Early Start Denver Model (ESDM) is a type of behavioral therapy based on methods used in Applied Behavior Analysis (ABA). Founded on the Denver Model, which is used to assist older children with Autism Spectrum Disorder (ASD), ESDM is an early intervention program for children ranging from 12 months to 4 years.
Toddlers learn and evolve through their developmental stages, and ESDM, once called the “play school model”, focuses on using play and the daily activities a child enjoys to foster positive and fun rapport between the therapist and/or parent and child.
This approach is designed to teach and build upon communication, socialization and cognition skills already acquired. The therapy may be done in any setting: in a therapist’s office, at school with a group, or one-to-one at home, and children of all abilities and learning styles can benefit from it.
Started in the 1980s by psychologists Sally Rogers, PhD and Geraldine Dawson, PhD, techniques were adapted from the Denver Model and Pivotal Response Training (PRT; Koegel & Koegel, 2006.) PRT is a type of therapy based on play that is initiated by the child and uses the concepts and theories of ABA.
The general idea of ESDM is that a baseline assessment is obtained based on observing the child, as well as parental input about the child’s skills and abilities with communication, socialization, fine and large motor functioning, imitation, play, cognition and self-sufficiency. By comparing average development with any difficulties a child with ASD is having, they would then address those areas. The child with ASD is given objectives or goals specific to them, usually in the area of social and relationship skills. Then using the ESDM Curriculum Checklist, progress is checked approximately every 12 weeks to see if the goals and objectives were reached.
What Evidence shows Early Start Denver Model Works?
The model for ESDM is founded on the evidence from a number of random clinical trials which showed it to be a useful intervention. Early Start Denver Model is thought to be based on more than 12 studies of children with a range of developmental abilities, working with a wide-range of therapists and professionals in different settings.
One study, according to Pediatrics (Official Journal of the American Academy of Pediatrics), compared 48 children ages 18 to 30 months in two groups, with one group receiving ESDM for two years and the other receiving whatever treatment was available. At the end of the two year period, the group receiving ESDM had an increase in IQ of 17.6 points, they continued their growth rate in the area of social and practical skills. Group 2 only had a seven point increase in IQ and more delays with regard to adaptive behavior. Also, Group 1 experienced more changes in diagnosis from autism to Pervasive Development Disorder, Not Otherwise Specified (PDD, NOS), as compared to Group 2. The results show the importance of detecting autism at an early age and providing some type of treatment.
The trials for ESDM showed that children with signs of autism who had 20 hours of total instruction at a young age did well later on in programs focusing on language and social skills, whether the child had mild or more severe learning issues. Other studies also showed that ESDM helped improve the brain function for social and communication skills.
While much of the research shows Early Start Denver Model to be helpful, the statistical validity is not as strong. However, a positive point for the program is that it can be used anywhere, which helps parents and caregivers of young children.
Who offers Early Start Denver Model Services?
Individuals who offer ESDM services can range from psychologists, developmental pediatricians, behavioral specialists, occupational therapists, and speech/language pathologists, to early intervention specialists.
Sally Rogers now uses the treatment in the preschool setting where support for the child with ASD is worked into the classroom at about 20 hours per week for a two year period.
UC Davis Health MIND Institute offers training for professionals, while also teaching others to provide training for therapists, other providers, and parents.
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Implementing ESDM in the home
It is important for parents to be involved in the therapy, choosing objectives they feel are significant, while also watching and learning the strategies from the providers who undergo special training. As parents or caregivers become trained, they can then utilize the program at home in addition to any outside help the child receives. This is important in today’s world where staying at home has become the norm in many situations.
It is also important to be educated about ESDM in order to know what types of questions to ask a potential therapist, as well as to be sure any caregiver working with your child will have proper training.
The Autism Speaks website lists the following questions to ask while looking for a therapist/provider of ESDM:
1. Who will be working with my child?
2. What training will you offer to parents?
3. Where do you hold therapy sessions?
4. How do you determine program goals?
5. Are you trained to offer ESDM therapy?
6. Can parents participate in therapy sessions?
7. Will sessions be one-on-one, or held in a group?
8. How do you handle challenging behavior?
9. How do you measure progress?
10. What type of progress should we expect?
One training manual that can be used by parents is called An Early Start for Your Child with Autism – Using Everyday Activities to Help Kids Connect, Communicate, and Learn. Written by Sally Rogers, Geraldine Dawson, and Laurie Vismara, it gives tips and suggestions for use during a child’s daily regimen and play.
Parents may also check out the UC Davis Health MIND Institute website for a monthly-updated list of all certified ESDM therapists, trainers and parent coaches around the world.
If a parent suspects their child has any developmental or cognitive issues, they should talk with the child’s pediatrician or health care provider to rule out Autism Spectrum Disorder as early as possible. If a diagnosis for ASD is made, it is better to seek help and intervention, whether or not it is Early Start Denver Model.
“Randomized, Controlled Trial of an Intervention for Toddlers with Autism: The Early Start Denver Model”
Geraldine Dawson, Sally Rogers, Jeffrey Munson, Milani Smith, Jamie Winter, Jessica Greenson, Amy Donaldson, Jennifer Varley
Pediatrics Jan 2010, 125 (1) e17-e23; DOI: 10.1542/peds.2009-0958
Retrieved from https://doi.org/10.1542/peds.2009-0958
Holehan, K. M., & Zane, T. (2019). Is there science behind that?: The Early Start Denver Model. Science in Autism Treatment, 16(2).