The Early Start Denver Model (ESDM)

What is The Early Start Denver Model (ESDM)?

The Early Start Denver Model (ESDM) is an intervention model that has adopted the use of ABA principles, Intensive Behavioural Intervention (IBI) and naturalistic teaching. It uses a comprehensive developmental and behavioural intervention framework for the assessment and intervention process for young children with ASD.  Goals are derived from assessing the child’s developmental skills and treatment is provided using the principles of ABA, (Antecedent, Behaviour and Consequence -ABC).  It incorporates teaching principles from Pivotal Response Training (PRT, Hanen “More Than Words”, PECS, Prompt, Direct Floortime, etc).

ESDM views ASD as a complex disorder affecting all areas of functioning and therefore believes it requires an interdisciplinary approach (Psychology, Speech-Language Pathology, Occupational Therapy, Physician etc).  Teaching can occur inside typical family routines (i.e., meals, bathing, playtime, chores, community outings etc), and targets all affected areas of development:

  • Receptive Communication
  • Expressive Communication
  • Social Skills
  • Cognition
  • Play
  • Fine Motor
  • Gross Motor
  • Personal Independence (General, Hygiene, Chores)
Why ESDM? What is the Research to support it?

A randomized controlled clinical trial of ESDM was conducted by Dawson and Colleagues out of the University of Washington and published in the Journal of Pediatrics in 2009.  For the study, which was funded by a grant from the National Institute of Mental Health, Dawson, Rogers and colleagues recruited 48 children with autism aged between 18 and 30 months old. None of the children had other health problems.

The researchers put the children into two groups. One group received 20 hours a week of intervention following the Early Start Denver Model(ESDM) for two years (comprising 2 x 2 hour sessions on five days a week, delivered by specialists from the university, plus 5 hours a week of parent-delivered therapy).

The other group of children underwent therapy in community-based programs.
At the start of the study period there was no substantial difference in functioning between the groups. Both groups were similar in their baseline in severity of autism symptoms, gender, IQ, and socioeconomic status.

The results showed that:

  • Compared to the children who had the community-based intervention, the children in the ESDM group showed significant improvements in IQ, adaptive behaviour and autism diagnosis.
  • Two years after starting the intervention, the ESDM children on average improved 17.6 standard score points (one standard deviation: 15 points) compared with 7.0 points in the community-intervention group, relative to their baseline scores.
  • The children who had ESDM had an average improvement in IQ of approximately 18 points compared to little more than 4 points in the community-intervention group.
  • The ESDM group also showed a nearly 18 point improvement in receptive language (listening and understanding) compared to about 10 points in the community-based group.
  • The adaptive behaviour in the ESDM group continued to grow compared with a normative sample of typically developing children.
  • In contrast, over the same 2 year period, the community-intervention group showed greater delays in adaptive behaviour.
  • Seven of the children in the ESDM group had enough improvement in overall skill to warrant a change in diagnosis from “autism” to the milder condition known as “pervasive developmental disorder, not otherwise specified”.
  • This compared to only one child in the community-base group having an improved diagnosis.
  • The researchers concluded that the findings underscored “the importance of early detection of and intervention in autism”.Rogers explained that they believed the ESDM group “made much more progress because it involved carefully structured teaching and a relationship-based approach to learning with many, many learning opportunities embedded in the play.””Parental involvement and use of these strategies at home during routine and daily activities are likely important ingredients of the success of the outcomes and their child’s progress,” said Dawson.Furthermore, in a follow up study published in the Journal of the American Academy of Child and Adolescent Psychiatry in November, 2012, Dawson and colleagues showed that this same ESDM group showed normalized EEG brain activity demonstrating that early intervention using the ESDM model alters the trajectory of brain development.     “Early Behavioural Intervention is Associated with Normalized Brain Activity in Young Children With Autism.”  Geraldine Dawson, Emily Jones, Kristen Merkle, Kaitlin Venema, Rachel Lowy, Susan Faja, Dana Kamara, Michael Murias, Jessica Greenson, Jamie Winter, Milani Smith, Sally Rogers, Sara Webb.  Journal of the American Academy of Child and Adolescent Psychiatry, Nov 2012. Volume 51, Number 11.
    “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, and Jennifer Varley.
    Pediatrics, Nov 30 2009. Vol 125, No. 1
What is the ideal amount of ESDM?

Based on the research described above,

Ideally, 4 hours of intensive ESDM provided 5 days per week (i.e., 20 hours per week) over a two year period can produce gains in:

  • IQ
  • Language
  • Adaptive Behaviours
  • Normalized Brain Activity on EEG