The Early Start Denver Model

The Early Start Denver Model


At CCSN, we are excited to provide a new clinical service for very young children with Autism Spectrum Disorder between the ages of 12 to 48 months using the Early Start Denver Model (ESDM). ESDM is a developmental behavioral teaching model that emphasizes integrating the child’s interests into learning sessions based on a developmental curriculum. Skills are taught during child-led activities, encouraging a fun, engaging, and customized approach to treatment.

Beginning with the play-based ESDM assessment, we work with you and your child to evaluate their developmental needs and build a customized treatment plan. During treatment sessions, we help your child learn new skills using play-based activities to promote:

  • Shared social experiences
  • Social skills development
  • Emotional connection between the caregiver and child

This treatment helps to further the child’s developmental achievements using highly engaging treatment methods. Caregivers also meet continuously with experienced clinicians for coaching sessions to promote generalization of skills to home and other settings.

CCSN has partnered with Dr. Giacomo Vivanti, Associate Professor at the AJ Drexel Autism Institute at Drexel University and an international expert on ESDM methods, as we expand this service through our Early Learning Center.

The Early Start Denver Model – a naturalistic developmental behavioral approach to address the needs of young children with Autism

Giacomo Vivanti, PhD

Associate Professor, AJ Drexel Autism Institute, Drexel University

During the summer, staff at CCSN has received an advanced training on the Early Start Denver Model (ESDM) a recently developed early intervention approach for young children ages 12-48 months with Autism Spectrum Disorder (ASD).

The ESDM uses a naturalistic developmental behavioral approach - that is, the application of principles derived from applied behavior analysis and literature on early development in the context of naturalistic interactions, such as play routines or daily activity routines. The goal of ESDM is to address the early emerging deficits that young children with ASD experience across developmental domains, with a focus on teaching the skills that provide the infrastructure for social learning during early development – imitation, joint attention, play, affect sharing, and verbal and non-verbal communication. In addition, cognitive, adaptive, and motor skills are targeted.

The treatment practices in the ESDM are rooted in the notion that children with ASD experience disruptions in social reciprocity and social orienting during early childhood, which lead to deviations in social-emotional, communicative and cognitive developmental trajectories. Early social learning and social motivational processes are therefore targeted during early childhood to mitigate the impact of autism symptoms on learning and to prevent escalating deviances from typical trajectories of social and cognitive development.

Additionally, the ESDM is influenced by the literature on typical development, with a particular emphasis on the preverbal origins of communication, such as the role of affect, social engagement and non-verbal communication on language development, as well as the importance of affectively rich interactions, self-driven goals, and the experience of natural contingencies of self-initiated behavior for child learning and development.

Finally, intervention practices in the ESDM are informed by the conceptual apparatus of Applied Behavior Analysis, with a particular focus on naturalistic practices derived from Pivotal Response Training.

In the ESDM, measurable treatment objectives are developed from a comprehensive assessment of each child’s profile of strengths and needs using the ESDM Curriculum Checklist, an assessment tool that measure children’s abilities across ten multiple domains. The data obtained from this measure provide information about the skills that the child already has in her/his repertoire, the ones that are emerging but used inconsistently, and the ones child has not yet acquired. This individual profile of strengths and needs, in turn, is used to generate intervention goals.

Intervention goals are then targeted within Joint Activity Routines (JARs), that is, activities that stem from the child’s initiative and choices. During a JAR, the adult follows the child’s lead in a way that mimics the child-caregiver exchanges in typical development, with the adult

scaffolding the child’s acquisition of new behaviors during daily routines (e.g., bath-time, meals) and playful face-to-face interaction (e.g., peekaboo routines, tickling and clapping games) or play activities involving objects (e.g., slinky, scarves).

During JARs the adult acts as a play partner, promoting a positive emotional exchange with the child, fostering the child’s enjoyment and engagement, and creating continuous opportunities for shared affect and reciprocity. Within this context, teaching episodes are delivered approximately every 10-15 seconds using operant conditioning principles, where the adult presents the child with a stimulus that cues a response (antecedent), the child emits the targeted response, or is prompted to do so (behavior), and a consequence directly follows the behavior (consequence). Consistent with the naturalistic and developmental principles of the ESDM, positive consequences are based on reinforcements that are intrinsic to the joint activity. For example, in a song routine, the adult might pause expectantly after saying “We all fall…” (antecedent), the child then responds by saying “Down!” while making eye-contact and smiling (behavior) and the adult repeats “Down!” while falling with the child on the floor (consequence). A growing literature has indicated that the use of these naturalistic developmental behavioral strategies is a powerful tool to support early learning and development in young children with ASD.

For more information on the principles, strategies, and empirical evidence supporting the ESDM, you can refer to the following literature:

Rogers, S. J., & Dawson, G. (2010a). Early Start Denver Model for Young Children with Autism. Promoting language, learning and engagement. Guilford Press.

Fuller, E. A., Oliver, K., Vejnoska, S. F., & Rogers, S. J. (2020). The effects of the Early Start Denver Model for children with autism spectrum disorder: A meta-analysis. Brain sciences, 10(6), 368.

Vivanti, G., & Stahmer, A. C. (2020). Can the Early Start Denver Model Be Considered ABA Practice?. Behavior Analysis in Practice, 1-10.

Vivanti, G., Zhong, N. (2020). Naturalistic Developmental Behavioral Interventions for children with Autism Spectrum Disorder. In Vivanti, G., Bottema-Beutel, K., Turner-Brown, L. (eds) Clinical Guide to Early Interventions for Children with Autism. Springer.