1. 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 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 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 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.
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 Jan;125(1):e doi: /peds Epub 2009 Nov 30. PubMed PMID:
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 May 9;2:40. doi: /fped eCollection PubMed PMID: ; PubMed Central PMCID: PMC
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 Oct;51(10): doi: /j.jaac Epub 2012 Aug 28. PubMed PMID: ; PubMed Central PMCID: PMC
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 Dec;44(12): doi: /s PubMed PMID: