EARLY START DENVER MODEL
The Early Start Denver Model (ESDM) is a comprehensive early intervention model designed to increase the social engagement and skill development of very young children (12 to 60 months) diagnosed with Autism Spectrum Disorder (ASD). The model incorporates decades of research and knowledge about how infants and toddlers learn. It has a few defining features: (1) the use of a specific developmental curriculum that guides which skills need to be taught for individual children and (2) the use of a specific set of teaching procedures rooted in Applied Behaviour Analysis (ABA) to teach targeted skills.
Children receiving ESDM services learn through “joint play routines” which are developed with the individual child’s interests and motivation in mind. The therapist and child construct the routines together, with the therapist providing many opportunities for the child to communicate and practice target skills across a variety of different domains (including communication, social, cognitive, play, fine motor, gross motor, and personal independence). The therapist presents opportunities to expand and extend the play routines to promote increased interests and flexibility. To the untrained eye, it may seem like the child and therapist are “just playing”, however, the therapist is deliberately arranging frequent opportunities to practice specific goals, and fading support to promote the child’s independence in these targeted areas. In a group setting, therapists and several children co-construct play routines together; children have the opportunity to practice individualized goals, including social skills with same-aged peers, and teaching is facilitated by a skilled therapist.
SELECTED ESDM RESEARCH
In 2010, Dawson and Colleagues conducted a randomized controlled clinical trial of ESDM out of the University of Washington funded by the National Institute of Mental Health. The trial involved 48 children diagnosed with ASD between the ages of 18 to 30 months. The results were published in the Journal of the American Academy of Pediatrics. The children involved were randomly assigned into one of two groups. One group received 20 hours of ESDM intervention per week while the other group received community-based therapy over a span of two years. At the start of the study there were no substantial differences between the two groups, with the children sharing equal severity of ASD symptoms, gender, IQ, and socioeconomic status. The results showed that the children in the ESDM group displayed significant improvements in IQ, adaptive behaviour, and ASD symptoms while the children in the community-based therapy did not.
In 2012, Dawson and Colleagues published a follow-up study in the Journal of the American Academy of Child and Adolescent Psychiatry replicating the above results with the addition of EEG brain scans showing normalized activity for the ESDM group following treatment. The EEG brain scans provide preliminary evidence that ESDM may alter the trajectory of atypical brain development in a positive way. The researchers concluded that the findings of both studies highlight the importance of early detection and early intervention of ASD. Children in the ESDM groups were thought to make such progress because ESDM involves carefully structured teaching techniques within a relationship-based approach to learning with many learning opportunities embedded within play routines. The ESDM model has since been studied in a variety of journal articles, and the science continues to support this approach as a developmentally appropriate and beneficial treatment for young children diagnosed with ASD.
Both of these studies are referenced here for those interested in learning more about the research behind ESDM:
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., & Varley, J. (2010).
Randomized, controlled trial of an intervention for toddlers with Autism: the Early Start Denver Model. American Academy of Pediatrics, 125(1), 17-23. http://0-dx.doi.org.orca.douglascollege.ca/10.1542/peds.2009-0958
Dawson, G., Jones, E., Merkle, K., Venema, K., Lowy, R., Faja, S., Kamara, D., Murias, M., Greenson, J.,
Winter, J., Smith, M., Rogers, S., & Webb, S. (2012). Early Behavioural 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. http://0-dx.doi.org.orca.douglascollege.ca/10.1016/j.jaac.2012.08.018