Le modèle de Denver (Early Start Denver Model). Une approche d’intervention précoce pour les troubles du spectre autistique

Abstract

The Early Start Denver Model for young children with autism (ESDM) is an early intervention program that integrates developmental, relationship-based, behavioral and learning concepts emerging from research on autism spectrum disorder (ASD), in order to provide a comprehensive intervention in particular for the very young children, from the age of 12months on. In close collaboration with parents and family, the ESDM aims to decrease the child's ‘social deprivation’ and its perpetuating impact on the neuronal and psychological development, in order to rekindle the altered developmental processes during this period of maximal brain plasticity. Designed as a naturalistic model that can be transposed into different contexts, the EDSM aims to stimulate in an intensive manner previously deficient functions such as social engagement, imitation, communication etc., through play sequences based on the child's interests. Following a precise evaluation of each child's developmental profile every three months, an individual intervention program is elaborated through a highly structured and standardized procedure using the ESDM curriculum. The ESDM is one of the only treatment approaches that have been scientifically validated in a randomized controlled trial, and it is one of the major programs recommended by the French High Authority of Health (HAS) for the treatment of children with ASD (since 2012). Questions remain regarding the necessary treatment intensity in order to obtain satisfying results with the ESDM (20–25hours per week or less), especially within the context of the French public health system, regarding its treatment modalities (one-on-one or small group settings) and regarding the profile of children that would benefit most from this intervention (e.g. ASD with or without associated developmental delay). As an example, we report here the results of a study on 16 children with ASD participating over at least one year in an early intervention program with flexible treatment hours based on ESDM principles.