Understanding Early Start Denver Model (ESDM)

To effectively support children with autism spectrum disorder (ASD), it's important to understand the Early Start Denver Model (ESDM). This evidence-based early intervention approach, rooted in applied behavior analysis (ABA), focuses on promoting learning and development in young children with ASD.

ESDM Overview

The ESDM is specifically designed for children aged 12 to 48 months who have been diagnosed with ASD. It emphasizes active experiential learning, early interaction, and social motivation for learning and development. The approach draws on developmental research on how typically developing children learn.

ESDM Principles

The ESDM utilizes principles from ABA and employs behavioral strategies, such as pivotal response training (PRT), to facilitate skill acquisition and manage unwanted behaviors. It incorporates measurable learning objectives, systematic progress recording, and decision trees for adjusting teaching techniques.

One of the key principles of the ESDM is its child-led model. During sessions, children are given the opportunity to make choices and lead the activities. This approach maximizes their motivation and enjoyment in learning and playing, creating an engaging and supportive environment.

Another important principle of the ESDM is its focus on managing unwanted behaviors. The approach emphasizes being responsive and sensitive to children's needs, valuing emotion coaching, and understanding the underlying causes of distress. By fostering co-regulation and addressing the root causes of unwanted behaviors, the ESDM aims to reduce their occurrence during sessions.

By embracing the ESDM, parents and professionals can provide early intervention that targets the unique learning and social needs of children with ASD. The approach combines the principles of ABA with child-led and responsive strategies, offering a comprehensive framework for supporting the development of children with autism.

Role of Applied Behavior Analysis (ABA)

Applied Behavior Analysis (ABA) plays a significant role in the Early Start Denver Model (ESDM), an evidence-based early intervention approach for young children with autism spectrum disorder (ASD). ABA is a scientific discipline that focuses on understanding and modifying behavior using principles of learning and reinforcement. It is widely recognized as an effective intervention for individuals with ASD.


The ESDM is rooted in ABA principles and incorporates them into its intervention strategies. ABA-based techniques are used to promote skill acquisition and manage unwanted behaviors in children with ASD. The ESDM uses operant conditioning principles and behavioral strategies, such as pivotal response training (PRT), to facilitate learning and development.

While there may be some variations in the use of rewards, both ABA and ESDM utilize positive reinforcement to encourage desired behaviors. In ABA, tangible rewards like stickers or food are commonly used, whereas the ESDM primarily employs social rewards such as praise and positive affect as consequences for correct behaviors. The goal of ABA within the ESDM framework is to create a positive and supportive learning environment that motivates children with ASD to actively engage in learning and play.

ABA-Based Interventions

ABA-based interventions have shown significant effects on various areas of development for children with ASD. Research findings indicate that ABA-based interventions have had positive impacts on socialization, communication, and expressive language outcomes. These interventions focus on teaching functional skills, reducing challenging behaviors, and promoting independence.

It is important to note that while ABA-based interventions have shown significant effects on certain areas, they may not impact all aspects of ASD symptoms. For instance, studies have not consistently found significant effects on general symptoms of ASD, receptive language, adaptive behavior, daily living skills, IQ, verbal IQ, nonverbal IQ, restricted and repetitive behavior, motor skills, and cognition. This highlights the need for comprehensive and individualized approaches like the ESDM, which integrates ABA principles with other components to address the diverse needs of children with ASD.

By incorporating ABA principles and interventions, the ESDM aims to enhance the development and functioning of children with ASD. The combination of ABA techniques, child-led sessions, and systematic progress recording in the ESDM provides a comprehensive approach that can help children with ASD reach their full potential.

Implementing ESDM for Children with Autism

When it comes to implementing the Early Start Denver Model (ESDM) for children with autism, there are several key factors to consider. These include the target age group, intervention techniques, and the importance of parent involvement.

Target Age Group

The ESDM is specifically designed for children with autism spectrum disorder (ASD) aged 12 to 48 months. This early intervention approach aims to capitalize on the critical period of brain development during early childhood, when neural plasticity is at its peak. By starting interventions at a young age, children have a greater opportunity for positive developmental outcomes.

Intervention Techniques

The ESDM utilizes a variety of evidence-based intervention techniques tailored to the individual needs of children with autism. These techniques focus on active experiential learning, early interaction, and social motivation for learning and development. The intervention is manualized and divided into four levels, each targeting different developmental areas.

The ESDM intervention aims to achieve generality by teaching objectives in the context of daily routines in natural settings. This ensures that the learned behaviors are observed across different people, tasks, and environments. The intervention may be delivered by transdisciplinary teams, including Board Certified Behavior Analysts, early childhood educators, and allied health professionals, across various settings and formats, such as therapist-delivered, parent-mediated, and teacher-delivered group-based programs in day care or preschool settings.

Parent Involvement

Parent involvement is a vital component of ESDM interventions. Parents play a crucial role in the development and well-being of their child with autism, and their active participation enhances the effectiveness of the intervention. The ESDM has been adapted to be parent-delivered, recognizing that young children with autism spend most of their time at home with their parents.

By involving parents in the intervention process, they can learn strategies to promote desired behaviors and redirect unwanted behaviors in different settings. This home-based approach allows parents to implement the intervention techniques consistently and effectively in their child's natural environment. However, it's important to note that access to parent-mediated ESDM programs may vary depending on community resources and ongoing research in the area.

In summary, implementing the ESDM for children with autism involves targeting the appropriate age group, utilizing evidence-based intervention techniques, and emphasizing the involvement of parents. By starting early and involving parents, the ESDM can make a positive impact on the developmental outcomes of children with autism.

Effectiveness of ESDM

The effectiveness of the Early Start Denver Model (ESDM) has been extensively studied and has shown promising results in improving outcomes for children with autism spectrum disorder (ASD). Research findings have consistently demonstrated the positive impact of ESDM on various aspects of development in children with ASD.

Research Findings

Studies have shown that the ESDM approach leads to significant behavior change in children with ASD, with large effect sizes observed in areas such as language, social communication, and cognitive functioning. The ESDM has been found to produce lasting behavior change across different settings and individuals, indicating its effectiveness in promoting generalization of skills.

Behavioral Outcomes

The ESDM intervention has resulted in significant gains in cognitive and language abilities in children with ASD. Research has shown that the behavior change achieved through ESDM is large enough to produce a clinically and socially meaningful impact [1]. Children who receive ESDM interventions have demonstrated improvements in their social interaction skills, communication abilities, and cognitive functioning.

The ESDM approach emphasizes teaching objectives within the context of daily routines and natural settings, promoting generalization of skills across people, tasks, and environments. This holistic approach contributes to the effectiveness of ESDM interventions, allowing children to transfer their learned skills to real-life situations.

Moreover, the ESDM has been shown to result in significant cost savings in healthcare services for children with ASD, further highlighting its benefits beyond behavioral outcomes. By providing early and effective intervention, the ESDM can potentially reduce the long-term need for intensive services, resulting in better long-term outcomes for children with ASD and their families.

The evidence supporting the effectiveness of the ESDM highlights its potential as a vital tool in early intervention for children with autism. By utilizing the principles of applied behavior analysis (ABA) and incorporating a comprehensive, naturalistic approach, the ESDM offers a promising framework for promoting positive developmental outcomes in children with ASD.

Parent-Mediated ESDM Programs

Parent-mediated Early Start Denver Model (ESDM) programs have emerged as a promising approach to support families with children and teens diagnosed with autism spectrum disorder (ASD). These programs aim to provide parents with the knowledge and skills necessary to implement the principles of ESDM in their daily interactions with their child.

Parent Coaching

Parent coaching is a key component of parent-mediated ESDM programs. It involves providing parents with guidance, support, and training to effectively implement ESDM techniques at home. The coaching sessions typically include group training, individualized intervention planning, live coaching, and assessment to track progress. The overall implementation of the parent coaching intervention program has been found to be satisfactory, with parents showing improvement in their teaching skills. This coaching approach ensures that parents are equipped with the necessary tools and knowledge to support their child's development.

Program Implementation

The implementation of parent-mediated ESDM programs involves a comprehensive approach that includes initial assessments, individualized intervention plans, coaching sessions, and feedback meetings with families. The program is designed to bridge service gaps and empower parents to maximize learning opportunities for their child in daily activities.

Studies have shown that parent-mediated ESDM interventions, such as the parent-delivered ESDM (P-ESDM), can lead to significant improvements in children's development, parental stress, and sense of competence. These interventions aim to teach ABA-based strategies to parents, allowing them to support their child's abilities across developmental domains and alleviate symptoms of ASD.

Feasibility and acceptability studies of parent-mediated interventions like the Early Start Denver Model (ESDM) emphasize the importance of verifying intervention success, identifying potential challenges, and estimating parameters for future studies. Acceptability is crucial for continued participation from families and service providers, as interventions perceived as acceptable are more likely to be implemented with fidelity, which is linked to efficacy.

Ensuring treatment fidelity is an essential aspect of program implementation. For example, the parent-implemented ESDM requires parents to implement specific techniques, such as gaining the child's attention, promoting engagement, enhancing communication, and incorporating play skills. Treatment fidelity is considered acceptable when there is an adherence of 80% or more to these techniques. However, it's important to note that achieving acceptable fidelity levels can be challenging, with only half of the studies reviewed meeting the benchmark.

Parent-mediated ESDM programs hold promise as a means to initiate intervention earlier, provide families with support while they wait for direct intervention, and have shown high social validity and satisfaction among stakeholders [4]. While evidence of their impact on children's development or core ASD symptoms is limited, the parent-mediated ESDM approach has yielded positive outcomes for both parents and children. By empowering parents with the necessary skills and support, parent-mediated ESDM programs can make a meaningful difference in the lives of children and teens with autism.

Future of ESDM Interventions

As the Early Start Denver Model (ESDM) continues to evolve, there are exciting prospects for its future implementation. Two areas that hold promise are telehealth delivery and the inclusion of fathers in the intervention process.

Telehealth Delivery

Telehealth-delivered interventions have shown great potential in making early intervention services more accessible, affordable, and convenient for families. This mode of delivery utilizes technology to provide remote support and coaching, allowing families to receive intervention services in the comfort of their own homes. The use of telehealth also eliminates geographical barriers, making it easier for families in remote areas to access specialized services.

With telehealth, families can receive training, guidance, and support from ESDM professionals through virtual platforms. This approach provides flexibility in scheduling sessions and reduces the need for travel, making it more convenient for families. Additionally, telehealth interventions have shown promising results in terms of effectiveness and acceptability.

Inclusion of Fathers

While mothers have traditionally played a prominent role in implementing early interventions, the inclusion of fathers in the ESDM process is gaining recognition. Involving fathers in the intervention has shown to have positive effects on child outcomes and family dynamics. Fathers can contribute unique perspectives, strengths, and parenting styles, which can enhance the overall effectiveness of the ESDM intervention.

Including fathers in the intervention process can lead to increased engagement, shared responsibility, and improved outcomes for children with autism. In order to promote father involvement, interventions should provide specific strategies and support tailored to fathers' needs and preferences. By actively involving fathers, ESDM interventions can create a more inclusive and supportive environment for the entire family.

As the ESDM continues to expand, research and feasibility studies are essential to verify the effectiveness, feasibility, and acceptability of interventions like the parent-mediated Early Start Denver Model (P-ESDM). These studies help identify potential challenges, fine-tune intervention parameters, and improve treatment outcomes. The goal is to ensure that interventions are successfully implemented, accepted by families and service providers, and ultimately have a positive impact on children's development.

With advancements in technology and a growing understanding of the importance of involving fathers, the future of ESDM interventions looks promising. Telehealth delivery and the inclusion of fathers hold the potential to enhance accessibility, engagement, and effectiveness of the Early Start Denver Model, ultimately benefiting children with autism and their families.


[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900312/

[2]: https://www.cdinstitute.com.au/uncategorized/the-differences-between-aba-and-esdm/

[3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265021/

[4]: https://www.sciencedirect.com/science/article/abs/pii/S0891422220301773

[5]: https://autismsciencefoundation.wordpress.com/2019/03/20/why-is-there-controversy-with-early-start-denver-model/

[6]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8870866/