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.
- (1) Developmental Framework. We understand that the neurobiology of ASD affects
infant-toddler development in many domains, with some developmental difficulties not specific to ASD (motor problems,
slower learning rates), and others highly specific (the unique social-communicative patterns associated with ASD).
Developmental research has demonstrated that young children with ASD make developmental progress, and their pattern of
development in each domain in general follows typical developmental pathways. Thus, the ESDM curriculum, or content of
intervention, draws from infant-toddler-preschool developmental sequences, and we address all developmental areas that
are affected in an individual child.- (2) Relationship-based. The research in early development clearly demonstrates
that child development is an interpersonal process, and that infant-toddler learning and development are enhanced by
adult-child relationships marked by adult sensitivity and responsivity to children's cues, positive affect, and reciprocal
rather than authoritarian relationships, that quality of relationships mediate development. This translates into intervention
practices in which child preferences, choices, and motivation lead the therapist into learning activities.- (3) Parents at the Helm. For young children, a focus on quality of relationships requires a focus on families
and parents as the most important adults, and interactive partners in a child's life. The child's family relationships
must be at the heart of the intervention, not replaced by it. As the most important adults on the team, parents'
preferences and priorities guide the team and their needs for supports are acted upon. Parents are part of all
activities and meetings. They join with the team to set learning goals. They learn to embed ESDM techniques into
their natural play and caregiving activities with their child throughout the day and week. Siblings and extended
family members are key family members and their relationships with the child with ASD are supported in play and
caregiving activities. We understand the opportunity that we have as the first interveners to support parents in
their current and future roles as decision-makers and advocates for their children's needs.- (4) The Science of Learning. We understand the power of empirically based methods for fostering young
children's learning and assure that the learning opportunities that therapists and parents are providing, and the
approaches to problem behaviors that we are using, are built upon the principles of applied behavior analysis.- (5) Interdisciplinary, Generalist Approach. Autism involves multiple disabilities, and no one professional
discipline has expertise in all the areas affected by ASD. In order to meet the diverse needs of each child with
ASD, interdisciplinary team input is needed so that each child's social, communicative, cognitive motor, adaptive,
and behavior needs are addressed appropriately in the day-to-day intervention plan.- (6) Immersion in social learning opportunities. Young children are immersed in learning experiences within
social interactions across all their environments and all their waking hours. If this kind of immersion is necessary
for young children to develop typically, then we assume it is also true for young children with ASD. We have designed
ESDM so that it can be embedded in all a child's environments and in all a child's social interactions across the day.- (7) The Early Autism profile. While ASD affects many areas of development, several difficulties specific to early
ASD particularly limit social learning. Difficulties with social orientation and attention, emotion sharing and attunement,
imitation, joint attention, nonverbal communication, language, functional and symbolic play become central foci of the
ESDM intervention, so that young children with ASD learn to use the social interactions going on around them as key
sources of learning.
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.- Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model2
Other Developmental Approach Research:
General Guides:
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).