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Early Start Denver Model

What is the Early Start Denver Model?
Developed by Dr. Sally Rogers and Dr. Geraldine Dawson in the 1980’s,1 the Early Start Denver Model (EDSM) is a “comprehensive, early intervention approach for toddlers with autism ages 12-36 months and continuing until ages 48-60 months…EDSM uses the knowledge of how the typical baby develops to facilitate a similar developmental trajectory in young infants who are at risk for autism.”2 The Early Start Denver Model is one of the few early intervention strategies designed for children as young as 12 months that is backed by peer-reviewed, published empirical work.3 The ESDM is an intervention that can be implemented in a variety of delivery settings such as a group program, in individual therapy sessions, by therapy teams, or at home by parents. The ESDM has been described as an eclectic treatment that combines Applied Behavior Analysis (ABA) -based approaches with a relationship-focused developmental model.3 Autism Speaks3 defines the core features of the Early Start Denver Model as:

  • Naturalistic applied behavioral analytic strategies
  • Sensitive to normal developmental sequence
  • Deep parental involvement
  • Focus on interpersonal exchange and positive affect
  • Shared engagement with joint activities
  • Language and communication taught inside a positive, affect-based relationship

The Early Start Denver Model follows a play-based approach that emphasizes the development of play skills, relationships, and language.4 According to the Early Start Denver Model for Young Children with Autism, authored by the developers of the intervention, the ESDM is “effective for increasing children’s cognitive and language abilities, social interaction and initiative, decreasing the severity of their ASD symptoms, and improving their overall behavior and adaptive skills.”2

How Does the Early Start Denver Model Make a Difference for Individuals with Diagnosis on the Autism Spectrum?
Some of the core deficits shared by individuals on the autism spectrum are difficulties in communication and building relationships. Much like Applied Behavior Analysis, the ESDM utilizes play as the medium for accomplishing the intervention’s goal, which is to “increase children’s interest in activities and other people. It also aims to improve communication skills and self-expression, helping children with ASD get along with others.”4 The teaching strategies of ESDM are consistent with “the well-validated teaching practices of Applied Behavior Analysis (ABA).”5 The ESDM employs the principles of operant learning and the specific ABA teaching tools utilized are prompting, fading, shaping, and chaining.2 According to one research study, which is discussed in detail below, the Early Start Denver Model has been found to improve IQ scores, adaptive behavior, and improve symptoms related to ASD.6

What do Early Start Denver Model Practitioners Do?
The Early Start Denver Model requires a team of practitioners consisting of therapists, early intervention staff, and parents. The team evaluates the child and creates a curriculum based on the individual’s needs and parental input. Parental input defines what objectives they feel are most important to their child’s education progress. Individually, the therapist teaches parents and other care givers how to implement the program, a member of the early intervention staff coordinate’s the child’s care, collects data, and assesses improvements. Parents are asked to implement the program at home and meet with the ESDM team on a regular basis to review progress.5 Additional team members may consist of early childhood educators, child psychologists, speech pathologists, and occupational therapists.4 As the child undergoes the joyful activities of the ESDM, a certified practitioner should utilize the Curriculum Checklist that helps to monitor communicative behavior, joint attention behaviors, motor functions, social skills, imitation, personal independence, and much more. A major aspect of the ESDM is team meetings. All team members of the ESDM must coordinate with one another to maximize the child’s education. Meetings should be conducted weekly or biweekly and are “necessary to maintain consistency of treatment across the various members, as well as in sharing discussions about difficult situation with family members and managing ethical dilemmas that inevitably rise.”2 During these meetings, team members need to review the child’s treatment notebook to coordinate and update the child’s treatment for the following week. A team leader should be appointed to help guide parents to implement the therapy at home, carry out assessments based on the Curriculum Checklist, develop quarterly objectives, and directly meets with the child during clinic and at home visits to determine if “the intervention is proceeding successfully and the child is progressing as rapidly as possible.”2

Where do Early Start Denver Model Practitioners Work?
The typical professionals that encompass an ESDM team can include a child psychologist, behavior analyst, speech-language pathologist, occupational therapist, physician, and other professionals working in related fields.2 A pre-school setting is a common atmosphere for conducting ESDM since the intervention is designed for infants and toddlers. The National Autism Network’s Resource Guide can help direct parents to find ESDM practitioners in their respective state.

What Research is there to Support the Early Start Denver Model?
A study published in the first Pediatrics of 2010, observed 48 children with ASD who were placed in 1 of 2 groups that either received the Early Start Denver Model or community-based interventions that are commonly available. The children underwent each intervention for a period of 2 years. The results of the study found that “children who received ESDM showed significant improvements in IQ, language, adaptive behavior, and autism diagnosis.”6 The study’s results indicate the importance of early intervention for children on the autism spectrum. This study met the requirements of a randomized, controlled trial (RCT), but the study does include a number of issues that are addressed here.

A review of autism therapies for children sponsored by the Agency for Healthcare Research and Quality (AHRQ) in 2011 found that the “[s]trength of evidence for ESDM-based intervention in affecting cognitive, language, and adaptive outcomes is currently insufficient.”7

The National Standards Project (NSP) 9 was designed to help parents and professionals determine which treatments are the most effective for individuals with autism based on the scientific research associated with a number of specific behavioral treatments. The National Standards Project classified the Denver Model as an “emerging” treatment, which means that there are one or more studies that suggest that the treatment is effective, but more high-quality, scientific studies must be conducted before the NSP can consider the treatment “established.”

Who is Qualified to be Practitioner of the Early Start Denver Model?
Parents interested in implementing and learning more about the Early State Denver Model are encouraged to attend introductory workshops offered at University of California Davis MIND Institute, the current funders of ESDM-related research. Professionals interested in ESDM certification are invited to attend advanced workshops, if they meet the following prerequisites established by the MIND Institute8:

  • Work regularly with 12-48 month-old children with Autism Spectrum Disorder
  • Have educational degrees beyond a bachelor’s (e.g., MA, Ph.D., MFT, SLP, OT)
  • Works as part of an interdisciplinary team (e.g., general/special education teacher, developmental/clinical psychologist, SLP, OT, behavior analyst)
  • Have read the ESDM Manual and bring their own copy to the workshop
  • Have completed each training step before advancing to the next
  • Have the resources to submit teaching materials (after the workshop is complete) to our center for fidelity review and certification

Where Can I Find Practitioners of the Early Start Denver Model?
Currently, there is not an extensive directory detailing ESDM certified practitioners nationwide. It is recommended that you search the National Autism Network’s Resource Guidefor certified ESDM practitioners. The Early Start Denver Model Manual is currently being translated into Spanish, Italian, French, and Japanese.