Autism is a complex neurodevelopment condition. Early intervention is key to helping children with autism. The Early Start Denver Model, or ESDM, is an intervention for young children with autism. It is delivered by certified ESDM therapist and we are proud to offer this early intervention to our families.
Choosing an intervention for your child
Now that you have chosen the intervention for your child with autism, understanding the goals for each intervention is the next step. The intervention that you choose for your child should have very clear:
- goals and objectives
- method to record of your child’s progress
- system for generalising the skills to other environments
- process for communicating the progress with you.
The Early Start Denver Model (ESDM) is an early intervention model for young children with autism. It targets the key features of autism, and involves intensive teaching in play-based sessions. Built into the ESDM is a comprehensive process to develop goals and monitor to each child’s progress. This leads to your child being able to independently use their new skills across a number of environments.
Each child’s progress in the ESDM is monitored in the following ways
The curriculum checklist
The first step in monitoring goals is completing the assessment. This helps us to understand:
- The things that your child does well
- The areas that challenge your child
- The sequence of skills to teach your child in each developmental area
We use the Early Start Denver Model Curriculum Checklist as our assessment. This is a play based assessment where the therapist uses toys and social activities to assess your child. The therapist follows the child’s interest and preference for toys. When the child approaches a toy then the therapist will play and engage with the child as they score the child. The Early Start Denver Model Curriculum Checklist has 480 curriculum items across four levels.
- receptive language
- expressive language
- joint attention
- social skills
- fine motor skills
- gross motor skills
- personal independence
Develop the goals
From the curriculum checklist the certified ESDM therapist creates your child’s first set of goals and objectives. We choose 3-4 goals from each developmental area. We choose these goals starting from the point where the child needs more skills in each developmental area. Some children have goals starting in Level 1, while other children have goals that start in Level 2 or Level 3. A goal sheets looks like this:
Write the teaching steps
The therapist writes teaching steps for each goal. This means that every goal that is chosen for your child has individualised teaching steps to teach your child. It is also used to monitor their acquisition of that goal. The teaching steps are written to progress your child from their current level of ability, to using the skill independently across a number of settings.
Code every session
The ESDM therapist keeps a record of every activity in every session. The data records the level of prompting that is needed to teach your child on that day. A number of different prompts are used in teaching:
- full prompt – complete physical assistance to learn the goal
- verbal prompt – talking to the child to give them verbal assistance to achieve the goal
- gestural prompt – some physical assistance or a gesture to achieve the goal
- a combination of verbal and gestural prompts
Our goal is for your child to independently use or demonstrate the skill with no prompting. A coding sheet looks like this:
You will often see notes ‘blu-tacked’ to the wall in each child’s ESDM session. These are the therapists cheat sheets. It can get confusing to remember 24-30 goals in every session! The therapist continually refers to these cheat sheets during the session to ensure that all goals are targeted regularly.
Feedback to parents after each session
The comprehensive nature of the goals and teaching steps in the ESDM mean that the therapist can clearly, and easily, show the parents the child’s progress at every session.
Generalise goals to other environments
Once your child has shown that they independently use the skill 80% of the time, we start the ‘out-of-clinic’ generalisation steps. We want to make sure that your child uses the skill independently at home and day care. If we were teaching your child to use a ring stacker then we need to make sure he does this skill:
- in the clinic 3 days in a row
- at home three days in a row, or
- at daycare three days in a row
When your child does this, the goals are ‘generalised’. When goals are generalised across environments, and with more people, that are more likely to be maintained and used by the child. There is no point teaching a chiild a skill if they only use it in the clinic situation.
Change therapists for a session every 8-10 weeks
Children become used to their regular therapists. They know them well and have a familiar routine with their therapist. Every 8-10 weeks your child will do a session with a different therapist. This helps us monitor their progress. If the scores for that session are consistent with the other therapists codes, then the child is using the skills consistently. If the scores vary, we will look at ways to help your child be more consistent with a variety of people. This makes a difference in generalising the skill to all the other places that your child is a part of.
Review goals as progress is made
As soon as a goal is generalised, a new goal is added to the list. Teaching steps are written for that goal. Once again, the teaching steps are individualised for your child.
Progress summary at the end of each term
At the end of each term the parents receive a progress summary. We met with you and go over your child’ progress. Each goal is reviewed. We discuss the highlights of your child’s progress and talk about the areas that need more development. This is an opportunity to answer all your questions. the review meeting also us to discuss plans for the following term.
Read stories about progress from some of our families
Where can I find the ESDM?
OneOnOne Children’s Therapy is located in Bondi Junction in Sydney. We train our team of ESDM therapists to the highest levels of fidelity so we can improve children’s lives. If you want to find out more about the Early Start Denver Model, then call our clinic on (02) 80657837 or email us.