ESDM 1:1 Sessions

Ages 18 months – 5 Years


In a 60 minute 1:1 Early Start Denver Model (ESDM) session, you can expect to see engaging and structured interactions between a therapist and a young child. The goal is to enhance social communication, cognitive, and motor skills. Here's a glimpse of what a standard session could entail:

  • The session often starts with a warm-up activity to help the child feel comfortable and engaged. This could involve a preferred toy, game, or song.

    • The therapist uses play-based activities tailored to the child’s interests and developmental level. These activities are designed to target specific skills, such as joint attention, imitation, and language development.

    •    Examples include playing with blocks, puzzles, or pretend play scenarios.

  • Learning opportunities are embedded every 30 seconds in natural interactions. The therapist follows the child’s lead while introducing learning objectives within the context of the child’s play.

  • The therapist models language and encourages the child to use words or gestures to communicate. This might involve prompting the child to ask for a toy, label objects, or respond to questions.

    •  Positive reinforcement is used to encourage desired behaviours. This might include verbal praise, high-fives, or access to a preferred toy or activity.

    • The therapist uses strategies to manage emotional dysregulation, such as redirecting the child’s attention or using a visual schedule to provide structure.

  • Fine and gross motor activities are incorporated, such as stacking blocks, drawing, or throwing a ball.

  • Parents are often included in the session as (invisible support) to observe and learn techniques they can use at home. They may also participate in activities to strengthen their interaction with the child.

  • The therapist tracks the child’s progress weekly on specific set goals throughout the session. This data helps in adjusting the intervention plan as needed.

  • The session concludes with a transition activity, helping the child move smoothly from the therapy session to their next activity. This might involve a calming routine or a favourite song.

The Early Start Denver Model (ESDM) is an evidence-based intervention designed for young children with autism spectrum disorder (ASD), typically between the ages of 12 and 48 months but can go up to 5 years. ESDM integrates principles from Applied Behaviour Analysis (ABA) with developmental and relationship-based approaches to promote language, cognitive, social, and motor skills.

Structure of 1:1 ESDM Therapy:

Efficacy and Outcomes:

Research indicates that ESDM can lead to significant improvements in cognitive, language, and adaptive behaviour in young children with ASD. Early intervention through ESDM has also been associated with gains in social-communication skills and reductions in autism symptom severity.

Conclusion:

1:1 ESDM therapy is a dynamic and flexible intervention tailored to support the developmental needs of young children with ASD. By integrating play-based learning with evidence-based behavioural strategies and involving families in the therapeutic process, ESDM aims to foster meaningful and lasting developmental gains.

  • Assessment:

    • The process begins with a thorough assessment of the child’s developmental level using standardised tools such as the ESDM Curriculum Checklist. This assessment helps identify the child's strengths and areas of need.

  • Individualised Treatment Plan:

    • Based on the assessment, a personalised treatment plan is created, outlining specific, measurable goals across various domains (communication, social skills, imitation, cognition, play, motor skills, and adaptive behaviour).

  • Session Structure:

    • Frequency and Duration: Typically, sessions occur several times a week, each lasting from 1 to 3 hours, depending on the child's needs and tolerance.

      Therapist’s Role: 

    • A trained therapist or a team of therapists (including speech and occupational therapists) conducts the sessions, ensuring consistency and comprehensive support.

      Environment:

    • Sessions can take place in various settings such as the child’s home, a clinic, or a preschool environment, aiming to generalise skills across different contexts.

  • Therapeutic Techniques:

    Naturalistic Teaching:

    • Embeds learning opportunities within natural play activities and daily routines, rather than using a structured, discrete trial training approach.

    Positive Reinforcement:

    • Uses reinforcement strategies to encourage desired behaviours and skills, including verbal praise, physical affection, or preferred activities.

    Joint Attention:

    • Focuses on building joint attention skills, crucial for social and communicative development, by engaging the child in activities that require shared focus and interaction.

      Imitation and Modelling:

    • Encourages the child to imitate both verbal and non-verbal behaviours demonstrated by the therapist, promoting learning through observation.

  • Parent Training and Involvement:

    Education and Training:

    • Parents receive training to implement ESDM techniques at home, enhancing the child’s learning opportunities outside of therapy sessions.

    Collaboration:

    • Therapists work closely with parents to set goals, review progress, and adapt strategies based on the child’s evolving needs.

  • Monitoring and Evaluation:

    Data Collection:

    • Regular data collection on the child’s performance and progress towards goals is a critical component.

    Ongoing Assessment:

    • Frequent reassessment ensures that the treatment plan remains aligned with the child’s developmental trajectory and emerging needs.

The Evidence

The Early Start Denver Model (ESDM) has been supported by various research studies that demonstrate its effectiveness in improving developmental outcomes for young children with autism spectrum disorder (ASD). Below is a summary of key evidence supporting ESDM therapy:

Key Studies and Findings:

Summary of Findings:

The body of evidence supporting ESDM therapy highlights several key outcomes:

  • Cognitive Improvements: Increased IQ scores and cognitive functioning.

  • Language Development: Enhanced expressive and receptive language abilities.

  • Adaptive Behaviour: Better performance in daily living skills and adaptive behaviours.

  • Reduction in Autism Symptoms: Decreased severity of core autism symptoms.

  • Neural Changes: Positive changes in brain activity patterns, indicating developmental progress.

Overall, ESDM is a well-supported early intervention approach that has shown significant benefits for young children with ASD across multiple domains of development.

  • Randomised Controlled Trials (RCTs)

    • Dawson et al. (2010):This seminal study is one of the most cited RCTs evaluating the efficacy of ESDM. The study involved 48 children with ASD aged 18-30 months who were randomly assigned to receive either ESDM therapy or community-based interventions for two years. Results showed that children in the ESDM group had significant improvements in IQ, language, and adaptive behaviour compared to the control group. Additionally, children in the ESDM group exhibited fewer autism symptoms.

    • Reference-Dawson, G., et al. (2010). Randomised, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. *Paediatrics, 125*(1), e17-e23.

  • Longitudinal Studies: 

    • Rogers et al. (2012):This follow-up study examined the long-term effects of ESDM on children who had participated in the initial RCT. It found that the gains made during the intervention period were maintained, and some children continued to show improvements even after the intervention ended.

    • Reference:Rogers, S. J., et al. (2012). Early Start Denver Model curriculum checklist for young children with autism. *University of Colorado Denver*.

  • Comparative Studies:

    Estes et al. (2015): This study compared the outcomes of children who received ESDM therapy with those who received other early intervention services in community settings. The results indicated that children in the ESDM group showed greater improvements in adaptive behaviour, communication, and social skills.

    • Reference:Estes, A., et al. (2015). The impact of parent-delivered intervention on parents of very young children with autism. *Journal of Autism and Developmental Disorders, 45*(3), 1415-1428.

  • Meta-Analyses and Systematic Reviews:

    • Reichow et al. (2012): This meta-analysis reviewed several studies on early intensive behavioural interventions (EIBI), including ESDM, and concluded that such interventions, including ESDM, are effective in improving cognitive, language, and adaptive behaviour in young children with ASD.

    • Reference:Reichow, B., et al. (2012). Early intensive behavioural intervention (EIBI) for young children with autism spectrum disorders (ASD). *Cochrane Database of Systematic Reviews*.

  • Neuroimaging Studies:

    • Dawson et al. (2012): In a study examining the neural effects of ESDM, researchers used electroencephalography (EEG) to measure brain activity in children with ASD before and after receiving ESDM therapy. They found that children who received ESDM showed patterns of brain activity more similar to typically developing children, suggesting that ESDM can positively influence brain development.

    • Reference: Dawson, G., et al. (2012). Early behavioural intervention is associated with normalised brain activity in young children with autism. *Journal of the American Academy of Child & Adolescent Psychiatry, 51*(11), 1150-1159.

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P-ESDM Parent Coaching