Graham is a 47-year old accountant. Two months ago he was diagnosed as having Huntington's disease. Sitting and talking with him, the casual observer might notice nothing unusual in Graham's presentation. It is only in the light of his diagnosis that his behavior and symptoms take on any significance. The involuntary choreic movements that characterize the disease are barely perceptible. He appears restless when seated with his legs constantly changing position, and his thumbs moving rhythmically even when his hands are clasped. More apparent are his chewing jaw movements, which he reports have increased in frequency in the last few months. Graham also believes that his coordination is not as good as it ought to be and that he can feel a “tremble’’ in his upper body. There are signs of dysfluency in his speech. He has difficulty finding and pronouncing words, and he reports that he has problems modulating the volume and tone of his voice. All these symptoms are unobtrusive and might easily be mistaken for signs of general nervousness.