What is ESDM?
The last several decades have witnessed an explosion of knowledge about how infants and toddlers learn. Given that the symptoms of autism spectrum disorder (ASD) often appear before the first birthday, this new knowledge can be brought to bear in our understanding of how best to intervene with young infants and toddlers who are at risk for autism. The Early Start Denver Model (ESDM) is a comprehensive, early intervention approach for toddlers with autism ages 12-36 months and continuing until ages 48-60 months.
The Denver Model began in the 1980s, as a developmentally based group preschool program for young children with autism ages 24-60 months (Rogers et al., 1986; Rogers & Lewis, 1989; Rogers, Hall, Osaki, Reaven, & Herbison, 2000). Seeing autism primarily as a failure of social-communicative development, the program focused on building close relationships with children as foundation for social and communication development. It primarily emphasised lively, dynamic interactions involving a strong positive affect that would lead children to seek out social partners as participants in favourite activities.
The rapid learning capacity of infants suggests the infant-toddler years are a period of a great plasticity and change. A variety of studies indicate that the ESDM is effective for increasing children’s cognitive and language abilities, social interactions and initiative, decreasing the severity of their ASD symptoms, and improving their overall behaviour and adaptive skills. The ESDM is defined by „(1) a specific developmental curriculum that defines the skills to be taught at any given time, and (2) a specific set of teaching procedures used to deliver the curriculum” (S.J. Rogers and G. Dawson, 2010, p.1). It is an intervention approach that is highly specified and yet quite flexible in term of teaching contexts, goals, and materials.
For whom it can be used?
The ESDM was developed to be carried out and overseen by early childhood professionals in special education, educational, clinical or developmental psychology, speech and language pathology, OT, and ABA, and the people who are directly trained and supervised by these professionals. Any individual who is using the ESDM needs background in the knowledge base, concepts, and practices from these disciplines. This is mostly easily gained within a team of early intervetionists who can cross train each other in the concepts and practices underlying the ESDM. Without acces to this interdisciplinary input, it will be difficult for any single discipline to implement the ESDM model at high levels of accuracy.
The ESDM has been developed for children with ASD starting at ages 1-3 years and continuing in treatment until ages 4-5. The curriculum adresses developmental skills from approximately 7-9 months to approximately 48 months age. The curriculum content and the teaching procedures are derived from the studies of parent-child interaction.
The ESDM is not meant to be used for children who are chronologically older than 60 months, even if their developmental skills are in the 12 to 60-month range.
Evidence-base
Several papers describing the effectiveness of the original Denver Model or the ESDM have been published in peer-reviewed journals. The first studies provided consistent evidence of developmental acceleration in a large group of children with ASD in Denver Model classrooms. Rogers and colleagues (Rogers et al., 1986) described the effects of the first interactions of the model which highlighted a developmentally oriented, center-based, small-group preschool setting model with chlid:adult ratios of 1:2 and emphasized play, language, cognition,, and social relations. Rogers and Lewis (1989) elaborated the above analyses on a larger group and demonstrate gains in symbolic play and social communication as well.
Thus, a variety of studies, including an randomized controlled trial, indicates that the ESDM is effective for increasing children’s cognitive and language abilities, social interactions, and initiative, decreasing the severity of their ASD symptoms, and improving their overall behavior and adaptive skills. While longer-term follow-up studies and replications are necessary to determine the long-term benefits of this treatment approach, the consistency the evidence across several different types of delivery (classroom, parent-delivered, and intensive at home delivery) suggests that the ESDM is efficacious in addressing a wide range of early symptoms of ASD and improving child outcomes during the preschool period at least.
Conclusion remarks
The main principles of the ESDM result from a combination of empirical evidence from studies of early autism, studies of typical infant and child development, and studies of learning. The treatment is characterized by a set of principles and practices that underlie both the content and the delivery of the intervention.
These involve interpersonal exchange and positive affect, shared engagement with real-life materials and activities, ongoing verbal and nonverbal communication, a developmentally based curriculum addressing all developmental domains, teaching practices based on learning theory and positive behavior approaches, a multidisciplinary perspective, and individualization of each child’s program.
References
Ingersoll, B., Dvortcsak. A. (2019) Teaching Social Communication to Children with Autism &Other Developmental Delays. Second Edition. The Guilford Press
Kasari, C. (2002). Assesing change in early interventions programs for children with autism. Journal of Autism and Developmental Disorders, 32(5), 447-461.
Prizant, , B. M., Wetherby, A. M., Rubin, E., Laurent, A. C., & Rydell, P. J. (2006). The SCERTS Model: A comprehensive educational approach for children with autism spectrum disorders. Baltimore: Brookes.
Rogers, S. J., Herbison, J., Lewis, H., Pantone, J., & Reis, K. (1986). An approach for enhancing the symbolic, communicative, and interpersonal functioning of young children with autism and severe emotional handicaps. Journal of the Division of Early Childhood, 10, 135-148.
Rogers, S. J., & Lewis, H . (1989). An effective day treatment model for young children with pervasive developmental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 207-214.
Rogers, S. J., & Pennington, B. F. (1991). A theoretical approach to the deficits in infantile autism. Development and Psychopathology, 3(2), 137–162.
Rogers, S. J., Hall, T., Osaki, D, Reaven, J., & Herbison, J. (2000). A comprehensive, integrated educational approach to young children with autism and their families. In S. L., Harris & J. S. Handleman (Eds.), Preschool education programs for children with autism (2nd ed., pp. 95-134) Austin, TX: Pro-Ed.
Rogers, S. J, & Dawson, G., (2010). Early Start Denver Model for Young Children with Autism. Promoting Language, Learning and Engagement.
