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. Certified ESDM therapists deliver the ESDM and this is our choice of early intervention for our families.
What are ESDM and ABA?
The Early Start Denver Model (ESDM) and Applied Behavioural Analysis (ABA) are interventions for children with autism. Why is it important to understand the differences between ESDM and ABA?
- There are been a rapid increase in the diagnosis of autism. In Australia, the rate of diagnosis is 1 in 100 people.
- This increase in diagnosis has led to more funding for research and intervention. There is constant research into the field of autism. The research is looking at the cause of autism, the early identification of autism, and the most effective interventions.
- There is concern that funding for intervention is going towards therapies with no research. This means that we do not know if the intervention works.
Families spend a lot of time deciding on the best intervention for their child with autism. Consequently, it is very important that they have access to information about each intervention. The information helps families make choices. The information should reflect the research that has been done on each intervention.
ABA in more detail
- The research paper that changed the landscape for autism intervention was released in 1987. This was the first research paper that showed significant improvements in children’s progress using ABA principles.
- This research project based the intervention on 40 hours per week
- ABA is a set of teaching principles that has extensive research to support their use in autism.
- The research is so extensive that using the ABA principles is considered a ‘gold standard approach’ to treating children with autism.should be applied to every intervention for every child with autism.
- We know that children with autism learn when these teaching principles are used.
- A high quality Speech Pathology or Occupational Therapy program will incorporate the teaching principles of ABA.
ESDM in more detail
- The Early Start Denver Model (ESDM) is based on 30 years of research by MIND Institute in the University of California.
- The pivotal paper was released in 2012. This drew a lot of attention to the ESDM.As a result, TIME magazine rated it as one of the top 10 medical breakthrough of that year.
- The ESDM is a set of specific strategies that professionals, parents and caregivers use.
- These strategies are based on the ABA teaching principles.
- The strategies apply to everyday activities. They can be incorporated while the child is playing, eating, putting clothes on, and interacting with other people.
How are ESDM and ABA similar?
- Both interventions target preschoolers with autism
- They each develop a detailed individual plan for the child.
- ESDM and ABA keep comprehensive data to track a child’s progress
- Both approaches use the Antecedent-Behaviour-Consequnce (ABC) principle. The National Research Council (2001) guidelines for best practice intervention for autism highlighted this as a critical principle for all interventions.
- They each use teaching principles of prompting, shaping and fading. This allows the therapist to teach a skill so that the child uses it independently.
How are ESDM and ABA different?
In the ESDM the child takes the lead.
The therapist follow the child’s interests to engage the child in positive social interaction. As a result, there is more motivation and the child stays in the interaction.
ESDM doesn’t use the discrete trial teaching as a predominant part of the regular teaching principles.
The ESDM uses it when a child isn’t progressing to do some short intense teaching. Discrete trial teaching is directive and very structured. Most of the time, it does not use natural reinforcers. In the ESDM, the therapist goes back to regular teaching and natural reinforcers as soon as the child has understood the behaviour that the therapist is trying to teach.
The ESDM uses least to most prompting.
The ESDM therapist teaches the child by using the least amount of prompting. As a result, the child becomes independent in the skill faster. ABA uses a most to least amount of prompting and fading of the prompts is part of the program.
The ESDM has the ‘joint activity routine’ as the basis for each activity.
This means that the child and the therapist develop the activity together. Initially, the therapist builds on the child’s choice. After the therapist understands what theme the child is developing in the activity, the therapist works with child so they both contribute to what happens in the activity.
ESDM targets multiple goals in the one activity.
For example, when the child chooses a puzzle, the therapist teaches goals in fine motor, receptive language, expressive language, joint attention and cognition.
ESDM uses the A-B-C principles but applies them in a natural way.
First we deliver a cue or instruction (Antecedent) and make sure that the child attends to it (e.g: we offer the child two toys). Then we wait for the child to use the behaviour that we want to teach (e.g: pointing to one of the toys). Last we reward the behaviour (e.g: the child point to one toy) with a natural reinforcer (e.g: the child gets to play with the toy).
The ESDM rewards all attempts (even prompted and incomplete ones) with a natural reinforcer.
The natural consequence could be that the child gets to play with the toy (e.g: the child gets the ball). It also includes a high number of natural social reinforcers such as smiling and positive talk (e.g: “yeah, it is a ball”).
The ESDM therapist modulates the child’s arousal and attention as soon as it fluctuates.
This keeps the child in an optimal state of learning.
ESDM is a transdisciplinary approach.
ASD is a complex disorder affecting many areas of development and learning. The ESDM program consists of speech pathologists, occupational therapists and psychologists. The therapists work together on the child’s assessment and learning plan so that they address all areas of development. Above all, parents are a part of the team.
The ESDM is used in small groups programs.
Just like most children, children with ASD learns from their peers. Australia is pioneering the research into group ESDM and group programs for young children on the spectrum. Group programs are carefully planned so that individual children’s objectives are addressed in the group activities. during these activities. The play and materials are carefully selected for each child. Then the room is organised so that the activities attract the children’s attention and facilitate transition from one activity to the next. Next, the therapists target each children’s objectives and learning steps in the group activities. Last, the therapist keeps detailed records on each children’s progress in group activities.
They target different age ranges.
ESDM is for children from 6 months up to 5 years. However, ABA is used across the lifetime.
Training and qualifications are different.
ABA programs are supervised by a Board Certified Behavioural Analyst (BCBA). The BCBA has hundreds of hours of training in behaviour analysis and management. It takes years to achieve the BCBA qualification. In many ABA programs, junior therapists deliver the majority of the ABA therapy. These junior therapists may have as little as 2 days training. The ESDM is delivered by Certified ESDM Therapists. To be certified in the ESDM you have to have a related degree such as Speech Pathology or Occupational Therapy. The allied health professional then completes a series of workshops. In addition, they submit videos to prove their ability to deliver the ESDM at fidelity. Certification in the ESDM takes 6-12 months of intensive supervision and training.
ABA has a higher amount of research but the ESDM has more research for very young children with autism. The research has been done on children as young as as 6 months of age.
Which one is better?
- That depends on each child and family. Every family is different and they have to take into consideration many things when they choose their intervention plan.
- Both approaches have an evidence base so we know that children improve with ESDM and ABA
- Many families use ESDM and ABA together and this works very well.
- As children approach school our ESDM families include more Speech Pathology and Occupational Therapy. Many children start ABA in the year before school.
Do they cost the same amount if money?
The cost of each program depends on how many hours your child does, whether the sessions are individual or group, and the level of experience of each therapist. ABA programs aim to do more hours of intervention. There are different levels of ABA therapists based on experience. You can reduce the cost of the ABA program by using junior ABA therapists to deliver the bulk of the early intervention sessions. The ESDM is delivered by qualified therapists who have been certified in the ESDM. The larger ESDM clinics offer group intervention programs and the cost of these is more affordable than individual sessions.
We use the ESDM in our clinic because it is a best practice intervention
It fulfils the National Research Council (2001) guidelines for:
- Firstly, this intervention starts early in life. It is for children between the ages of 2-5 years. Children as young as 6 months do the program. The ESDM improves the outcomes of children with autism.
- Therapists and parents use the program across the child’s whole day. The Certified ESDM Therapists use it during individual and group programs. Parents use it during the child’s everyday routines. The ESDM is easy to incorporate into daily routines.
- Another key point is that the teaching principles of prompting, shaping and fading are part of the ESDM. The principles are ABA teaching principles. This because research shows that these teaching principles work best with children with autism.
- Each child gets an individual program. Specifically, we write individual teaching steps for each goal. This means we can track the child through to generalisation for each goal. In fact, we want children to use skills across all environments. In particular, parents take part in the generalisation process.
- The program targets the main feature of autism. As a result, each child learns functional skills and their development and learning improves. Features of autism reduce using the ESDM.
- The therapist monitors each child’s progress. The therapist scores the child’s progress every 15 minutes. They share the child’s progress with the parents at the end of each session. We review the goals every 10 weeks and update them as required.
- Last but not least, the program includes family in the decision making process. Parents know what the current goals are and how their child is progressing. Parents follow through on goals at home to get the progress we need across different environments.
Should I do the ESDM or ABA?
This is a decision that every parent of a child with autism should make after doing their own research. Speak to your child’s developmental paediatrician about the choice. Speak to early intervention clinic who offer these models of intervention. Most early intervention clinic for children with autism will meet with you to explain their program. There is usually no cost to these sessions.
Our clinic offers the ESDM because we see young children with autism. This model is very play based and young children, even those wth autism or other developmental delays, should have the opportunity to learn through fun activities that motivate them.
How do I found out more abut the ESDM?
OneOnOne Children’s Therapy is located in Bondi Junction and Mascot in Sydney. We are the largest ESDM practice in Sydney, and have the highest number of Certified ESDM Therapists for any clinic in NSW. Our team of Certified ESDM Therapists is trained at the highest levels of fidelity so we can improve children’s lives. If you want to find out more about the ESDM, then call our clinic on (02) 80657837 or email us.
Learn more about the ESDM here: