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The Early Start Denver Model (ESDM) had its origins in a university based demonstration group program for young children with ASD at the University of Colorado Health Sciences Center in the early 1980's. Funded by the U.S. Department of Education, the Denver Model approach used empirically based findings from child development research and early intervention research from other disabilities to develop a curriculum and approach to build social, communicative, cognitive, and play abilities for children ages 2-5 that included families and professionals working together. From this core, the Denver Model expanded its focus to include principles of applied behavior analysis, intensive home programs, and inclusive group programs in the 1990's. In 2003, the Early Start Denver Model was developed by Sally Rogers and Geri Dawson to address the needs of toddlers with ASD and their families for parent involvement and intensive intervention. The ESDM seamlessly fused findings from developmental, relationship, and learning sciences to create a play based, relationship based, and communication based model that fit into a family's ongoing play and caregiving activities. The ESDM supports children's progress in reaching typical developmental milestones and incorporates principles of applied behavior analysis in ongoing play interactions. The efficacy of this approach was demonstrated in an NIH-funded randomized controlled trial by Dawson and her colleagues in 2010 and it is continuing to be tested in a variety of additional studies.
There are seven main elements to the ESDM philosophy, and each is actualized in the day to day delivery of ESDM with young children.
Children are assessed using the ESDM Curriculum Checklist every twelve weeks, and from that information and their parents' goals their team leader writes a set of 15-25 objectives that map out the skills that the interventionists and parents will focus on for the next 12 weeks. Each one of those objectives is then broken down into around 6 teaching steps, and these steps map out the child\'s intervention activities for each hour of intervention. These steps also form the data sheet that is completed every 15 minutes of intervention and allows for child progress to be examined daily. Parents also incorporate a focus on teaching steps into their daily play and caregiving routines. For problem behaviors, a functional assessment of the behavior is carried out and a positive behavior support plan is developed and put into place. Progress data are reviewed weekly and intervention plans are updated weekly from the data. The intervention procedures that ESDM therapists and parents use to teach the steps and skills focus on creating a joint activity with the child that begins from the child's choice or interest in a particular toy, game, food, or other type of activity. From the child's interest, the adult then develops a joint activity that has four steps: a set-up, a theme, one or more variations, and a closing. The two interact in a reciprocal, turn taking fashion in which both are inventing and participating in the activity, sharing roles, sharing materials, imitating each other, talking about the activity, having fun. The adult weaves several of the teaching steps from various objectives into each joint activity, so that children's communication and other learning objectives are being targeted inside the interaction. The adult provides many learning opportunities marked by clear antecedent-behavior-consequence (ABC) relationships, to reinforce children's efforts to respond appropriately with the activity or object the child desired at the start of the interaction (the intrinsic reward) and to use teaching procedures that may involve prompting, shaping, chaining, and/or fading to assure that the child carries out the target behavior as independently as possible. Building spontaneous, meaningful speech is a very important teaching target in ESDM, and the approach used to do so begins by building up a repertoire of nonverbal actions and gestures as children develop increasing use of their voice as a communication tool. Over 90% of children enrolled in the ESDM studies develop useful, communicative speech in the first two years after their enrollment.
ESDM is an intervention approach for young children with ASD, ages 12-48 months. Our research studies have demonstrated that best outcomes are attained when children receive 15 or more hours weekly at home from a trained deliverer in addition to parents using the ESDM techniques during their ongoing play and caregiving activities at home. Both previous and ongoing studies indicate that ESDM can be carried out in small groups with ratios of 1 adult to 2 children, but we do not know yet whether children attain the same level of outcomes that they do from individual delivery. We have seen ESDM well-delivered inside community day care centers and in early childhood inclusive group programs within the general program structure, as long as there are sufficient numbers of trained teaching staff to support the child with ASD, and children with ASD can learn side by side with their typically developing peers. We have also learned that most parents who want to can learn ESDM techniques and can use them at home. However, autism is a major developmental disorder, and while parents can provide extremely important learning opportunities in their daily lives, we assume that both parent intervention and additional intervention from others will be needed to attain best outcomes for the majority of young children with ASD. All the ESDM materials are published and in the public domain. However, most professionals will need access to both materials and training in order to provide ESDM to children and families at a high level of skill.
Evidence-Based research on ESDM:
Effectiveness and Feasibility of the Early Start Denver Model Implemented in a Group-Based Community Childcare Setting.1The Early Start Denver Model (ESDM) is a comprehensive early intervention program for toddlers and pre-schoolers with Autism Spectrum Disorders (ASD). The program uses developmental and behavioral approaches, focusing on social learning and social-cognitive development to increase communication, imitation, sharing, join attention, and play. Goals are based on the child’s strengths and weaknesses. Previous studies found the ESDM model effective in a one on one setting. This study investigated whether delivering ESDM in a group day care setting would be feasible and effective.In Australia, 27 preschoolers with ASD received from 15 to 25 hours of ESDM per week for a year in a group setting. Their results were compared with a similar group of children with ASD who received a combined educational and therapy program at another day care center. The staff of that combined program included teachers, childcare workers, speech pathologists, and occupational therapists. At the end of a year, improvement in adaptive, cognitive, and social skills were seen in both groups. Greater gains in receptive language and developmental rate were made by children in the ESDM group.
Other Developmental Approach Research:
1 Vivanti G, Paynter J, Duncan E, et al. Effectiveness and Feasibility of the Early Start Denver Model Implemented in a Group-Based Community Childcare Setting. Journal of autism and developmental disorders. Jun 29 2014.
2 Geraldine Dawson, Sally Rogers, Jeffrey Munson, Milani Smith, Jamie Winter, Jessica Greenson, Amy Donaldson, Jennifer Varley Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. Pediatrics. January 2010, Volume 125 / Issue 1.
3 Solomon, R., Necheles, J., Ferch, C., & Bruckman, D. Pilot study of a parent training program for young children with autism: The PLAY project home consultation program. Autism, 11, 205-224. (2007).