WHAT IS THE EARLY START DENVER MODEL (ESDM)?
Early Start Denver Model or ESDM therapy is a model of intervention for young children with autism. It targets the key features of autism that interfere with a child’s ability to learn, make friends and participate in the world around them.
The ESDM is a comprehensive, developmental, behavioural early intervention program for young children with autism. What exactly does that mean?
- It is comprehensive because it addresses all areas of development. The ESDM program addresses communication and social skills, but it also targets gross and fine motor skills, and personal independence skills. We want every child to improve across all areas of development
- A behavioural program refers to the method of writing a child’ program, monitoring their progress and teaching the child to ensure that change occurs and that we can show where the child has progressed.
- The ESDM is developmental in that it follows the general developmental expectations for all children. It does, however, target the areas of development that are more challenging for children with autism
WHO IS THE EARLY START DENVER MODEL (ESDM) FOR?
Children in an ESDM program are usually between 2-5 years of age. ESDM is a play based intervention and has a strong focus on communication, social attention, imitation and play skills. Every skill is taught within a fun, social activity that uses natural reinforcers.
The Early Start Denver Model (ESDM) has four levels that follow general development for children. Each level corresponds to a developmental period. Level 1 (12 – 18 months), Level 2 (18 – 24 months), Level 3 (24 – 36 months) and Level 4 (36 – 48 months). As children work through the ESDM, their goals tend to cluster across one or two levels. Despite being play based, the ESDM involves intensive teaching. Every session in the Early Start Denver Model (ESDM) aims to engage the child and teach every 20-30 seconds. This seems like a lot of teaching, but most children engage at this rate. The Early Start Denver Model (ESDM) aims to do the same thing. It builds upon these through the following techniques ( as summarised from Rogers and Dawson, 2010).
WHAT TECHNIQUES ARE USED IN THE EARLY START DENVER MODEL (ESDM)?
The ESDM takes everything we have learned from the research about how children with autism learn. It fuses these components into the one approach using the following techniques:
- The child’s choice of activity or toy frames each learning opportunity
- Positive Affect keeps the child focussed on the play partner, not just the toys
- Play is the basis for ever activity
- Teaching occurs at a rapid rate
- Challenging behaviours improve with a positive behaviour approach
- Family help select the goals
- Parents learn to deliver the ESDM at home
- Importantly, the Early Start Denver Model (ESDM) is available for day care and preschool staff so that intensity of learning increases. This means that the child uses their new skills in a variety of settings.
WHAT IS THE EVIDENCE BEHIND THE ESDM THERAPY?
The following links give an idea of the research base to the Early Start Denver Model:
- The original study that showed significant changes in all developmental areas
- One hour a week of ESDM leads to improvement in children with ASD
- Parent model of ESDM found to be effective in very young children at risk of ASD
- ESDM improves long-term outcomes for children with autism
- This approach to addressing unwanted behaviour shows significant improvements in behaviour
- ESDM intervention found to normalise brain activity in children as young as 18 months
- Starting the ESDm at a younger age leads to better outcomes
- The initial cost of ESDM is offset by savings down the track
For more information about the research supporting the ESDM, this article about ESDM at Autism Queensland is excellent.
HOW DO WE ASSESS?
The assessment in the Early Start Denver Model is a critical part of a child’s program. We use the ESDM curriculum checklist to assess the child’s current performance in a variety of developmental domains. The certified ESDM Therapist uses their own careful observations of the child, and the parent or caregiver’s report, to understand the child’s strengths and needs within each developmental domain.The results of this assessment form the basis of the child’s program for the next 10 weeks. Certified ESDM Therapists use the assessment to individualise the program. They use the skills that the child has already learned and develop the next set of skills that the child needs to learn.
The Early Start Denver Model curriculum checklist has 480 curriculum items across four levels. They cover the following developmental areas:
- receptive language
- expressive language
- joint attention
- social skills
- fine motor skills
- gross motor skills
- personal independence
For more detailed information about how we assess in the ESDM, read this blog we have also posted.
HOW DO WE CHOOSE ESDM GOALS?
The therapist creates the child’s first set of goals and objectives. They 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. The therapist writes teaching steps for each goal. This allows the Certified ESDM Therapist to monitor progress. It also means that the parents can see their child’s progress after each session. In the Early Start Denver Model, a child is considered to have passed a goal when they are using that skill 80% of the time. They also need to show that they can use that skills on 3 consecutive occasions in at least two different settings.
HOW DO WE REVIEW ESDM GOALS?
The ESDM program runs in quarters that are equivalent to the school terms here in Sydney. Each quarter lasts three months. As the child progresses through the term, the Certified ESDM Therapist reviews progress after each session. Goals are updated as a child passes each goal. The therapist does not wait until the end of term to update goals. The data that is recorded during every session forms the decision regarding progress for each goals.
Some children progress very quickly through their ESDM program. Their goals are reviewed and rewritten more frequently.
At the end of each term the Certified ESDM Therapist and the senior ESDM therapist review all goals for each child. This ensures an individualised program that reflects each child’s strengths and weaknesses.
WHAT DOES AN ESDM SESSION LOOK LIKE?
When you watch an ESDM session it should look like play. The child and the ESDM therapist are both engaged in fun, activities that help facilitate communication and social interactions. The activities are age and developmentally appropriate for each child. In the ESDM the child and the therapist are both actively engaged in every activity. Both of them add ideas, take turns and are responsible for initiating, changing, enhancing and ending each activity.
Before the session begins, the ESDM therapist carefully chooses activities that are:
- Motivating for the child
- appropriate for the child’s developmental age
- address each child individual goals
The Certified ESDM Therapist puts a lot of time and thought into the materials for each session
ESDM sessions can happen in any environment at any part of the child’s daily life – clinic, home, day care or grandma’s house. Any adult who spends time with the child, such as a day care worker or parent, can learn to use the ESDM strategies across everyday activities.
WHO DOES THE ESDM THERAPY?
A certified ESDM Therapist delivers the ESDM intervention. The ESDM has to train to fidelity in the ESDM. This takes about 6-12 months of intensive training. Certified ESDM Therapists have to have another allied health qualification. They must also Speech Pathologists, Occupational Therapists or Psychologists. This means that they have the knowledge to understand the child and develop a program to target all areas of development.
HOW DO I FIND CERTIFIED ESDM THERAPISTS?
There is a list in the MIND website. Is a therapist is not on this list, then they are not certified in the ESDM.
WHAT IS THE ROLE OF PARENTS IN THE ESDM?
Parents are instrumental in the intervention of their child with autism. After completing the Parent-ESDM, parents are able to facilitate their child’s learning and communication across the whole day. It is a reflective style of training that current research strongly supports. OneOnOne Children’s Therapy uses Parent-ESDM because we believe that a parent knows their child best and family is most important for the child.
The Parent-ESDM is a 12 week course. It has the parent, child and therapist in a one hour work and play session. We use the parent ESDM manual, ‘An Early Start For Your Child With Autism’.
During the Parent-ESDM sessions, we work with you and your child to develop the ability to understand and use the principles of the Early Start Denver Model. When parents use these principles across their child’s day then the child’s ability to learn is exponentially increased. Parent -ESDM also ensures that your child uses their new skills in other environments.
WHO IS ON THE ESDM TEAM?
Our ESDM team consists of Speech Pathologists, Occupational Therapists and Psychologists. The Senior ESDM Therapist oversees the ESDM program in the clinic. She reviews every child’s program weekly and meets with the parents at the end of each quarter. The ESDM therapists are highly skilled in delivering the program on a daily basis. The Speech Pathologist provides input and support to each child’s speech, language, social and communication goals. The Occupational Therapist gives input and support to the child’s gross motor, fine motor and sensory areas. The ESDM team meet regularly to ensure that each child progresses in all areas of the program.
WHERE CAN I FIND OUT MORE ABOUT THE ESDM THERAPY?
OneOnOne Children’s Therapy is located in Bondi Junction in Sydney. Our team of 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.
Updated November 2018