The Early Start Denver Model (ESDM) approach to therapy uses core components of behavior therapies like applied behavior analysis (ABA) to treat young children, typically 1 to 4 years old. This therapy is offered by a range of providers, including ABA therapists, psychologists, and occupational therapists.
ESDM uses play as a way to encourage this age group to interact with peers, caregivers, therapists, and parents. The therapy provides positive rewards for these interactions, so the child learns how to communicate and socialize more effectively.
Children on the autism spectrum tend to socially isolate early. They become focused on learning about objects, which may become an obsessive interest later. They may not have strong verbal and nonverbal communication skills, gross or fine motor skills, or learning skills that would be seen in a neurotypical child.
These skills often remain underdeveloped and underused in children with autism. By involving a child in play sessions that develop these skills, ESDM reduces the impact of autism in that child’s life.
What Is the Early Start Denver Model?
People who have developmental conditions like autism benefit greatly from working with therapists trained in applied behavior analysis (ABA).
This approach to treatment should be tailored to each individual’s needs. Someone who functions normally in much of their life may still need help with subtle social cues. Another person who is nonverbal may need help learning other ways to communicate with neurotypical adults in their daily life.
Children with autism benefit from specific types of therapy using ABA methods, and one of these types is the Early Start Denver Model. This behavior therapy is intended for children between 12 and 48 months, or 1 to 4 years old. In this model, parents and therapists use play-based activities to boost the child’s language, thinking, and social skills.
The Early Start Denver Model (ESDM) is based on the current understanding of average early childhood development. The focus is on building positive relationships between parents, therapists, and peers by combining lessons with regular daily activities, including natural playtimes or dedicated time for creativity.
For most children, playing together is about interaction and communication. ESDM uses this natural aspect of a neurotypical child’s development and adds it to the routine of a child with autism.
ESDM benefits children who have a wide range of needs on the autism spectrum. For example, children with significant learning challenges can benefit from play-based ESDM approaches to learning, while children without the same level of challenge still get a lot out of these activities. Virtually all children who participate experience improved learning ability.
Because the Early Start Denver Model is geared toward very young children, parents are vital parts of the process. ESDM therapists model approaches to encourage skill development in the child. Ongoing play at home with parents can reinforce these skills.
The Importance of Socialization
The Early Start Denver Model focuses on young children to take advantage of the brain’s plasticity in early life. Retraining behaviors and helping the child understand socializing, communication, and learning approaches at that early stage can alter their developmental trajectory. This reduces symptoms of autism later in life, making it easier for the growing child to navigate school, friendships, and, eventually, adulthood.
Children on the autism spectrum are typically less focused on socializing. As a result, they end up with fewer opportunities to engage in social activities. This means neurotypical children generally have many more opportunities to build important life skills, such as communication and social skills.
The developers of the ESDM model start on the basis that children with autism engage in different activities, which builds their brain pathways differently. These activities are either object-oriented or socially oriented, and ESDM gears activities toward socializing rather than object-focused undertakings.
The founders of ESDM base their practice on the social motivation hypothesis of autism, which states that children on the autism spectrum are not sensitive to social rewards, so they have little interest in social activities.
The founders also state, in their model of interpersonal development in autism, that children on the autism spectrum lack the natural ability to imitate others, and this slows down certain social milestones. By finding natural ways to regularly incorporate positive social interactions into the young child’s life, the child will become more motivated for social collaboration.
Like many types of behavior therapy for people who have autism, ESDM therapy uses one-on-one interactions. The focus is on incorporating standard socializing routines into an autistic child’s regular playtime and daily life, so they feel normal from the beginning of life. As a result, the child will not isolate as much later in life.
Areas of Improvement
This therapy incorporates ABA teaching techniques to improve development in areas like:
Fine and gross motor skills.
Adaptive behavior skills.
Relationships with caregivers and peers.
ESDM Training & Tools
Training to become an ESDM therapist requires proficiency in specific areas, such as:
- Administering and completing an assessment of the child’s skill level.
- Developing personalized teaching techniques that are developmentally appropriate for the child’s physical age and mental skill level.
- Implementing ESDM teaching practices.
- Using the fidelity system to evaluate which techniques work for the child.
- Maintaining appropriate data management.
- Addressing poor progress in the child.
Specific therapy tools used with children in ESDM therapy include:
Didactic instruction, a type of education that works well for giving brief, factual information.
Group discussion, which involves peer-based talks or play sessions led by one or a few ESDM therapists.
Professionals who can become credentialed to practice ESDM therapy include:
Board certified behavior analysts (BCBAs).
Early intervention specialists.
There are three basic paths you can take if you want to become certified in the Early Start Denver Model.
ESDM therapist program: You must be a professional in a field related to this form of therapy, like medicine or education. You must complete the introductory and advanced workshops, learning about the principles of the Early Start Denver Model and how it works. Then, you must practice ESDM therapy with groups of three to five children on the autism spectrum.
Once you have completed the workshop requirements, you must complete the steps in the Action Plan, supervised by a certified trainer.
Apprentice trainer program: Completing the therapist program means you can take additional workshops to focus on specific paths within ESDM therapy practices. One path is to become an apprentice to a certified trainer, so you can run workshops and oversee the certification process. These apprenticeships are limited.
Parent coach program: This process aims to support parents who incorporate the Early Start Denver Model into their everyday activities with their child, helping to reinforce behavioral change.
ESDM-certified therapists who have been practicing for at least six months qualify to enter this certification program. You will then participate in the Parent Coaching Workshop and complete the Action Plan under the supervision of a certified parent coach trainer.
If you want to work with young children on the autism spectrum, the Early Start Denver Model is a good focus. With a certification in ESDM therapy, you can help to improve clients’ interactions, develop and implement personalized treatment plans, and measure positive changes with an objective, scientific process.
To become a certified ESDM therapist, you must:
Attend a training workshop to get the required number of hands-on hours to understand this process.
Submit a video using ESDM treatment techniques in session with a child.
Demonstrate through the video and the workshop training that you understand how to reliably and ethically use ESDM therapy.
Once you complete the required steps, you can submit your training materials to receive your certification.
Scientific Research Backs the Effectiveness of the Early Start Denver Model
Research has shown that children with autism who receive ESDM therapy, compared to community interventions, had significant improvements in IQ, lessening of autism symptoms, and advances in adaptive behaviors. The study reported that, two years after entering either community intervention or ESDM therapy, the ESDM group improved 17.6 points overall, while the standard group improved 7 points, relative to their baseline scores. The ESDM group also maintained their rate of improved adaptive behaviors, compared to neurotypical peers. Within the two-year follow-up, the comparison group with community interventions showed greater delays in positive adaptive behaviors.
Another study comparing the Early Start Denver Model to community approaches found that there was overall lower health care costs among people who had received ESDM early in life, compared to those who received other childhood interventions.
These lowered costs did not become apparent until later in the child’s life. This is because ESDM is a very early intervention, compared to other models that might not begin until preschool, kindergarten, or elementary school. The upfront cost for toddlers undergoing ESDM was much higher than the same age group participating in community interventions.
Results From Early Intervention
Our understanding of autism has changed a lot over the past few decades, but there is no question that early intervention services significantly benefit children with autism. The sooner they get professional services, the better their long-term outcomes.
Scientific research backs the Early Denver Start Model as a form of early intervention that helps children with autism to develop more positive behaviors, reduce maladaptive behaviors like socially isolating, and move within a neurotypical society with much less discomfort and misunderstanding. ABA therapists are able to provide this important early therapy in the home.
- Early Start Denver Model. Autism Speaks.
- Evidence for the Implementation of the Early Start Denver Model for Young Children With Autism Spectrum Disorder. (September 2015). Journal of the American Psychiatric Nurses Association.
- Evaluation of the Social Motivation Hypothesis of Autism: A Systematic Review and Meta-Analysis. (August 2018). JAMA Psychiatry.
- UC Davis MIND Institute ESDM Training Program. University of California, Davis.
- Didactic Method. Definitions.net.
- Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. (January 2010). Pediatrics: Official Journal of the American Academy of Pediatrics.
- Cost Offset Associated with Early Start Denver Model for Children With Autism. (September 2017). Journal of the American Academy of Child and Adolescent Psychiatry.
- Early Intervention for Autism. (January 2017). Eunice Kennedy Shriver National Institute of Child’s Health and Human Development.
- Effects of Parent-Implemented Early Start Denver Model Intervention on Chinese Toddlers With Autism Spectrum Disorder: A Non-Randomized Controlled Trial. (April 2018). Autism Research.