant other or family, the therapeutic work done in session can promote a better quality of life. My experience in the social work field over the past 14 years includes working with client populations in medical social work, homeless and near homeless housing placement, and treatment for at risk client populations on the Rosbeud Reservation to develop skills and flexibility for working with most ages and client needs.
(605) 307-3079 View (605) 307-3079
Photo of undefined - Nikki Roth, LPC-MH, LAC, LPCC, CCTP, Licensed Professional Counselor
Nikki Roth
Licensed Professional Counselor, LPC-MH, LAC, LPCC, CCTP
Verified Verified
2 Endorsed
Sioux Falls, SD 57105
Waitlist for new clients
I believe Forrest Gump said it best when he stated "Life is like a box of chocolates"-as life can be sweet and enjoyable; but it can also be bitter and painful. It can definitely send us on emotional roller coaster rides that are not fun. My approach to working with mental health is to meet people where they are and provide individualized care. It's about building and fostering relationships for growth. Similar to the analogy of chocolates, I believe every individual is unique and present with their own life experiences. Thus, there is no one size fits all, & mental health does not fit in a box.
I believe Forrest Gump said it best when he stated "Life is like a box of chocolates"-as life can be sweet and enjoyable; but it can also be bitter and painful. It can definitely send us on emotional roller coaster rides that are not fun. My approach to working with mental health is to meet people where they are and provide individualized care. It's about building and fostering relationships for growth. Similar to the analogy of chocolates, I believe every individual is unique and present with their own life experiences. Thus, there is no one size fits all, & mental health does not fit in a box.
(605) 205-7820 View (605) 205-7820
Photo of Jennie Mayer, MS, QMHP, LPC-MH, LAC, NCC, Licensed Professional Counselor
Jennie Mayer
Licensed Professional Counselor, MS, QMHP, LPC-MH, LAC, NCC
Verified Verified
Sioux Falls, SD 57108
I approach therapy and treatment of individuals, couples, groups and families in a manner consistent with principles of integrity, cooperation and connectedness. I am dedicated to assisting individuals in improving the quality of their lives and in addressing mental health and substance use disorders with compassion.
I approach therapy and treatment of individuals, couples, groups and families in a manner consistent with principles of integrity, cooperation and connectedness. I am dedicated to assisting individuals in improving the quality of their lives and in addressing mental health and substance use disorders with compassion.
(605) 250-6911 View (605) 250-6911
Photo of Jess Grueneich, CSW-PIP, QMHP , Clinical Social Work/Therapist
Jess Grueneich
Clinical Social Work/Therapist, CSW-PIP, QMHP
Verified Verified
Sioux Falls, SD 57105
Waitlist for new clients
Tired of pretending everything is ok? All the while, you're in your own private battle with anxiety, depression, low self-esteem, or grief. Life stress is inevitable. However, lack of support and distress tolerance skills can make managing life's stressors nearly impossible. It's exhausting keeping on that mask. How are you really though? Luckily, I come offering knowledge, tools, and support to get you back on the right track. My therapy style is real, relatable, and empathetic. I strive for openness and collaboration, so treatment is based on your needs and goals. It's your life, let's get you living it the way you want.
Tired of pretending everything is ok? All the while, you're in your own private battle with anxiety, depression, low self-esteem, or grief. Life stress is inevitable. However, lack of support and distress tolerance skills can make managing life's stressors nearly impossible. It's exhausting keeping on that mask. How are you really though? Luckily, I come offering knowledge, tools, and support to get you back on the right track. My therapy style is real, relatable, and empathetic. I strive for openness and collaboration, so treatment is based on your needs and goals. It's your life, let's get you living it the way you want.
(605) 453-4771 View (605) 453-4771
Photo of undefined - Yellow Brick Road Counseling and Therapy, LPC-MH, NCC, LMHC, Licensed Professional Counselor
Yellow Brick Road Counseling and Therapy
Licensed Professional Counselor, LPC-MH, NCC, LMHC
Verified Verified
Sioux Falls, SD 57108
Life can be better! Yellow Brick Road Counseling and Therapy is a safe and comfortable place to address your concerns. Many of us carry hurt and pain for years but choosing therapy to address it helps your life to become better. With a passion for helping people through difficult times in their lives, I use a refreshing approach to address crisis, hurt, and pain. I enjoy working with all ages, individuals, couples and groups with a special interest in adolescents and young adults. I use a variety of tools to address anxiety, depression, behavior and relationship issues. Let's begin your journey to healing for a better life!
Life can be better! Yellow Brick Road Counseling and Therapy is a safe and comfortable place to address your concerns. Many of us carry hurt and pain for years but choosing therapy to address it helps your life to become better. With a passion for helping people through difficult times in their lives, I use a refreshing approach to address crisis, hurt, and pain. I enjoy working with all ages, individuals, couples and groups with a special interest in adolescents and young adults. I use a variety of tools to address anxiety, depression, behavior and relationship issues. Let's begin your journey to healing for a better life!
(605) 546-9331 View (605) 546-9331
Photo of Clint Sperle, MA, LPC-MH, QMHP, Licensed Professional Counselor
Clint Sperle
Licensed Professional Counselor, MA, LPC-MH, QMHP
Verified Verified
Sioux Falls, SD 57105
I received my degree in Counseling and Psychology in Education and am a Licensed Professional Counselor-MH. I have worked with children and adolescents in individual, group and family settings for the past 24+ years. Special areas of interest include working with children and adolescents in areas related to: abuse issues, trauma, evaluations and therapy for children with sexualized behaviors, grief and loss, depression, anxiety, divorce issues, behavioral issues and adjustment issues. I also work with children, adolescents and adults with developmental disabilities.
I received my degree in Counseling and Psychology in Education and am a Licensed Professional Counselor-MH. I have worked with children and adolescents in individual, group and family settings for the past 24+ years. Special areas of interest include working with children and adolescents in areas related to: abuse issues, trauma, evaluations and therapy for children with sexualized behaviors, grief and loss, depression, anxiety, divorce issues, behavioral issues and adjustment issues. I also work with children, adolescents and adults with developmental disabilities.
(605) 303-6587 View (605) 303-6587
Photo of Ashley Anson, Pre-Licensed Professional
Ashley Anson
Pre-Licensed Professional
Verified Verified
2 Endorsed
Sioux Falls, SD 57106
As a therapist, my journey is deeply rooted in personal transformation. Having navigated my own path of healing from childhood abuse, I understand the profound complexities of overcoming deep wounds and embracing self-love. My mission is to provide a sanctuary where individuals can embark on their healing journey, unveiling buried pains to foster self-compassion and prosperity. My professional background extends beyond therapy, having spent a decade as a lawyer specializing in criminal law. This experience, among others, fueled my passion for guiding children away from negative cycles toward empowerment and positive change.
As a therapist, my journey is deeply rooted in personal transformation. Having navigated my own path of healing from childhood abuse, I understand the profound complexities of overcoming deep wounds and embracing self-love. My mission is to provide a sanctuary where individuals can embark on their healing journey, unveiling buried pains to foster self-compassion and prosperity. My professional background extends beyond therapy, having spent a decade as a lawyer specializing in criminal law. This experience, among others, fueled my passion for guiding children away from negative cycles toward empowerment and positive change.
(605) 250-0971 View (605) 250-0971
Photo of Jennifer Walker, MSW, LCSW, QMHP, ACT, Clinical Social Work/Therapist
Jennifer Walker
Clinical Social Work/Therapist, MSW, LCSW, QMHP, ACT
Verified Verified
2 Endorsed
Sioux Falls, SD 57105
I believe success in therapy is linked to the importance of building a strong therapeutic alliance with clients. I achieve this relationship through a non-judgmental, gentle demeanor, and compassionate approach. My passion is working with people who may feel overlooked, forgotten, or left out. I love working with a variety of clients through the lifespan; with those needing support, help finding life purpose, and strengthening communication and relationships. I am also passionate about serving Autistic individuals, parents who have children with disabilities, adolescents, and navigating and managing positive coping skills.
I believe success in therapy is linked to the importance of building a strong therapeutic alliance with clients. I achieve this relationship through a non-judgmental, gentle demeanor, and compassionate approach. My passion is working with people who may feel overlooked, forgotten, or left out. I love working with a variety of clients through the lifespan; with those needing support, help finding life purpose, and strengthening communication and relationships. I am also passionate about serving Autistic individuals, parents who have children with disabilities, adolescents, and navigating and managing positive coping skills.
(605) 205-8956 View (605) 205-8956
Photo of Darcy Amanda Wiebrand, MSW, CSW, QMHP, Clinical Social Work/Therapist
Darcy Amanda Wiebrand
Clinical Social Work/Therapist, MSW, CSW, QMHP
Verified Verified
1 Endorsed
Sioux Falls, SD 57108
The world is a complicated and messy place, and life can be the same way. Luckily resilience, coping, and inner strength are all skills we can learn, not traits that we either have or don't have.
The world is a complicated and messy place, and life can be the same way. Luckily resilience, coping, and inner strength are all skills we can learn, not traits that we either have or don't have.
(605) 674-6973 View (605) 674-6973
Photo of Sherry L. Bartels, MA, QMHP, LPC-MH, LAC, NCC, Licensed Professional Counselor
Sherry L. Bartels
Licensed Professional Counselor, MA, QMHP, LPC-MH, LAC, NCC
Verified Verified
Sioux Falls, SD 57108
I am a Qualified Mental Health Professional, Licensed Professional Counselor - Mental Health, Licensed Addiction Counselor, Approved Clinical Supervisor, Approved Supervisor Status, and National Certified Counselor. I have over 30 years of experience in working with individuals, couples, and families (children, adolescents and adults). I have also provided counseling and education to healthcare professionals, legal professionals, athletes, educational organizations, workplace environments, and community groups.
I am a Qualified Mental Health Professional, Licensed Professional Counselor - Mental Health, Licensed Addiction Counselor, Approved Clinical Supervisor, Approved Supervisor Status, and National Certified Counselor. I have over 30 years of experience in working with individuals, couples, and families (children, adolescents and adults). I have also provided counseling and education to healthcare professionals, legal professionals, athletes, educational organizations, workplace environments, and community groups.
(605) 988-8369 View (605) 988-8369
Photo of Rebecca Sather Durr, MSW, LCSWPIP, Clinical Social Work/Therapist
Rebecca Sather Durr
Clinical Social Work/Therapist, MSW, LCSWPIP
Verified Verified
Sioux Falls, SD 57103
As a therapist I enjoy meeting clients where they are and together designing a plan of action that will put their life in line with their goals. I use a strengths based, solution focused perspective. I help my clients learn tactics of cognitive behavioral therapy that they can use comfortably to obtain desired results in their life. I use a variety of family therapy techniques to help my clients understand relationships within a family. From this analysis, the client can safely explore these subjects and work towards resolution of the issue. I hold a Master's Degree in Social Work from The Ohio State University.
As a therapist I enjoy meeting clients where they are and together designing a plan of action that will put their life in line with their goals. I use a strengths based, solution focused perspective. I help my clients learn tactics of cognitive behavioral therapy that they can use comfortably to obtain desired results in their life. I use a variety of family therapy techniques to help my clients understand relationships within a family. From this analysis, the client can safely explore these subjects and work towards resolution of the issue. I hold a Master's Degree in Social Work from The Ohio State University.
(605) 988-8737 View (605) 988-8737
Photo of Jennifer M. Albrecht, MA, LPC-MH, LAC, Counselor
Jennifer M. Albrecht
Counselor, MA, LPC-MH, LAC
Verified Verified
Sioux Falls, SD 57105
Life offers ample opportunity to learn from adversity and other life experiences. My goal is to help guide you through accepting loss or change while transforming into a stronger overall person. To personalize and individualize care, I work from an eclectic, humanistic approach, including cognitive behavioral therapy, motivational interviewing, mindfulness, art therapy, and other techniques while offering a safe, nonjudgemental healing space. Working in this field since 2006 has allowed me to further my education and licensure to provide quality care to individuals with a wide range of mental health, addiction, and life issues.
Life offers ample opportunity to learn from adversity and other life experiences. My goal is to help guide you through accepting loss or change while transforming into a stronger overall person. To personalize and individualize care, I work from an eclectic, humanistic approach, including cognitive behavioral therapy, motivational interviewing, mindfulness, art therapy, and other techniques while offering a safe, nonjudgemental healing space. Working in this field since 2006 has allowed me to further my education and licensure to provide quality care to individuals with a wide range of mental health, addiction, and life issues.
(605) 864-4190 View (605) 864-4190
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.