Predictors of Developmental and Adaptive Behaviour Outcomes in Response to Early Intensive Behavioural Intervention and the Early Start Denver Model

The effectiveness of early intensive interventions for Autism Spectrum Disorder (ASD) is now well-established, but there continues to be great interindividual variability in treatment response. The purpose of this systematic review is to identify putative predictors of response to two different approaches in behavioral treatment: Early Intensive Behavioral Interventions (EIBI) and the Early Start Denver Model (ESDM). Both are based upon the foundations of Applied Behavioral Analysis (ABA), but the former is more structured and therapist-driven, while the latter is more naturalistic and child-driven. Four databases (EmBase, PubMed, Scopus and WebOfScience) were systematically screened, and an additional search was conducted in the reference lists of relevant articles. Studies were selected if participants were children with ASD aged 12-48 months at intake, receiving either EIBI or ESDM treatment. For each putative predictor, p-values from different studies were combined using Fisher's method. Thirteen studies reporting on EIBI and eleven on ESDM met the inclusion criteria. A higher IQ at intake represents the strongest predictor of positive response to EIBI, while a set of social cognitive skills, including intention to communicate, receptive and expressive language, and attention to faces, most consistently predict response to ESDM. Although more research will be necessary to reach definitive conclusions, these findings begin to shed some light on patient characteristics that are predictive of preferential response to EIBI and ESDM, and may provide clinically useful information to begin personalizing treatment.

Autism spectrum disorder is a neurodevelopmental disorder with a rising prevalence disorder. This high-cost/high-burden condition needs evidence-based behavioral treatments that are able to reduce the impact of symptoms on children’s functioning. This retrospective chart review study compared the impact of different types of early interventions on toddlers diagnosed with an autism spectrum disorder developmental profile. Analyses were conducted on 90 subjects (mean = 27.76 months, range 18–44 months; M:F = 4.29:1), of which 36 children underwent the usual treatment, 13 children underwent an intervention based on early intensive behavioral intervention (EIBI) and 41 children received the Early Start Denver Model, for one year, with the same weekly frequency of about 6 h a week. A significant decrease in the severity of autism symptoms was observed for all children when looking at the Ados-2 severity score (average difference = 3.05, SD = 0.71, p = < 0.001) and the Ados-2 social subscale (average difference = 2.87, SD = 0.59, p < 0.001). Otherwise, for most of the Griffiths subscales, we found a significant improvement only for those children who underwent the Early Start Denver Model intervention (General Quotient average difference = 14.47, SD = 3.22, corrected p < 0.001). Analyzing the influence of age on the investigated scores, we found a significant association with the Eye–hand Coordination Quotient (p = 0.003), Performance Quotient (p = 0.042) and General Quotient (p = 0.006). In all these domains, a mild negative correlation with age was observed, as measured by the Pearson’s correlation coefficient (r = −0.32, p = 0.002; r = −0.21, p = 0.044; r = −0.25, p = 0.019, respectively), suggesting less severe developmental skills at the start of treatment for older children. Our results are consistent with the literature that underlines the importance of early intervention, since prompt diagnosis can reduce the severity of autism symptoms; nevertheless, in toddlers, our study demonstrated that an intervention model based on naturalistic developmental behavioral principles such as the Early Start Denver Model is more effective on children’s developmental profile. Further studies are required to assess the extent of effectiveness of different early intervention models in community settings.

Early intensive intervention has been shown to significantly affect the development of children with autism spectrum disorder. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of the Early Start Denver Model into community preschool programs for children with autism spectrum disorder in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented a multidisciplinary developmental intervention which is widely applied in Israeli community autism spectrum disorder preschools. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention settings. Groups were comparable on age, developmental functioning, and socio-economic status. Compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment made greater gains on blinded measures of overall cognitive development, receptive and expressive language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. In the preschool-based Early Start Denver Model group, children with lower symptom severity, higher adaptive functioning, and receptive language abilities at pre-treatment showed greater improvement. This study documents the successful integration of an Early Start Denver Model intervention into pre-existing community preschools, underlining the importance of disseminating evidence-based early intervention in community settings.Lay Early intensive intervention has been shown to significantly affect the development of children with Autism. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of a research-supported early intensive intervention model called the Early Start Denver Model into community preschool programs for children with Autism in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented the existing multidisciplinary developmental intervention which is widely applied in Israeli community preschools for children with autism. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention preschools. Before the intervention began, groups were comparable on children’s age and developmental functioning and on families’ socio-economic status. Results showed that, compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment group made greater gains on measures of overall cognitive development, language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. Children who had lower autism symptom severity, higher adaptive functioning and better language understanding abilities before taking part in the preschool-based Early Start Denver Model program showed greater improvements following it. This study documents the successful implementation of an intensive early intervention program in pre-existing community preschools, underlining the importance of the integration of research-supported intervention programs into community settings.

Impact of the ESDM on the development of children with ASD in a European French-speaking population: First results of the intervention implementation

Cost Offset Associated With Early Start Denver Model for Children With Autism

BackgroundThe rising number of children identified with autism has led to exponential growth in for-profit applied behavior analysis (ABA) agencies and the use of highly structured approaches that may not be developmentally appropriate for young children. Multiple clinical trials support naturalistic developmental behavior interventions (NDBIs) that integrate ABA and developmental science and are considered best practices for young autistic children. The Early Start Denver Model (ESDM) is a comprehensive NDBI shown to improve social communication outcomes for young autistic children in several controlled efficacy studies. However, effectiveness data regarding NDBI use in community-based agencies are limited.MethodsThis study uses a community-partnered approach to test the effectiveness of ESDM compared to usual early behavioral intervention (EBI) for improving social communication and language in autistic children served by community agencies. This is a hybrid type 1 cluster-randomized controlled trial with 2 conditions: ESDM and EBI. In the intervention group, supervising providers will receive training in ESDM; in the control group, they will continue EBI as usual. We will enroll and randomize 100 supervisors (50 ESDM, 50 EBI) by region. Each supervisor enrolls 3 families of autistic children under age 5 (n = 300) and accompanying behavior technicians (n = 200). The primary outcome is child language and social communication at 6 and 12 months. Secondary outcomes include child adaptive behavior, caregiver use of ESDM strategies, and provider intervention fidelity. Child social motivation and caregiver fidelity will be tested as mediating variables. ESDM implementation determinants will be explored using mixed methods.DiscussionThis study will contribute novel knowledge on ESDM effectiveness, the variables that mediate and moderate child outcomes, and engagement of its mechanisms in community use. We expect results from this trial to increase community availability of this model and access to high-quality intervention for young autistic children, especially those who depend on publicly funded intervention services. Understanding implementation determinants will aid scale-up of effective models within communities.Trail registrationClinicaltrials.gov identifier number NCT06005285. Registered on August 21, 2023.Protocol versionIssue date 6 August 2024; Protocol amendment number: 02.

Imitation is foundational to early social learning, yet autistic children often exhibit significant impairments in imitation, potentially impacting their social communication skills. This study examined the relationship between imitation abilities and social communication in autistic children and evaluated the effectiveness of the Early Start Denver Model (ESDM) intervention. The study included 52 autistic children aged 2–5, divided into an experimental group receiving ESDM intervention and a control group undergoing standard rehabilitation. We assessed the children’s imitation and social communication skills before and after the intervention. Results indicated a significant positive correlation between imitation and social communication skills both before and after the intervention. Specifically, various forms of imitation (e.g., vocal, gestural, object-related) were closely linked to different domains of social communication (e.g., expressive communication, joint attention, social skills). Baseline imitation levels and improvements in imitation were significant predictors of enhanced social communication, jointly accounting for over half of the observed improvements in social communication, with imitation improvement being the strongest predictor. Age positively moderated the relationship between imitation and social communication, with older children showing a stronger impact of imitation on social communication. Although these effects were evident across groups, the ESDM group showed greater gains in imitation skills compared to the control group. However, we did not find evidence of an intervention effect on social communication skills. This study underscores the critical role of imitation in the social communication development of autistic children. These findings support the enhancement of imitation skills in early interventions for autistic children, highlighting the effectiveness of ESDM in fostering imitation abilities.

Recommendations for ABA for children with Autism have exponentially increased, creating a shortage of qualified ABA consultants. The increase in demand, lack of financial support for in-home programs and difficulty of maintaining in-home staff create a need for alternative delivery models for Early Intensive Behavioral Intervention (EIBI). We present a preliminary analysis of learning rates and psychometric outcomes for children in 3 different delivery models--Home based EIBI, only; and Home and School EIBI; Home Based EIBI with alternative school methods. ********** An impressive body of research exists that supports the effectiveness of early intensive behavioral intervention (EIBI) programs based on principles of applied behavior analysis (ABA) implemented with preschool age children diagnosed with autism and PDD-NOS (see New York State Department of Health Early Intervention Program, 1999a, 1999b, 1999c). Traditionally, these programs have included 40+ hours per week of programming conducted by trained therapists in home settings over a period of 2-3 years. Given the daunting financial and logistical demands inherent in organizing and implementing programs of this type, it is often necessary to implement different service delivery models. Some of these models have included school-based programs (often housed in special needs schools), combined home/school programs, and partial home programs - among others. Relatively little research has been done comparing the outcomes and relative effectiveness of these program variants. Effective EIBI programs can significantly increase the quality of life of children and families, and can significantly reduce costs to society (Jacobson, Mulick, & Green, 1998). Increased knowledge of the comparative efficacy of EIBI program variants can be of benefit to school districts and parents of autistic children attempting to balance limited resources with effective intervention. This study is viewed as a pilot project. Data are presented for children in 3 different service delivery models: Home based EIBI, only; Home based and School EIBI; and Home based EIBI and alternative school program. The intent of the study is to obtain initial data to be used in formulating follow-up studies of the efficacy of alternative EIBI service delivery models. Method Participants This study was conducted with children of preschool age (N = 5) initially diagnosed with autism or PDD-NOS currently in EIBI programs followed by the psychology department of Columbus Children's Hospital. Participants were between 3 and 6 years of age, who received a comprehensive psychological evaluation at least twice by the Psychology Department, have received at least 10 hours per week of EIBI intervention over the past 18 months (or more), and have tutors other than parents. Exclusionary criteria included diagnoses of Asperger's, Rett's, Fragile X without Mental Retardation, Mental Retardation without Autism, and Tuberous Sclerosis. See Table 1 for a brief description of each participant. Materials Because of age and skill differences, children received a variety of standardized cognitive and language measures. These measures included: Cognitive measures: 1. Bayley Scales of Infant Development Second Edition (Bayley; Bayley, 1993) The Bayley was designed to assist professionals in early identification of developmental delays. Standardized scores for cognitive, motor, and behavioral development are available. Correlations with measures of cognitive ability (e. g. IQ tests) are adequate for estimates of developmental delay (correlation with WPPSI-R Full Scale IQ = .73). Test-retest reliability for the mental scale was also adequate (.87). 2. Mullen Scales of Early Learning Manual (Mullen; Mullen, 1995) The Mullen was designed to provide estimates of cognitive development for young children. …

Early intensive behavioral and developmental interventions for young children with autism spectrum disorders (ASDs) may enhance developmental outcomes. To systematically review evidence regarding such interventions for children aged 12 and younger with ASDs. We searched Medline, PsycINFO, and ERIC (Education Resources Information Center) from 2000 to May 2010. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of-evidence ratings using predetermined criteria. Thirty-four unique studies met inclusion criteria. Seventeen studies were case series; 2 were randomized controlled trials. We rated 1 study as good quality, 10 as fair quality, and 23 as poor quality. The strength of the evidence overall ranged from insufficient to low. Studies of University of California Los Angeles/Lovaas-based interventions and variants reported clinically significant gains in language and cognitive skills in some children, as did 1 randomized controlled trial of an early intensive developmental intervention approach (the Early Start Denver Model). Specific parent-training approaches yielded gains in short-term language function and some challenging behaviors. Data suggest that subgroups of children displayed more prominent gains across studies, but participant characteristics associated with greater gains are not well understood. Studies of Lovaas-based approaches and early intensive behavioral intervention variants and the Early Start Denver Model resulted in some improvements in cognitive performance, language skills, and adaptive behavior skills in some young children with ASDs, although the literature is limited by methodologic concerns.

&lt;p&gt;Autism spectrum disorder (ASD) is a pervasive developmental disorder that is characterised by deficits in social communication and restricted and repetitive behaviours, interests and activities. Recent developments in identification techniques mean that many children can be reliably diagnosed with ASD before the age of 2. Early identification creates the opportunity for early intervention. In fact, some research suggests that the earlier a child with ASD receives intervention, the greater the progress he or she is likely to make. Naturalistic developmental behavioural interventions are a relatively recent method of early intervention for children with ASD, which combine elements of previous intervention approaches (behavioural, naturalistic behavioural, and developmental/relationship-focused intervention). One such naturalistic developmental behavioural intervention is the early start Denver model (ESDM), which is designed for children with or at risk for ASD between the ages of 12 and 60 months (5 years). Research suggests that ESDM intervention may improve a range of child outcomes when delivered for at least 15 hours per week over at least 10 months. However, many families may not be able to access or afford such intensive intervention. Therefore, the two studies in this thesis evaluated the effectiveness of two ESDM delivery approaches that required relatively few hours of professional input per week. Specifically, low-intensity therapist delivered ESDM intervention, and ESDM parent training. Study 1 used a multiple probe across participants design to evaluate the effectiveness of 3 hours per week of home-based ESDM therapy for 12 weeks for improving imitation, communication, and engagement for four young children with ASD. It also examined whether children showed increases in these outcomes with their mothers following the intervention. The results of this study suggest that, following the intervention, all four children increased their imitation skills and their engagement with the therapist. In addition three of the children had more functional utterances and one child increased his use of intentional vocalisations. These results were maintained four weeks after intervention and generalised to a lesser degree to each child’s mother. This suggests that low-intensity therapist delivered ESDM intervention may improve outcomes for children with ASD. The results of Studies 1 and 2 suggest that both low-intensity therapist delivered ESDM intervention and ESDM parent training may be promising intervention approaches for young children with ASD. This is particularly encouraging as both approaches involved relatively few hours of professional input per week. In theory, this could increase the number of families who are able to access such intervention. More research is needed to identify the most effective low-intensity ESDM intervention method, or combination of methods.&lt;/p&gt;

&lt;p&gt;Autism spectrum disorder (ASD) is a pervasive developmental disorder that is characterised by deficits in social communication and restricted and repetitive behaviours, interests and activities. Recent developments in identification techniques mean that many children can be reliably diagnosed with ASD before the age of 2. Early identification creates the opportunity for early intervention. In fact, some research suggests that the earlier a child with ASD receives intervention, the greater the progress he or she is likely to make. Naturalistic developmental behavioural interventions are a relatively recent method of early intervention for children with ASD, which combine elements of previous intervention approaches (behavioural, naturalistic behavioural, and developmental/relationship-focused intervention). One such naturalistic developmental behavioural intervention is the early start Denver model (ESDM), which is designed for children with or at risk for ASD between the ages of 12 and 60 months (5 years). Research suggests that ESDM intervention may improve a range of child outcomes when delivered for at least 15 hours per week over at least 10 months. However, many families may not be able to access or afford such intensive intervention. Therefore, the two studies in this thesis evaluated the effectiveness of two ESDM delivery approaches that required relatively few hours of professional input per week. Specifically, low-intensity therapist delivered ESDM intervention, and ESDM parent training. Study 1 used a multiple probe across participants design to evaluate the effectiveness of 3 hours per week of home-based ESDM therapy for 12 weeks for improving imitation, communication, and engagement for four young children with ASD. It also examined whether children showed increases in these outcomes with their mothers following the intervention. The results of this study suggest that, following the intervention, all four children increased their imitation skills and their engagement with the therapist. In addition three of the children had more functional utterances and one child increased his use of intentional vocalisations. These results were maintained four weeks after intervention and generalised to a lesser degree to each child’s mother. This suggests that low-intensity therapist delivered ESDM intervention may improve outcomes for children with ASD. The results of Studies 1 and 2 suggest that both low-intensity therapist delivered ESDM intervention and ESDM parent training may be promising intervention approaches for young children with ASD. This is particularly encouraging as both approaches involved relatively few hours of professional input per week. In theory, this could increase the number of families who are able to access such intervention. More research is needed to identify the most effective low-intensity ESDM intervention method, or combination of methods.&lt;/p&gt;

The Early Start Denver Model is an evidence-based early intervention program for young and very young children with autism. This interdisciplinary model is used by many types of professionals, such as psychologists, occupational therapists, speech pathologists, early child special educators, and paraprofessionals, as well as by parents. Most previous studies on the Early Start Denver Model were conducted in the West, and there are scarce studies on the topics of generalization in culture and countries outside the Western world. In this study, we evaluated the effect of the Early Start Denver Model with some adaptations, including a lower intensity, shorter duration, and delivery in regional general hospitals in Northern Taiwan. In total, 45 young children with autism, aged 2-4 years, were divided into the Early Start Denver Model and community-based control groups. The children in the Early Start Denver Model group received one-on-one intervention for approximately 8-9 h per week for 6 months. The results revealed that compared with the control group, the Early Start Denver Model group showed greater gains in overall development ability and nonverbal development ability from pre- to post-intervention. However, these differences did not sustain at the 6-month follow-up after the completion of the intervention. Being mindful of some caveats in trial designs, this study provides preliminary evidence to support the effectiveness of the Early Start Denver Model intervention in the regional general hospital settings in the context of Han-Chinese-mainly culture. Our findings can provide helpful information to stakeholders and policymakers of early intervention service systems for children with autism in Taiwan, as well as in Asian countries.

Numerous studies reveal the benefits of early intervention for the adequate development of children with autism spectrum disorders (ASD). Most of the interventions designed for people with ASD focus exclusively on a sole methodology. This study proposes a Combined Early Intervention Program (hereafter CEIP) using different methodologies with scientific evidence: Early Intensive Behavioral Interventions (EIBI), Early Start Denver Model (DENVER), spatial-temporal organization (TEACCH), augmentative communication systems (the Picture Exchange Communication System—PECS—, Total Communication Program, Picture Communication Symbols—PCS), behavioral strategies, and training of the parents. This CEIP contemplates intervention in areas that are typically affected in ASD: socialization, communication, symbolization, and behavioral flexibility, producing considerable improvement in the children's behavior, decreasing problem behaviors and improving social communication.

Each child with Autism Spectrum Disorder has different symptoms, skills and types of impairment or disorder with other children. This is why the word “spectrum” is included in this disorder. Eapen, Crncec, and Walter, 2013 claimed that there was an emerging evidence that early interventions gives the greatest capacity of child’s development during their first years of life as “brain plasticity” are high during this period. With this, the only intervention program model for children as young as 18 months that has been validated in a randomized clinical trial is “Early Start Denver Model” (ESDM). This study aimed to determine the effectiveness of the outcome of “Early Start Denver Model” (ESDM) towards young children with Autism Spectrum Disorders. This study made use of meta-analysis method. In this study, the researcher utilized studies related to “Early Start Denver Model (ESDM)” which is published in a refereed journal which are all available online. There were five studies included which totals 149 children exposed to ESDM. To examine the “pooled effects” of ESDM in a variety of outcomes, a meta-analytic procedure was performed after the extraction of data of the concrete outcomes. Comprehensive Meta Analysis Version 3.3.070 was used to analyze the data. The effectiveness of the outcome of “Early Start Denver Model” towards young children with Autism Spectrum Disorders (ASD) highly depends on the intensity of intervention and the younger child age. This study would provide the basis in effectively implementing an early intervention to children with autism such as the “Early Start Denver Model” (ESDM) that would show great outcome effects to those children that has “Autism Spectrum Disorder”.

&lt;p&gt;Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by difficulties in social communication and the presence of restricted or repetitive behaviours or interests. There is evidence to suggest that early intervention (EI) can lead to improved outcomes for children with ASD. Inclusive preschool-based delivery of EI appears to satisfy current legal and best-practice recommendations around the delivery of EI for young children with ASD. It may also offer several potential benefits including cost-effectiveness, efficiency and opportunities for children with ASD to learn from their peers. The Early Start Denver Model (ESDM) is a promising naturalistic behavioural developmental intervention for young children with ASD aged between 12 and 60 months. The ESDM can be delivered to children in a group-based format and several studies have demonstrated its effectiveness when delivered for 15 to 25 hours per week in designated ESDM preschools with low child–teacher ratios. However, the preschools involved in these studies may not be representative of the typical preschool setting for many communities. Thus, more research is needed to determine the effectiveness of this intervention when delivered under conditions that more closely reflect the typical real-world preschool setting. In the present thesis, two studies with multiple probe across participants designs, each involving three preschool children with ASD, examined the feasibility and effectiveness of the use of the ESDM in an inclusive preschool setting. Specifically, Study 1 evaluated the effectiveness of a modified version of ESDM therapy delivered by a certified therapist and Study 2 evaluated (a) the effectiveness of a brief ESDM coaching programme, and (b) the effectiveness of a modified version of ESDM therapy delivered by preschool teachers. For both studies, the intervention was delivered in regular community preschools and no major changes were made to the typical preschool environments or routines. Effectiveness was assessed by measuring improvements in child active participation, vocal/verbal communication and imitation, and, for Study 2, teachers’ fidelity of implementation of ESDM techniques. Teachers’ perceptions of the acceptability and effectiveness of the intervention were also assessed via a questionnaire and in-depth interviews. In Study 1, an outside certified therapist delivered 3 hours per week of ESDM to three children with ASD over an 8- to 10-week period. Participants showed improvement in active participation, imitation and either intentional vocalisations or spontaneous functional utterances. These results were generally maintained at follow-up. For Study 2, a brief coaching programme was used to train three preschool teachers to use the ESDM with a child with ASD who attended the inclusive preschools where they worked. Teachers improved in their use of the ESDM strategies and children demonstrated improved levels of active participation but results for child imitation and communication were mixed. Teachers also found the intervention to be acceptable and effective. Together, the results from these studies provide preliminary support for the feasibility and effectiveness of the ESDM when delivered in real-world inclusive preschool settings. More research is needed to determine the most effective approach to delivering EI for ASD in an inclusive preschool setting. It may also be valuable to evaluate the extent to which gains made by children and teachers during intervention generalise to other people and/or settings.&lt;/p&gt;