ESDM Early Start Denver Model “Early Start Denver Model” Cut Version 5 – Sally Revised Titles TRT – 12:21 April 12, 2012 Editor: Josie Azzam The Early Start Denver Model is a comprehensive, early intervention treatment for children with autism which had its origins in Denver, Colorado, in the 1980s and was further developed by psychologists Sally Rogers and Geraldine Dawson in the past decade. It is a play-based intervention for learning that fuses a developmental model of skill development and a naturalistic application of teaching procedures from applied behavior analysis. These sessions were recorded at the MIND Institute in Sacramento, one of three university Autism Centers of Excellence (along with Seattle and Michigan) participating in a rigorous, randomized study sponsored by the NIH (the National Institute of Health). The study compares the improvement of children being treated with the Early Start Denver Model and those of a control group being treated with any other approach available in their community. Andrew Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute with Andrew: Let’s find a bathtub for that dirty kitty and that dirty puppy. Oh, I see something that could be a bathtub. Could this be a bathtub? No? No, I think it could be a bathtub. Oh, I see a better bathtub. Alright, Spot’s in the water. What are you pouring? I’m pouring soap. You’re pouring soap? Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute: The Early Start Denver Model is built for children who are in the infantile-toddler-preschool period. And a lot of the research that’s come out has shown that children with autism are in fact very much on a typical developmental trajectory, but at different points than their same-age peers. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute with Andrew: Bops, bub. Is she clean? Yes. Well, what do you do after she’s clean? I think she needs to be dried off. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute I met Andrew when he was still a one-year-old. When I met him he was in his house carrying around two toys. What he did with them was to drop one on the floor and then drop the other on the floor and then walk a circle around them, staring at them. Then he picked them up and turned half way, drop, drop, circle, pick up, drop, drop, and he did this lots of the day. As much as possible he shut himself in his mother’s closet, and this was his routine. There was no face expression, there were no sounds, no eye contact, that was what Andrew did at that time. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute with Andrew He needs a towel. He needs a towel. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute And so in the developmental model, the child is his or her own best teacher. What is important in our therapy isn’t that the adult is saying, ‘This is what we do,’ but the adult and the child together create something that’s interesting for both. Elijah Vanessa M. Avila-Pons, M.A., UC Davis M.I.N.D. Institute with Elijah: Hey, so what do you want to play today? You have a kitchen here. You want to play in the kitchen? Yes. Oh, O.K., which kitchen? Shall be play restaurant or store. I want restaurant. Restaurant? O.K. That sounds good. Carrie, Elijah’s Mom watching Vanessa M. Avila-Pons, M.A., UC Davis M.I.N.D. Institute with Elijah: O.K. Mr. Chef, we need to get you some food. Where’s your food, chef? Vanessa M. Avila-Pons, M.A., UC Davis M.I.N.D. Institute: When he first started he was not quite two. He was not talking. Elijah didn’t have any language. He had some aggression, mainly due to frustration because of lack of communication. Vanessa M. Avila-Pons, M.A., UC Davis M.I.N.D. Institute reading with Elijah: Oh, no. Oh, no. ‘Jeep in a heap.’ Oh! What? ‘And the sheep weep.’ Simon Katie Wallace, UC Davis M.I.N.D. Institute reading with Simon: ‘Sheep in a jeep on a hill that’s steep.’ Sheep. Yes, they’re sticky and they’re dirty. Katie Wallace, UC Davis M.I.N.D. Institute: Now Simon came to us when he was just over two years old, just about turning two, and got a diagnosis of autism. When he came in, he didn’t have any words that I had heard. He was pretty limited in his expressive and receptive language as well as his play skills. He had a lot of deficits coming in, and we started treatment. The family goes through a twelve-week parent coaching period. Katie Wallace, UC Davis M.I.N.D. Institute with Simon: Chicken. Oh, wow! Baack, baack, baack, baack. Baack, baack (holding chicken). Simon, shall we make a house or a bed? I make a, I make a farm. Oh, you want to make a farm. That’s a good idea. Baack, baack. Here’s some blocks. Susan, Simon’s Mom: When we first started with the M.I.N.D. Institute, Simon was not talking. I had been trained to work with him on sign language, so he had a few signs, maybe four or five signs, and he had some animal sounds, and that was it. Now he just has a huge vocabulary, and he’s even reading right now. Katie Wallace, UC Davis M.I.N.D. Institute: And then he started the intensive in-home treatment with us. And we do twenty hours per week of therapists going to his home. And then some ongoing parent training as well. Susan, Simon’s Mother with Simon: Good job. Hold up your fishing rod. A green. A green what? A green fish. A green fish? Simon. Ba, ba, ba, ba (puckering). Susan, Simon’s Mother with Katie Wallace, UC Davis M.I.N.D. Institute: Sometimes it feels a little forced. How did you land on that activity? Because he was gravitating towards it. I let him choose. Yeah, you did a good job following. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute: Well, parent training is a very important part of any kind of autism intervention. Really, if you’re talking about infants and toddlers and young children, all interventions with all children in this age group involve families. Carrie, Elijah’s Mother and Vanessa M. Avila-Pons, M.A., UC Davis M.I.N.D. Institute with Elijah: O.K. So I’m going to work on this side. You want to keep your track over there so it’s more in your area, if you can. The box of the tracks. Yeah. Put them towards you so he has to go through you to get the materials, or direct you. See, here’s one. Do you want one with a little ramp? Two. Carrie, Elijah’s Mother: I didn’t really appreciate it until I saw it in action, but I was completely exposed to all the play tools they use. Literally it is like a tutor relationship, tutor client; they’re going to be a skilled play peer. The power of play should not be denied from an autistic child. They’re like if the child doesn’t know how to play, we’re going to teach the child how to play. ‘Cause they want to take advantage of this powerful tool. Through play they’re going to learn. But we just have to have their motivation, and so that commitment to say we’re going to be creative, this is going to be fun. I even took the television out of the house. So we just really capitalize on every play opportunity. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute: Parents are the most important relationships in a very young child’s life. If the parent isn’t using successful interaction, communication techniques for the young child, there’s really no substitute for that. Susan, Simon’s Mom with Simon: You want to be Owl, Can I be Tigger? Can I be Tigger? Thank you. Who wants to get on this side too? Unidentified therapist speaking to Susan, Simon’s Mother: An objective you might be able to throw in is that in back of, in front of, in behind. Getting in line, you can target that effective and then going down. He seems pretty motivated by that. Susan, Simon’s Mother with Simon: O.K., can you put Owl in back of Piglet? Good job. Perfect. Whee. Whee! Ah. Susan, Simon’s Mother: I’ve really learned how to be patient with Simon, and how to try to come to him with an open mind. They call them the a – b – c- ‘s: the antecedent, the behavior, and the consequence. And when Simon does have, whether it be a negative behavior or a positive behavior, looking at what happened before it and what brought that on, and so, you know, sometimes when he does get upset, it’s looking for things like, O.K., is he on sensory overload or is he in pain that I can’t see? I’m trying to understand why he’s acting the way that he is. He’s been growing so much, I can’t imagine doing it any other way. Susan, Simon’s Mother with Simon: Pooh, what does Pooh say? I love you , Eeyore. Oh, I love you. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute: I think the things that are unique about Early Start Denver Model is the developmental realm, the fact that we explicitly incorporate principles of applied behavioral analysis into what the adults are doing, embedded in the play. And we don’t see that as a contradiction. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute with Andrew learning scissors: And then I can make it open and shut. Open and shut. Those are your fingers. Good. You got fingers. Good. You got your thumb. Alright. Here we go. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute: He has a set of fine motor activities involving tracing, coloring, cutting and gluing, and so as I was preparing, I was thinking about his objectives, which I have posted here on the walls for myself so I knew what I was going to focus on. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute with Andrew: Go around. This is tracing. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute: I didn’t say, ‘You do this. You do this.’ I said,’ I’m going to make a valentine. I’m going to trace this heart. Look, it’s a heart for Valentine’s Day.’ And then he picked that idea up. ‘I want to make a valentine. I want to trace the heart.’ Vanessa M. Avila-Pons, M.A., UC Davis M.I.N.D. Institute with Elijah: Here are all the groceries. O.K. Vanessa Avila-Pons, M.A., UC Davis M.I.N.D. Institute: And once you have their motivation, they’re engaged, then you can start elaborating the skills that you want to teach them, which is more of your agenda, what you’re trying to teach the child. Vanessa M. Avila-Pons, M.A., UC Davis M.I.N.D. Institute with Elijah, exchanging play money for groceries: O.K. Thank you, sir. Welcome. Katie Wallace, UC Davis M.I.N.D. Institute with Simon: Let’s see the eagle. Here he is. Here he is. Katie Wallace, UC Davis M.I.N.D. Institute: We’re focusing now on increasing his expressive language and his flexibility in terms of play skills. He can get a little bit repetitive in his play and a little bit inflexible, especially with certain toys like his animals. Katie Walker, UC Davis M.I.N.D. Institute with Simon: Are you all done with these chickens or do you want to play more? Visit to the jungle. More chicken? O.K. Katie Walker, UC Davis M.I.N.D. Institute, voice over; visual Susan, Simon’s Mother with Simon: So we’re really focusing on expanding his flexibility there and allowing other people in to play with his toys differently. Katie Walker, UC Davis M.I.N.D. Institute with Simon: I spy an animal that’s dirty and pink. Dirty and pink. There it is. There he is. He’s dirty and pink. Vanessa M. Avila-Pons, M.A., UC Davis M.I.N.D. Institute with Elijah: What’s your favorite food? I don’t know. Let’s see. Do you like vanilla shakes? Yes. You do? Where do you buy your vanilla shakes? At Whole Foods. Oh, at Whole Foods. Vanessa M. Avila-Pons, M.A., UC Davis M.I.N.D. Institute: The objectives and the skills that we are working with Elijah currently are moving towards more conversational skills, more of a reciprocal conversation, so a back-and-forth, really having him expand his sentence phrase. Vanessa M. Avila-Pons, M.A., UC Davis M.I.N.D. Institute with Elijah: Do you want to go to Whole Foods or Trader Joe’s? Trader Joe’s. O.K., let’s do it. Let’s do Trader Joe’s. O.K. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute: Autism is a disability. It impairs people’s functioning across multiple life settings. And so my goal is to support children’s development enough that they’re no longer disabled, that they’re functioning without disability: at school, at home, in the community. I feel that if a child is functioning adequately in terms of all the life demands, it doesn’t matter to me what other idiosyncratic characteristics they may have. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute with Andrew: Goodbye. Goodbye. Thank you, Andrew. Thank you for playing with me. Bye. Bye. Dr. Sally Rogers, Ph.D., UC Davis M.I.N.D. Institute: I don’t see any disability in Andrew. He is a social, sweet, loving boy. He’s cooperative, he’s creative, he’s got good language and cognitive skills. He doesn’t have any areas of dysfunction compared to his age right now. So I feel like we have arrested the onset of autism, and kind of stopped it in its tracks and helped re-right his development into a more normal path and I have great hopes for him.