The Effectiveness of the Early Start Denver Model (ESDM) in Early Intervention Programs for Toddlers with Autism Spectrum Disorder Jennifer van Gelder, B.S., Genetic Counseling Student Research Question Results Group-based Community Childcare Approach What are the benefits of using the Early Start Denver Model (ESDM) in parent-centered and community-centered early intervention programs for toddlers with Autism Spectrum Disorder? Parent-Delivered (P-ESDM) Approach Vivanti et al., 2014 27 preschoolers with ASD receiving 15-25 hours per week of ESDM in a community child care program vs. 30 preschoolers with ASD receiving different intervention program in a similar environment Over 12 month period Both groups showed significant increase in cognitive abilities and adaptive functioning over 12 months Similar pattern of results to the Dawson et al., 2010 paper using the ESDM in a parent-delivered method ESDM group showed greater developmental rates and significant increases in receptive language development over control group in MSEL Gains in VABS comparable in both groups No significant effects in ADOS Feasibility difficult due to demand and the resource needs and staff needed to run the intervention successfully Overall, the ESDM model may be effective in community-based group settings for producing positive effects in development for children with ASD Dawson et al., 2010 48 toddlers with Autism Disorder (AD) or Pervasive Developmental Disorder (PDD) between age 18-30 months, randomly assigned to ESDM group and control group Evaluated at pre-intervention, 1-year and 2-year Significantly improved cognitive abilities and increased IQ after 1-year and 2-year by MSEL Significant differences in adaptive behavior at 2-year by VABS – steady rate of development in ESDM group, decline in rate in control group Toddlers in ESDM group significantly more likely to have improved diagnosis status at 2-year outcome (P=0.041) Overall, the ESDM model showed to be an effective intervention for improving outcomes of toddlers with ASD Rogers et al., 2012 98 toddlers with ASD ages 12-24 months randomly divided into P-ESDM group and community treatment group Assessments completed at baseline and 12 weeks later after parent coaching No effect of group assignment on child outcomes – both groups showed improved development in children Significantly more interaction hours in community group vs. P-ESDM group The amount of gains made were influenced by the age the of the child receiving the intervention and the amount of hours of intervention – children of a younger age and receiving more hours of therapy showed more improvements in development Overall, this paper showed no significant difference between the P-ESDM model vs. community treatment – children benefit in development from any form of treatment Rationale Autism Spectrum Disorder (ASD) is a continuum of disorders characterized by impaired communication skills, impaired social engagement, and restricted, repetitive behaviors. 1 in 68 children are diagnosed with ASD. Children tend to be diagnosed young and continue to have challenges throughout their lifespan; these challenges can vary to each individual. Studies have shown that children with ASD who receive services while they are young have improved outcomes on development. Early intervention programs were designed as a method to provide services to children under age 3 with developmental delays as an opportunity to improve developmental outcomes. Early Start Denver Model (ESDM) A comprehensive behavioral and developmental intervention used in early intervention programs (Dawson et al, 2010). Used to promote language, engagement and learning Created as an approach to helping the needs of toddlers with ASD as young as 1 year old This approach combines applied behavior analysis (ABA) with relationship-based and developmental therapies. The intervention takes place in the child’s natural environment. 1:1 ratio with child Variations to the traditional ESDM model Parent-delivered approach (P-ESDM) Teaching parents fundamentals of ESDM Parents provide the intervention at home ESDM for maladaptive behaviors Group-based community childcare approach Integrating therapy into childcare setting 1:3 ratio Conclusion The ESDM is an effective program for increasing cognitive abilities, increasing developmental skills and reducing maladaptive behaviors in toddlers with ASD. Current research shows the potential of implementing the ESDM intervention effectively in both parent-delivered environments and group-based community childcare environments. Implementing this intervention in both environments can lead to increases in developmental outcomes which can in turn lead to decreases in the symptoms of ASD. Communication is key between the parents of the child, the specialized instructors in ESDM, and the school or childcare teachers for the program to be carried out effectively. Future research could expand upon these finding to look at the effectiveness of implementing a parental aspect into group-based community childcare ESDM intervention. The lack of resources and funding is a large set back for the implementation of the ESDM approach in all community centers for toddlers (Vivanti et al, 2014). With the use of the ESDM, toddlers are able to receive the appropriate interventions at an earlier age resulting in the overall improvements in developmental outcomes that will help them function better in society as they grow older. ESDM on Maladaptive Behaviors Fulton et al., 2014 38 preschoolers at Autism Specific Early Learning and Care Centre Study used ESDM curriculum in a group setting Amount of maladaptive behavior steadily decreased by end of intervention Success in reducing the level and amount of maladaptive and challenging behaviors after the intervention while also improving developmental skills. Overall, ESDM has the potential to improve maladaptive behaviors which will in turn increase the likelihood for children with ASD to participate in intervention programs for improving other areas of development. https://www.autismspeaks.org/what-autism/treatment/early-start-denver-model-esdm References Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, Donaldson A, Varley J. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics. 2010 Jan;125(1):e17-23. doi: 10.1542/peds.2009-0958. Epub 2009 Nov 30. PubMed PMID: 19948568. Fulton E, Eapen V, Crnčec R, Walter A, Rogers S. Reducing maladaptive behaviors in preschool-aged children with autism spectrum disorder using the early start denver model. Front Pediatr. 2014 May 9;2:40. doi: 10.3389/fped.2014.00040. eCollection 2014. PubMed PMID: 24847474; PubMed Central PMCID: PMC4023017 Rogers SJ, Estes A, Lord C, Vismara L, Winter J, Fitzpatrick A, Guo M, Dawson G. Effects of a brief Early Start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2012 Oct;51(10):1052-65. doi: 10.1016/j.jaac.2012.08.003. Epub 2012 Aug 28. PubMed PMID: 23021480; PubMed Central PMCID: PMC3487718. Vivanti G, Paynter J, Duncan E, Fothergill H, Dissanayake C, Rogers SJ; Victorian ASELCC Team.Effectiveness and feasibility of the early start denver model implemented in a group-based community childcare setting. J Autism Dev Disord. 2014 Dec;44(12):3140-53. doi: 10.1007/s10803-014-2168-9. PubMed PMID: 24974255. https://www.ucdmc.ucdavis.edu/mindinstitute/research/esdm/ http://www.examiner.com/article/early-intervention-autism