Early Start Denver Model is a therapeutic intervention for autistic children aged 1 to 5 years old. It is delivered by therapists to families for a period of two years, and aims to improve children’s cognitive, communicative, and social-emotional skills.
The information above is as offered/supported by the intervention provider.
1 to 2 years old
Individual
The Early Start Denver Model (ESDM) is an intensive, play-based intervention designed for autistic children aged 1 to 5 years old. Delivered in homes, community settings, or clinical environments, it focuses on developing cognitive, communicative, and social-emotional skills through one-to-one therapy. Sessions are built around engaging, real-life activities that encourage learning through social interaction.
ESDM is a naturalistic, play-based intervention, centred on teaching learning through social interaction. It is based on developmental psychological theories about how children typically learn and develop, especially how learning occurs within the context of social relationships by engaging in joint interactions in a shared activity, and learning to attend to important aspects of the environment needed for learning (e.g. in a routine such as playing ‘peekaboo’). The intervention integrates several approaches within therapy for autistic children, most significantly teaching techniques from Applied Behavioural Analysis, including:
Its overall goal is “to decrease the symptoms of autism that impair children’s ability to learn from everyday experiences and interactions”.
The manualised intervention is administered one-to-one by a certified therapist, ideally working in an interdisciplinary team, in 10 sessions 1.5 to 2 hours long for 20 hours a week. This continues for around two years, or until the ESDM Curriculum is completed. Every 12 weeks, the child’s progress is reviewed using the intervention checklist across a number of communicative, social and, cognitive domains and new individualised learning objectives are set. They set discrete, quantifiable goals, e.g. “When the child is hungry, he will approach an adult and say, ‘I’m hungry,’ spontaneously, with eye contact, several times per week, at home and at preschool” (Rogers, 2016:52). The therapist works with the child and parents to identify their priorities, and incorporates the child’s own interests and preferences into the therapy. The sessions ideally take place in a familiar environment for the child, such as at home. Parent involvement is important in the intervention, and parents are taught skills to embed ESDM techniques in everyday life. At preschool age, playdates with peers are incorporated.
The most rigorous evaluations of ESDM did not measure outcomes for children and young people’s wellbeing, or long-term effects. Additional research in this area would be valuable, particularly as some members of the autistic community advocate for shifting from ‘intervention’ (focus on changing autistic behaviour) to ‘support’ (focus on accommodation) (Davis et al., 2022) and parents of autistic children as well as autistic adults call for a focus on ‘real world’ outcomes, especially mental health and wellbeing (Autistica, 2016). For more on different approaches to autism interventions and support, the voice of the autistic community, and consideration of individuals’ needs, see Davis et al. (2022).
1 to 5 years old
Children aged 1 to 5 years old with a diagnosis of Autistic Disorder or Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS).
Disclaimer: The information in this section is as offered/supported by the intervention provider.
Science-based assumption
On some theoretical models, autistic traits reduce children’s ability to learn from everyday interactions in early development, increasing the risk of poor outcomes in communication, social interaction, and self-care.
Science-based assumption
Positive relationships provide a rich learning context in which children develop communicative skills, including language and social interaction.
Science-based assumption
Young children with a diagnosis of autism.
Intervention
Therapists and parents develop positive relationships with the child, with responsive and sensitive strategies
Therapists use a range of Applied Behavioural Analysis techniques in a developmentally appropriate, play-based way to teach a range of skills, including communication skills
Parent training helps parents to implement ESDM techniques in everyday life.
Short-term
Parents learn ESDM techniques
More positive parent–child relationship
Improved child focus on aspects of environment and social interactions.
Medium-term
Improved child communication, which may involve verbal or non-verbal communication
Improved child social-emotional skills
Improved play
Improved self-care skills.
Long-term
Improved communication skills
Improved social interaction
Improved life chances.
Children aged 1 to 5 years old diagnosed with autism spectrum disorder (ASD), particularly those with early social and communication challenges, and whose families can engage in a home-based, parent-involved treatment model.
Early Start Denver Model is delivered in sessions twice per day, five days a week of two hours’ duration each by a therapist, to individual families for a period of two years.
The practitioner who delivers this intervention is a therapist. Certified therapists have at least a BSc or BA in a relevant degree (e.g. Early Years Education, Psychology, etc.) and a MSc or MA, and have successfully completed the ESDM training and certification process.
Training includes:
It is recommended that practitioners are supervised by an ESDM trainer.
Intervention fidelity is maintained through the following processes:
Contact person: Ifigeneia Mourelatou
Organisation: Recognition Health
Email address: imourelatou@re-cognitionhealth.com
Website: https://www.esdm.co/
*Please note that this information may not be up to date. In this case, please visit the listed intervention website for up to date contact details.
Early Start Denver Model’s most rigorous evidence comes from an RCT conducted in the United States consistent with Foundations’ Level 3 evidence strength threshold.
Children in the intervention group demonstrated statistically significant improvements in receptive language at post-intervention and one-year follow-up and expressive language at one-year follow-up.
ESDM can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome.
| Identified in search | 23 |
| Studies reviewed | 1 |
| Meeting the L2 threshold | 0 |
| Meeting the L3 threshold | 1 |
| Contributing to the L4 threshold | 0 |
| Ineligible | 22 |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 48 children aged 18 to 30 months (1.5 to 2.5 years old) who are diagnosed with autism. |
| Race, ethnicities, and nationalities |
|
| Population risk factors | None |
| Timing |
|
| Child outcomes | Improved receptive and expressive language |
| Other outcomes | None |
| Study rating | 3 |
| Citations | Study 1a: Sullivan, K. A. (2013) The Early Start Denver Model: Outcomes and moderators of an intervention for toddlers with autism (Doctoral dissertation, University of Washington). Study 1b: Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A. & Varley, J. (2010) Randomized, controlled |
The following studies were identified for this intervention but did not count towards the intervention’s overall evidence rating. An intervention receives the same rating as its most robust study or studies.
Aaronson, B., Estes, A., Rogers, S. J., Dawson, G. & Bernier, R. (2021) The Early Start Denver Model intervention and Mu rhythm attenuation in autism spectrum disorders. Journal of Autism and Developmental Disorders. 52 (7), 3304–3313.
Chiang, C. H., Lin, T. L., Lin, H. Y., Ho, S. Y., Wong, C. C. & Wu, H. C. (2022) Short-term low-intensity Early Start Denver Model program implemented in regional hospitals in Northern Taiwan. Autism. 27 (3), 778–787.
Colombi, C., Narzisi, A., Ruta, L., Cigala, V., Gagliano, A., Pioggia, G., Siracusano, R., Rogers, S. J. & Muratori, F. (2018) Implementation of the Early Start Denver Model in an Italian community. Autism. 22 (2), 126–133.
Cucinotta, F., Vetri, L., Ruta, L., Turriziani, L., Benedetto, L., Ingrassia, M., Maggio, R., Germanò, E., Alquino, A., Siracusano, R., Roccella, M. & Gagliano, A. (2022) Impact of three kinds of early interventions on developmental profile in toddlers with autism spectrum disorder. Journal of Clinical Medicine. 11 (18), 5424.
Dawson, G. et al. (2012) Early behavioral intervention is associated with normalized brain activity in young children with autism. Journal of the American Academy of Child and Adolescent Psychiatry. 51 (11), 1150–1159.
Devescovi, R., Colonna, V., Dissegna, A., Bresciani, G., Carrozzi, M. & Colombi, C. (2021) Feasibility and outcomes of the Early Start Denver Model delivered within the public health system of the Friuli Venezia Giulia Italian Region. Brain Sciences. 11 (9), 1191.
Estes, A. et al. (2015) Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 54 (7), 580–587.
Estes, A. et al. (2021) The effect of early autism intervention on parental sense of efficacy in a randomized trial depends on the initial level of parent stress. Autism. 25 (7), 1924–1934.
Feng, J. Y. et al. (2019) Clinical effect of vitamin D3 combined with the Early Start Denver Model in the treatment of autism spectrum disorder in toddlers. Chinese Journal of Contemporary Pediatrics. 21 (4), 337–341.
Gao, D. et al. (2020) Effect of parental training based on Early Start Denver Model combined with intensive training on children with autism spectrum disorder and its impact on parenting stress. Chinese Journal of Contemporary Pediatrics. 22 (2), 158–163.
Laister, D. et al. (2021) Social-communicative gestures at baseline predict verbal and nonverbal gains for children with autism receiving the Early Start Denver Model. Autism. 25 (6), 1640–1652.
Laister, D. et al. (2021) Enhancement of social communication behaviors in young children with autism affects maternal stress. Frontiers in Psychiatry. 12, 797148.
Li, H.H. et al. (2018) Preliminary application of Early Start Denver Model in children with autism spectrum disorder. Chinese Journal of Contemporary Pediatrics. 20 (10), 793–798.
Normand, J. (n.d.) L’Early Start Denver Model (Modèle de Denver): étude contrôlée dans une population d’enfants avec Trouble du Spectre de l’Autisme (Master’s thesis).
Rogers, S. J. et al. (2019) A multisite randomized controlled two-phase trial of the Early Start Denver Model compared to treatment as usual. Journal of the American Academy of Child & Adolescent Psychiatry. 58 (9), 853–865.
Rogers, S. J. et al. (2021) A multisite randomized controlled trial comparing the effects of intervention intensity and intervention style on outcomes for young children with autism. Journal of the American Academy of Child & Adolescent Psychiatry. 60 (6), 710–722.
Sayid, H. A. (2020) Early Start Denver Model developing social skills for virtual autism children. Al-Adab Journal. 1 (135 Supplement 1).
Vismara, L. A. et al. (2009) Dissemination of evidence-based practice: Can we train therapists from a distance? Journal of Autism and Developmental Disorders. 39, 1636–1651.
Waddington, H. (2018) Evaluation of low-intensity therapy and parent training for young children with autism based on the Early Start Denver Model (Doctoral thesis, University of Wellington).
Waddington, H. et al. (2022) Evaluation of low-intensity therapist-delivered intervention in addition to parent coaching for young children with autism spectrum disorder. International Journal of Disability, Development and Education. 71 (2), 1–21.
Wang, J. et al. (2019) Efficacy analysis of Early Start Denver Model in children with autism spectrum disorder. Chinese Journal of Behavioral Medicine and Brain Science. 10, 684–688.
Xu, Y. et al. (2018) A pilot study of a culturally adapted early intervention for young children with autism spectrum disorders in China. Journal of Early Intervention. 40 (1), 52–68.
Zelmar, A. et al. (2018) Impact of the ESDM on the development of children with ASD in a European French-speaking population: First results of the intervention implementation. Revue d’Épidémiologie et de Santé Publique. 66, S416.
Note on provider involvement: This provider has agreed to Foundations’ terms of reference (or the Early Intervention Foundation's terms of reference), and the assessment has been conducted and published with the full cooperation of the intervention provider.
Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.
Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.
Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.
Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.
Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.
Set up and delivery cost is not applicable, not available, or has not been calculated.
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Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing child maltreatment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Enhancing school achievement & employment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing crime, violence and antisocial behaviour: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
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Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.
Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.
Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.
Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.
Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.
Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.
Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.
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