EVIDENCE-BASED
THERAPY
GERMANY

Beyond Direct Associations: Instead of just learning “A equals B” (a picture of an apple means “apple”), humans understand “A is related to B” (an apple is similar to a pear because both are fruits, but different from a car).

Potential Challenges: Autistic individuals might have challenges forming or using these relational connections in typical ways. Often traditional methods of ABA encourage rote memorization of discrete targets rather than understanding concepts and using them in novel situations. This is avoided when RFT lessons are introduced to the ABA programming to foster the emergence of novel relationships between concepts.

Therapeutic Approach: Our programs aim to teach building relations between concepts to help autistic clients better understand and use these connections. Scientific teaching strategies such as multiple exemplar training, multiple exemplar instruction, instructive feedback, and observational learning are implemented as soon as the associative discrete trial training no longer benefits the client’s development.

Our staff is certified in: PEAK Training Modules which promote the emergence of advanced knowledge through derived-relational responding to establish the formation of advanced and generalised language and cognitive skills.

Acceptance and Openness: ACT teaches us to accept difficult thoughts and feelings, instead of avoiding or fighting them, which helps in reducing distressing feelings and rigid thought patterns.

Commitment and Action: This approach emphasizes the importance of personal values and goals. With ACT, one actively commits to living a fulfilling and meaningful life aligned with these values.

Psychological flexibility: The main goal of ACT is to increase one’s ability to remain in the present moment, opening non-judgementally to one’s feelings and thoughts, and aligning actions with one’s core values.

Family Involvement: ACT is not only intended for the individual. It can also support families in facing the challenges together that come with having an autistic family member and growing from them.

Our staff has obtained trainings in: DNA-V – psychological model designed for supporting young people to thrive in life; MAGPIES – systemic acceptance and mindfulness based, transdiagnostic intervention for children with a wide range of social, emotional, behavioral difficulties and mental health concerns; and AIM – a curriculum for social-emotional development rooted in RFT and ACT.

Embedded in Everyday Life: Discrete Trial Training (DTT) is not the main method of delivery of learning opportunities as this is unnatural for your children. Interventions are often conducted in everyday situations, be it at home, in the park, or during shared activities. This promotes learning meaningful skills in real contexts and facilitates the application of newly acquired skills.

Social infrastructure: Strong foundation of social and play skills is required before advanced language learning can begin. We focus on foundational skills such as attending and imitating others, sharing emotions and interests via joint attention, sharing a common frame of reference with a partner, engaging in coordinated, reciprocal activities with others, and understanding that meanings are transmitted between people via gestures, sounds, body language, and words.

Parent Involvement: As a parent, you are an integral part of the NDBI process. You are encouraged and trained to take active roles in the interventions to continually promote your child’s learning and development.

Positive Natural Reinforcement: NDBI utilizes positive natural reinforcement. This means that behaviors are not reinforced with a candy or a toy unless this is the natural outcome of the behavior being taught. This helps children understand the natural consequences of their actions. Social reinforcement is deliberately prioritised and when not present – induced.

Our staff is certified in: Early Start Denver Model (ESDM), Pivotal Response Training (PRT) & Project ImPACT.

Neurodiversity is natural among brain functioning expressions and we approach our clients as sovereign unique individuals. We balance between the acknowledgement of society’s pathologizing of certain autistic traits and our response to our clients’ needs and contextually-specific, biological, mental and behavioral challenges.

Polarization and misrepresentation: Since the term ‘neurodiversity’ was coined, we are witnessing Autism war campaigns on social media which reject the nuances that come with autism diagnosis and forget to mention that under the spectrum’s umbrella there are many people who require substantial support in their day-to-day living. Our experience of 20+ years working with clients shows that autism isn’t a unitary condition and sometimes comes with comorbidity. We have seen that lives at the two ends of the spectrum are quite different and that those who are mildly affected cannot fully represent those who are severely impacted.

We appreciate and learn from many autistic advocates and incorporate their advice into our practices – placing priority in helping our clients unmask, build safe relationships, alleviate neurodivergent burnout, and advocate for their needs. However, we remain critical neurorealists.

Neurorealism: Twenty-five years after the Australian sociologist Judy Singer introduced the revolutionary term “neurodiversity,” she offers a new word to reflect the current situation in our society when it comes to Autism and helps us move forward. According to her to be realistic means that if a child can’t swim and does not understand the word ‘danger’, they might be at a higher risk of water related accidents. NeuroRealism demands that ”we aim to meet the actual needs of everyone, as they experience them, whether they consider themselves disabled or different.”

Our company is genuinely interested in collaboration. We believe that autistic individuals, their families, researchers, and clinicians are all important stakeholders who deserve to be heard. To advance the goals of the entire community, we have to recognize that those goals will look very different at the opposite ends of the spectrum.

Our company’s compass is oriented by the steward-ownership principles and we are pioneering this business philosophy in the medical therapeutic field in Germany. Steward-ownership economy has already been successfully applied by leading companies such as Zeiss, Bosch and Ecosia. These organisations have demonstrated that retaining both profits and decision power within the organization by ensuring that the company’s shares cannot be bought by outsiders forcing the company’s wealth to become a commodity can promote long-term stability, ethical responsibility and higher employee’s satisfaction.

We hope to become the first company in our field in Germany to implement these principles and set new standards than ‚business as usual’. Firmly anchoring our business into an ethically oriented healthcare system, we strive to ensure that we are not driven by short-term profit interests, but led by our vision.

A quick overview of Today’s ABA by Dr. Greg Hanley summarises the spirit of PFA/SBT approach to problem behaviors.

Teaching through joy: Creating a joyful, relaxed, enriching and engaging environment is at the core of learning, and clinicians strive to create and maintain learning contexts where autistic individuals feel comfortable, safe, and in control.

Building trust: Once a safe and engaging context has been established, the focus shifts to building trust between the therapist and the autistic individual, empowering the client further. PFA/SBT promotes fostering communication and cooperation, continually adapting to the feedback from the autistic individual.

Trauma-Informed and focused on client’s dignity: The protocols are trauma-informed, acknowledging potential traumatic histories and avoiding possible re-traumatisation. Prevention and de-escalation are firmly integrated within the process of addressing severe challenging behaviors.

Our staff is certified in: Level 3 (Support) and Level 4 (Lead) by FTF Behavioral Consulting and currently working to achieve Level 5 (Advanced). Additionally, our staff holds certifications through the Professional Crisis Management Association (PCMA).

• Our company uses software that allows digital clinical observation notes, data collection and graphing. With the digitalisation of our record-keeping, parents are given the opportunity to observe progress in real time by logging into their child’s account. Goals, videos and lessons can be shared among stake-holders and therapy providers thus boosting transparency, continuation of care and involvement.
• This means that families do not have to wait 6 or 12 months to receive a written progress report but monitor moment-to-moment their child’s advancement and the adjustments our clinicians make based on the client’s response to treatment and instant digital feedback loops.
• The same is true for our clinical directors who can analyse clinic-wide reports regarding all clients’ outcome measures with few clicks, allowing them to hold both an eagle-eye view as well as detailed picture for the quality of services our staff provides!