Early Start Denver Model Intervention Research Articles

Randomized, controlled trial of a mixed early start Denver model for toddlers and preschoolers with autism.

The early start Denver model (ESDM) has been extensively studied as a promising early intervention approach for young children with autism spectrum disorder (ASD). Various methodological drawbacks from earlier ESDM investigations must be rectified to expand the application scopes. For this purpose, the present study recruited a very large sample of 249 autistic children (aged 24-47 months), and used a randomized controlled design to compare outcomes from a mixed ESDM (M-ESDM) intervention with a mixed discrete trial teaching (M-DTT) intervention which remains one of the most commonly-used programming for early intervention. Over the course of a 12-week period, both groups (i.e., M-ESDM and M-DTT groups) received 25 h of intensive intervention per week using individual, group, and parent coaching techniques. Findings showed that: (i) the M-ESDM significantly outperformed the M-DTT in enhancing children's developmental abilities in gross motor and personal-social skills for toddlers and preschoolers, as well as in language for preschoolers with mild/moderate ASD and toddlers; and (ii) the M-ESDM dramatically reduced the severity of autistic symptoms in toddlers with severe ASD only, when compared to the M-DTT. However, the M-ESDM did not outperform the M-DTT in terms of improving children's developmental abilities in adaptability and fine motor for toddlers and preschoolers, as well as in language for preschoolers with severe ASD. In addition, when compared to the M-DTT, the M-ESDM did not show an advantage in reducing the severity of autistic symptoms in toddlers with mild/moderate ASD and preschoolers. Clinical Trial Registration: Chinese Clinical Trial Registry. Registration number ChiCTR200039492.

Short-Term Outcomes of an ESDM Intervention in Italian Children with Autism Spectrum Disorder following the COVID-19 Lockdown.

The COVID-19 pandemic caused a temporary lockdown period in Italy, during which the delivery of in-person treatment for children with autism spectrum disorder (ASD) in public health services was discontinued. This occurrence represented a crucial challenge for both families and professionals. We assessed the short-term outcomes of a sample of 18 children who received an early intervention with the Early Start Denver Model (ESDM), delivered at low intensity over one year in the pre-pandemic period, after six months of interruption of in-presence treatment due to lockdown restrictions. Children who received the ESDM treatment maintained their gains in sociocommunicative skills and did not exhibit any developmental regression. Additionally, there was evidence of a decrease in the restrictive and repetitive behavior (RRB) domain. The parents, who were already familiar with the principles of the ESDM, only received telehealth support from therapists that aimed to sustain the gains already achieved. We believe that it is always helpful to support parents in their daily lives by implementing interactional and play skills with their children to integrate and consolidate the results obtained in the individual interventions conducted by experienced therapists.

Impact of Three Kinds of Early Interventions on Developmental Profile in Toddlers with Autism Spectrum Disorder.

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.

Evaluation of Low-intensity Therapist-Delivered Intervention in Addition to Parent Coaching for Young Children with Autism Spectrum Disorder

ABSTRACT Parents are often expected to be the primary implementers of intervention for their young children with autism spectrum disorder (ASD). The provision of a few hours a week of intervention by a trained therapist, in addition to parent-implemented intervention, could increase child outcomes compared to parent-implemented intervention in isolation. This study evaluated the effects of a 12-week parent coaching program based on the Early Start Denver Model (ESDM) followed by 12-weeks of therapist-delivered ESDM intervention for four children with ASD. The effects of these interventions on child participation, functional utterances, and imitation were evaluated using a multiple probe across participants design. Children’s participation improved during both interventions. Children generally showed greater improvements in imitation with the therapist than with their parents but showed minimal improvements in functional utterances. This suggests there may be some benefit to low-intensity therapy in addition to parent coaching, but more research is needed.

Short-term low-intensity Early Start Denver Model program implemented in regional hospitals in Northern Taiwan.

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.

The Early Start Denver Model Intervention and Mu Rhythm Attenuation in Autism Spectrum Disorders.

We examined the relationship between the Early start Denver model (ESDM) intervention and mu rhythm attenuation, an EEG paradigm reflecting neural processes associated with action perception and social information processing. Children were assigned to either receive comprehensive ESDM intervention for two years, or were encouraged to pursue resources in the community. Two years after intervention, EEG was collected during the execution and observation of grasping actions performed by familiar and unfamiliar agents. The ESDM group showed significantly greater attenuation when viewing a parent or caregiver executing a grasping action, compared with an unfamiliar individual executing the same action. Our findings suggest that the ESDM may have a unique impact on neural circuitry underlying social cognition and familiarity.

The Efficacy of Early Start Denver Model Intervention in Young Children with Autism Spectrum Disorder Within Japan: A Preliminary Study.

ObjectivesAmong the many intervention programs for children with autism spectrum disorder (ASD), the Early Start Denver Model (ESDM) is one of the few approaches that has succeeded in demonstrating clinical efficacy in randomized control trials. Here, we investigate the clinical efficacy of ESDM intervention in young children with ASD in a community setting within Japan.MethodsAll subjects were children with ASD who received ESDM intervention during the study period. Each ESDM session lasted 75 min and occurred once per week for at least 12 weeks. The outcome measures consisted of the Kyoto Scale of Psychological Development (K-test), Aberrant Behavior Checklist-Japanese version (ABC-J), and the Clinical Global Impression-Severity scale (CGI-S).ResultsTwenty-seven subjects (29.4±6.4 months old) received ESDM intervention that lasted for 8.0±2.6 months on average. The score on Language and Social developmental quotient on the K-test increased significantly after the intervention. The total scores on the ABC-J and CGI-S significantly decreased after completion of the ESDM intervention.ConclusionOur results suggest that ESDM intervention could reduce the severity of distinct clinical features of ASD, such as impairments in social interaction and communication assessed by the K-test, and maladaptive behavior rated by the ABC-J and CGI-S. We believe that the ESDM adapted to each institution might become one of the standard options for children with ASD in Japan.

Integrating the Early Start Denver Model into Israeli community autism spectrum disorder preschools: Effectiveness and treatment response predictors.

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.

Preliminary clinical outcomes of a short-term low-intensity Early Start Denver Model implemented in the Taiwanese public health system.

The Early Start Denver Model is a comprehensive naturalistic developmental behavioral intervention for young children with autism spectrum disorder. Rigorous studies indicate that long-term, high-intensity Early Start Denver Model in home-based settings can help young children with autism spectrum disorder have great progress in language, cognitive development, and adaptive skills and reduce overall symptom severity. In accordance with the current limitations in resourcing for early intervention in Taiwan, this study evaluated the effects of implementing the Early Start Denver Model in the Taiwanese public health system with some adaptations, including lower intensity, shorter duration, and delivery in general hospitals. A total of 16 children with autism spectrum disorder, aged between 25 and 46 months, received approximately 8 h per week one-on-one Early Start Denver Model intervention. After 6 months of intervention, the children showed great improvements in language and overall cognitive functioning and reduced symptom severity in communication and play. This study suggests that directly delivering the Early Start Denver Model in community-based hospitals may be an effective intervention, which can make more young children with autism spectrum disorder in Taiwan access the Early Start Denver Model service.

Using ESDM 12 hours per week in children with autism spectrum disorder: feasibility and results of an observational study.

Early intervention for Autism Spectrum Disorder (ASD) in France is heterogeneous and poorly evaluated to date. Early Start Denver Model (ESDM) is a developmental and behavioral model of intervention for toddlers with ASD which has already shown very interesting outcomes on the development of children with ASD in various studies with different settings. However, it is not possible with the current research to agree on the best setting. Thus, we implemented an ESDM program according to our context where children are often pre-schooling early from 30 months old. This therapy was applied by a multidisciplinary team working in close collaboration with parents and other partners. A prospective observational study including 19 toddlers with ASD was conducted. We evaluated improvement on the cognitive level of toddlers with ASD receiving therapist-delivered ESDM intervention for 12 hours per week. Significant improvements in verbal and nonverbal cognitive skills at the Mullen Scale of Early Learning were obtained after 10 months of intervention in our sample. The largest improvement was in receptive language development quotient with a mean improvement of 19.6 points. We also observed promising outcomes in daily adaptive behavior, with a slight improvement in communication at the Vineland Adaptive Behavioral Scale. These outcomes, when compared to the conclusions of previous studies, are leading us to the need for a therapy duration beyond 10 months. Our outcomes were very encouraging even with low cognitive and nonverbal children. These outcomes may be confirmed in a multicenter randomized controlled trial that is ongoing.

Feasibility and Outcomes of the Early Start Denver Model Implemented with Low Intensity in a Community Setting in Austria.

To investigate the feasibility and effectiveness of early autism intervention with the Early Start Denver Model (ESDM) implemented with low intensity in a community service in Europe. Subjects were boys (n = 13, ages 34-54 months, mean age 43.3 months) consecutively diagnosed with autism spectrum disorder in a regional autism center in Austria. The subjects either received the ESDM intervention for 4.6 hours weekly over 12 months (n = 7) or intervention as usual (n = 6). Feasibility of the ESDM intervention was evaluated by parent and teacher questionnaires, ESDM fidelity measures, and therapists' feedback. Developmental status was assessed through standardized instruments (Mullen Scales of Early Learning [MSEL], Vineland Adaptive Behavior Scales Second Edition, Communicative Development Inventory, Pervasive Developmental Disorder Behavior Inventory [PDDBI], Parenting Sense of Competence Scale) at baseline and after intervention. The ESDM intervention was delivered with high fidelity (>80%) by a newly trained multiprofessional team. Acceptability by parents was rated as high. The ESDM was considered to be compatible with both family and preschool routines without any major adaptations. The ESDM group showed a trend toward improved receptive language (MSEL receptive language; p = 0.09, effect size [ES] = 0.72) and reduction in parent-reported core autism symptoms (PDDBI Autism Composite Score; p = 0.04; ES = 0.95). No such improvement was noted in the control group. Low-intensity implementation of the ESDM in a non-English-speaking community service context is feasible. Although outcomes from this small feasibility study should be interpreted with caution, our findings suggest a more favorable response to the ESDM intervention group compared with the control group.

Evaluation of a low-intensity version of the early start Denver model with four preschool-aged boys with autism spectrum disorder

Objectives: Data indicate that some developmentally and behaviorally based early intervention programs can lead to a range of improvements in children with autism spectrum disorder. However, many such programs call for a fairly intensive amount of intervention. The objective of this preliminary study was to evaluate the effectiveness of a low-intensity therapist delivered intervention for young children with autism spectrum disorder.Methods: The study evaluated the outcomes of 3 hours per week of therapist-delivered early start Denver model intervention (ESDM) over a 12-week period for four preschool-aged boys with autism spectrum disorder. The effects of intervention on communication, imitation, and engagement were evaluated using a non-concurrent multiple probe across participants design.Results: Following the intervention, all four children showed increases in imitation, engagement, and either functional utterances or intentional vocalizations. These results were maintained after 4 weeks and mostly generalized to each child’s mother.Conclusion: These preliminary results suggest that low-intensity therapist delivered ESDM intervention may be of some benefit to children with autism spectrum disorder.

A Multisite Randomized Controlled Two-Phase Trial of the Early Start Denver Model Compared to Treatment as Usual.

This single-blind, randomized, multisite, intent-to-treat study was designed to replicate and extend Dawson etal.'s (Pediatrics. 2010;125: e17-e23) randomized controlled trial testing the effects of the Early Start Denver Model (ESDM), an intensive play- and routines-based intervention delivered in natural settings. A randomized controlled trial was conducted at 3 universities. One hundred eighteen children 14 to 24 months old with autism spectrum disorder were enrolled and randomly assigned to ESDM or community interventions for 27 months. Eighty-one children completed the full treatment course and all assessments; data from all 118 children were used in analyses. Children assigned to the ESDM intervention received 3 months of weekly parent coaching followed by 24 months of 15 hour per week (on average) 1:1 treatment weekly on average in homes or daycare settings from supervised therapy assistants while parents received coaching 4 hours monthly from a certified ESDM therapist. For the primary analyses, there were time-by-group and time-by-group-by-site interactions for language outcome. In the significant 3-way interaction involving site, 2 sites showed a significant ESDM advantage and the third site showed no significant group differences. In the planned 2-way analysis that pooled data across all 3 sites, there was a significant advantage found for the ESDM group. For the secondary analyses, there were no significant differences between the ESDM and community groups involving developmental quotient, autism severity, or adaptive behavior. The treatment effect of group on language outcomes was not moderated by baseline developmental quotient, autism severity, or language. Results of the primary analysis provide a partial replication of Dawson etal.'s 2010 language findings. Intensive Intervention for Toddlers with Autism; https://clinicaltrials.gov/; NCT00698997.

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

Introduction Early intervention for autism spectrum disorder (ASD) in the European French-speaking countries is heterogeneous and poorly evaluated to date. Early intervention units applying the Early Start Denver Model (ESDM) for toddlers and young children with ASD have been created in France and Belgium to improve this situation. It is essential to evaluate this intervention for the political decision-making process regarding ASD interventions in European French-speaking countries. We selected the implementation of a 12-hour ESDM intervention for children with ASD over a 2-year period as part of the IDEA trial. This ESDM intervention can be complex to implement. It is subject to many organizational constraints. It relies on a strong involvement of both ESDM professional teams and parents to implement this individual intervention adapted to each child. It is therefore important at this stage of the IDEA study to evaluate the ESDM intervention implementation. Methods The IDEA trial is an ongoing multicentre, randomised controlled trial, using a two-stage Zelen design. Children included are aged 15 to 36 months, diagnosed with ASD and with a Developmental Quotient (DQ) of 30 or above on the Mullen Scale of Early Learning (MSEL). We use a stratified minimisation randomisation at a ratio 1:2 in favour of the control group. The sample size requires is 180 children (120 in the control and 60 in the intervention group). The intervention evaluated is a 12-hour per week ESDM by trained therapists (10 hours in the centre and 2 hours in the toddlers’ natural environment). The control group receives care available in the community. Our aim was to evaluate the ESDM intervention implementation for children in the intervention group, by evaluating the number of sessions and the number of hours ESDM conducted and analyzing reasons for absence and organization of centers. Results To date, 131 children have been included: 88 randomized children in the control group, 43 randomized in the intervention group. At inclusion, children’ characteristics in the intervention group were mean age 29.8 months, the level of behavioral change and severity of autistic symptoms at ADOS score of 7.6 (max score 10.0) and developmental quotient at Mullen score of 45.9 (max score 59.1). ESDM intervention sessions were completed for 65% of the children. Seventy-five percent of the reasons for cancellation were related to the organization of ESDM professional teams (holidays, training/absences of professionals). The average number of intervention hours delivered was of 8 hours per week. The average number of hours delivered increased (from 6.6 hours to 9.6 hours per week) during the months of ESDM intervention implementation, suggesting a gradual implementation. Conclusions The evaluation of the intervention implementation showed that children received on average 4 hours less ESDM intervention than initially planned by the protocol. The reasons for canceling sessions related to families are limited (25%), which shows a strong motivation and involvement on their part. The results highlight the factors limiting the ESDM intervention implementation (necessary adaptation period, organizational constraints of the professional teams).

An Evaluation of the Research Evidence on the Early Start Denver Model

The Early Start Denver Model (ESDM) has been gaining popularity as a comprehensive treatment model for children ages 12 to 60 months with autism spectrum disorders (ASD). This article evaluates the research on the ESDM through an analysis of study design and purpose; child participants; setting, intervention agents, and context; density and duration; and overall research rigor to assist professionals with knowledge translation and decisions around adoption of the practices. Ten research studies are included in this systematic review. Findings indicate variability in methodologies, participant and intervention characteristics, and research rigor. The ESDM shows promise as an evidence-based practice for young children with ASD and there is preliminary evidence to support implementation of the ESDM. Children are progressing with ESDM intervention and fidelity of implementation has been achieved in community-based settings. The extent to which child improvements are due to the ESDM intervention alone is not fully known. Additional studies are needed including replication by independent researchers to determine “active ingredients,” level of effectiveness, and whether the ESDM is better than other treatment options. This review highlights research opportunities to expand professionals’ knowledge of the ESDM’s effectiveness. Clinical decisions around adoption and feasibility of implementation in communities will be enhanced with greater knowledge and understanding.

Expérimentation de la prise en charge Early start Denver model (ESDM) : les effets sur le développement de 4 jeunes enfants avec troubles du spectre de l’autisme

IntroductionThe Early start Denver model (ESDM) is today recommended by the High authority of health for very young children with disorders of autism spectrum disorders (ASD). Different studies highlight the effectiveness of the method on different areas of development. The ESDM is an intensive method, it recommends at least 20hours of individual intervention per week. This method is still little used in France, the structures do not have enough human resources, equipment and premises are not suitable, the overall cost is too high. Faced with this problem, our research examines whether there may be a significant impact of the ESDM method on child development even if it is less intensive. MethodWe proposed four older ASD children of 27 to 35 months to have 4 hours of ESDM with a therapist and 3 hours with their parents for a year. All the children had a developmental assessment in using the PEP-3 (receptive and expressive language, verbal and preverbal cognition, imitation, gross motor and fine motor), the Vineland and ADOS 2, at the beginning of the ESDM therapy and 1 year after. ResultsThe development profile at the time of inclusion shows great difficulties in language (receptive and expressive) and imitation. After a year of ESDM therapy, development profile shows a more homogeneous trajectory. For some children, there is little change in expressive language. Conversely, the statistical results indicate significant increases in three areas of development: receptive language, the hand-eye imitation and verbal cognition and preverbal. Children have acquired pointing and the object and activity demand have increased in quantity and quality. Instrumental and conventional gestures have also been widely used. In the imitation domain, children have more reproduce object manipulations, they also invest in gestural imitation of songs and social routines. In the cognition area, sorting and categorization activities have quickly developed. Children are more attentive to the material during their handling, and objects are more used in line with their function. Although this group of children could benefit only from 7 hours ESDM intervention per week, their developmental trajectory have been impacted and improved. It also lead to a more homogeneous development and a stabilization of their skills. ConclusionThese positive results with less intensity could be interesting for structures or professionals who have fewer resources. Moreover, the foundations of this method: social communication, social motivation, positive affect and mutual sharing can stimulate the acquisitions and experimentations which are necessary to child development. Finally, these preliminary results are encouraging and lead us to consider the renewal of our study on a larger sample.

Impact of the Early Start Denver Model on the cognitive level of children with autism spectrum disorder: study protocol for a randomised controlled trial using a two-stage Zelen design

IntroductionEarly intervention for autism spectrum disorder (ASD) in the European French-speaking countries is heterogeneous and poorly evaluated to date. Early intervention units applying the Early Start Denver Model (ESDM) for...

Implementation of the Early Start Denver Model in an Italian community.

Identifying effective, community-based specialized interventions for young children with autism spectrum disorder is an international clinical and research priority. We evaluated the effectiveness of the Early Start Denver Model intervention in a group of young children with autism spectrum disorder living in an Italian community compared to a group of Italian children who received treatment as usual. A total of 22 young children diagnosed with autism spectrum disorder received the Early Start Denver Model in a center-based context for 6 h per week over 6 months. The Early Start Denver Model group was compared to a group of 70 young children diagnosed with autism spectrum disorder who received treatment as usual for an average of 5.2 h over 6 months. Children in both groups improved in cognitive, adaptive, and social skills after 3 months and 6 months of treatment. Children in the Early Start Denver Model group made larger gains in cognitive and social skills after 3 and 6 months of treatment. The Early Start Denver Model group made larger gains in adaptive skills after 3 months of treatment. Our results are discussed in terms of implications for intervention research and clinical practice. Our study supports the positive impact of the Early Start Denver Model in a non-English-speaking community.

Early diagnosis and Early Start Denver Model intervention in autism spectrum disorders delivered in an Italian Public Health System service

BackgroundEarly diagnosis combined with an early intervention program, such as the Early Start Denver Model (ESDM), can positively influence the early natural history of autism spectrum disorders. This study evaluated the effectiveness of an early ESDM-inspired intervention, in a small group of toddlers, delivered at low intensity by the Italian Public Health System.MethodsTwenty-one toddlers at risk for autism spectrum disorders, aged 20–36 months, received 3 hours/wk of one-to-one ESDM-inspired intervention by trained therapists, combined with parents’ and teachers’ active engagement in ecological implementation of treatment. The mean duration of treatment was 15 months. Cognitive and communication skills, as well as severity of autism symptoms, were assessed by using standardized measures at pre-intervention (Time 0 [T0]; mean age =27 months) and post-intervention (Time 1 [T1]; mean age =42 months).ResultsChildren made statistically significant improvements in the language and cognitive domains, as demonstrated by a series of nonparametric Wilcoxon tests for paired data. Regarding severity of autism symptoms, younger age at diagnosis was positively associated with greater improvement at post-assessment.ConclusionOur results are consistent with the literature that underlines the importance of early diagnosis and early intervention, since prompt diagnosis can reduce the severity of autism symptoms and improve cognitive and language skills in younger children. Particularly in toddlers, it seems that an intervention model based on the ESDM principles, involving the active engagement of parents and nursery school teachers, may be effective even when the individual treatment is delivered at low intensity. Furthermore, our study supports the adaptation and the positive impact of the ESDM entirely sustained by the Italian Public Health System.

Effectiveness of the Early Start Denver Model: a Systematic Review

The present review identified 15 studies that have evaluated the Early Start Denver Model (ESDM) as an early intervention program for a total of 209 children with autism spectrum disorder. The articles were summarized in terms of participant characteristics, intervention characteristics, study design, quality of the study/research rigor, and outcomes. ESDM intervention characteristics included provision of training to parents or therapists, intensive one-to-one intervention, and group intervention. Most studies reported positive child, parent, and therapist outcomes. The included articles used a range of group and single-case designs, but nearly half of the studies were rated as having weaknesses in terms of quality/rigor. We conclude that the ESDM is a potentially promising intervention, but the limited number of high-quality studies indicates the need for additional research to evaluate its effectiveness.