The Early Start Denver Model (ESDM) is a comprehensive, evidence-based program of intervention for children with autism spectrum disorder (ASD) that combines the principles of positive behavioural support with play- and relationship-based approaches to promoting language development, social skills, positive behaviour, adaptive functioning, and independence. ESDM is a naturalistic intervention that is delivered in the child’s day-to-day environment, typically at home or in a daycare or preschool setting, and involves intensive, individualized intervention focusing on social communication, language, and cognitive development.

In ESDM parents are considered experts on their children, and their perspectives and insights are highly valued. Parents have a unique understanding of their child’s strengths and weaknesses, which is used to inform the therapy goals and objectives. Moreover, ESDM recognises that parents have a more significant impact on their child’s development than anyone else. They are trained to work alongside  ESDM therapists and to implement the ESDM curriculum during their child’s daily routines and play. Working alongside ESDM therapists, parents learn how to promote their child’s learning and development in everyday activities, which favours the acquisition of skills relevant to daily life.

In the same vein, a core goal of ESDM is to enhance the social interaction between children and their parents. By participating in therapy, parents can learn how to interact with their children in ways that promote effective communication, empathy, theory of mind and other skills essential to healthy development and strong interpersonal relationships. This approach also helps to strengthen the bond between parent and child, conferring significant benefits for the child’s psychosocial, behavioural, and emotional well-being.

Ample research has shown that ESDM can have significant positive effects on the development of young children with ASD. Below is an overview of some of the major areas of development targeted by ESDM intervention:

Social Communication:

Social communication skills are critical for children with autism, as difficulties with social communication are a hallmark of ASDs. ESDM interventions use a variety of play-based activities, such as social games, turn-taking games and reciprocal play, to engage children and promote social communication skills. Parents and therapists work together to ensure that activities are enjoyable and meaningful to the child, in order to increase motivation and engagement. As an example, a child might play a game of red-light-green light, which helps them learn turn-taking, understanding and giving instructions, and other important skills, such as inhibition and self-regulation.

The use of play-based activities in ESDM interventions is particularly effective because it allows children to learn social skills naturalistically, in a manner that is consistent with individual development and interests. In ESDM, children are encouraged to interact with their parents, caregivers and peers in a fun, low-stress way that doesn’t feel like traditional, across-the-table therapy. This can help to reduce anxiety and make the learning experience more enjoyable and motivating.

Language Development:

Another key focus of ESDM therapy is language development. Children with autism often have delayed language skills, and ESDM interventions aim to address this challenge through the use of naturalistic language strategies, as opposed to the more didactic or contrived activities that might feature in other forms of therapy. Parents, caregivers and therapists use everyday situations and routines to teach language skills, such as labeling objects, following simple instructions, expressing needs and desires and asking and answering questions. This approach encourages children to learn language in a way that is meaningful and relevant to them, which can improve motivation and engagement.

A particularly effective language strategy used in ESDM is modeling language during play, by commenting on what the child is doing or asking questions about their activities. This helps the child to learn how to use language to communicate with others and to express their ideas and interests. As an example, a caregiver might label objects in the child’s environment during play, such as saying ‘train’ when the child is playing with a train. If the child then repeats the word, a naturalistic reinforcer, such as verbal praise, might be offered. This helps the child to learn and expand their language skills in a way that is relevant to their play and respectful of their interests. It can also increase the child’s motivation to communicate and learn language skills.

Positive Behaviour:

ESDM includes specific strategies designed to promote positive behaviour without recourse to punishment, scolding or lecturing. Likewise, the ESDM approach to behaviour is proactive rather than reactive. This means that therapists and parents work together to identify potential triggers for negative behaviour and develop strategies to prevent such behaviour from occurring in the first place. For example, if a child becomes distressed or tantrums when transitioning from one activity to another, therapists and parents may use strategies such as creating predictable routines, providing visual schedules, informing the child of the transition in advance, or providing a comfort object during the transition.

ESDM also includes specific strategies for managing challenging or harmful behaviors. These strategies are designed to be supportive rather than punitive. For example, if a child engages in self-injurious behavior such as head-banging, the therapist may work with the parent to teach the child a safe alternative behavior such as squeezing a stress ball or taking a break in a low-stimulation area.

Finally, therapists and parents use naturalistic positive reinforcement, such as praise, affirmation and increased time on a preferred activity to encourage positive behaviour. Tangible reinforcers such as stickers or other small rewards are also sometimes used, but only if other strategies have failed.

Cognitive Development:

ESDM interventions not only focus on social communication, language and behavioural development but also aim to support cognitive development. This is done through the use of structured activities that promote problem-solving, attention, and working memory skills. By engaging in activities that require sustained attention and working memory, children can improve their executive functioning and enhance their self-regulatory skills. For example, during therapy, a child might complete an enjoyable puzzle or sorting task, which can help them develop cognitive skills like sequencing, inhibition, psycho-motor coordination, spatial reasoning and visual discrimination.

ESDM interventions also use repetition and naturalistic reinforcement to support cognitive development. Through repeated exposure to purposeful play, children develop and strengthen their cognitive skills and learn to generalise those skills to a greater number of activities. Positive reinforcement —  such as smiles, verbal affirmation, or additional time on a favoured activity —  is also used to encourage children to engage in tpurposeful play and to celebrate their progress.

School Readiness:

Research has shown that ESDM interventions can improve school readiness in children with autism. As previously mentioned, ESDM interventions promote school readiness by focusing on social communication, language, behaviour and cognitive development. By targeting these areas, children can develop the skills needed to participate in classroom activities, understand instructions, and communicate their needs, interests, and ideas to peers and teachers.

Future Achievement:

While longitudinal research on the ESDM model is scant given its relatively recent development, ESDM interventions may also have long-term benefits for children with autism. Research has shown that early intervention for autism can improve outcomes later in life, including academic achievement, social skills, and independence. By providing intensive, individualized intervention at a young age when children are most receptive to intervention, ESDM may help children with autism to develop the skills they need to succeed in school and in their adult lives. Moreover, while ESMD therapy can be resource-intensive in the short term, it may have considerable benefits in the long term. By improving outcomes in areas such as academic achievement, social skills, and independence, children who receive ESDM interventions may be better prepared for adulthood and more likely to succeed in relationships and in the workforce.

Here are some ways that you can use ESDM strategies at home while waiting for therapy:

Use naturalistic language strategies:

Parents can use everyday situations and activities to teach language skills, such as labeling objects, following simple instructions, and asking and answering questions. This can help children learn language in a way that is meaningful and relevant to them, improving their motivation and engagement. For example, while playing with toys, parents can label each toy and encourage the child to repeat the word. Once the child repeats the word, praise, smiles, high-fives, additional time with the toy, or another naturalistic form of reinforcement that the child responds to can be offered.

Incorporate play into your daily routine:

ESDM interventions use play-based activities to engage children and promote social communication and cognitive development. Parents can use similar activities at home, such as playing simple interactive games, engaging in pretend play, and practicing turn-taking. As an example, parents can play a game like hide-and-go-seek with their child. Such games can help children learn turn-taking and reciprocal communication skills.

Use visual aids:

Visual aids can help children with autism understand and process information. Parents can use visual aids, such as picture-based communication systems, picture cards, visual schedules, illustrations, or charts, to help their child understand daily routines, learn new concepts, and communicate their needs. A visual schedule, for example, can help a child understand what activities will occur throughout the day and reduce the distress than can sometimes accompany transitions.

Promote the development of social skills:

ESDM interventions aim to support social communication skills, which are critical for children with autism. Parents can promote social skills at home by engaging in social games and activities that promote social communication, such as taking turns during a game of catch or playing a game of charades. Likewise, parents can play games like Simon Says or Mother, May I with their children to promote turn-taking and understanding and giving instructions.

Promote positive behaviour:

A number of ESDM strategies can be used to promote positive behaviour. These include identifying and reducing triggers for challenging behaviour, teaching self-regulatory skills, and teaching children replacement behaviours that allow them to get their needs met without causing distress to themselves or others. One simple way to promote positive behaviour is to create a sensory-friendly environment in your home. This can involve reducing noise and bright lights, providing a quiet space for your child to retreat to when feeling overwhelmed, and using toys and activities to provide sensory stimulation in a safe way. Children with autism often struggle with understanding verbal information, so it’s also important for parents to provide clear, comprehensible and consistent instructions. This can involve using simple language, breaking instructions into smaller steps, and using visual aids to reinforce verbal instructions. Another important strategy that can help promote positive behaviour is teaching replacement behaviours. The first step in teaching replacement behaviours is to identify the cause or need behind a challenging behaviour. Then parents can teach new behaviours that help the child to get their needs met without causing distress to themselves or others. Finally, it’s important that parents avoid punishment, which can have a host of unintended consequences for children with ASD, and provide positive reinforcement for appropriate behaviour instead. This can involve specific verbal praise, high-fives, smiles, or other naturalistic rewards that your child finds motivating.

Foster cognitive development:

ESDM interventions use structured activities that promote problem-solving and attention skills, which can improve cognitive development. Parents can use similar activities at home, such as puzzles, sorting tasks, and memory games. Likewise, they can engage their children in active games that involve attention and inhibition, such as Simon Says and Mother May I. These fun activities can help children develop the cognitive and executive functioning skills that are essential for later success.

Books can provide valuable guidance and support for parents who want to use ESDM strategies at home. Below are a few good options:

An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn, by Sally Rogers, Geraldine Dawson, and Laurie Vismara. This book, authored by the developers of the ESDM model, provides practical strategies and guidance to parents on how to use ESDM methods at home to promote social communication, language, cognitive development, and positive behaviour in children with autism.

Teaching Young Children with Autism Spectrum Disorder, by Clarissa Willis. This book offers numerous ideas for teaching young children with autism, including strategies for promoting communication, social skills and positive behaviour, that are consistent with the ESDM approach.

Early Intervention Games: Fun, Joyful Ways to Develop Social and Motor Skills in Children with Autism Spectrum or Sensory Processing Disorders, by Barbara Sher. This book provides a collection of games and activities that parents can use to promote social communication, motor skills, and sensory integration in children with autism and other disorders that affect sensory processing.

Finally, if you have questions about ESDM or would just like to talk about your experiences, please feel free to reach out to ASK or join one of our parent support groups. We are here to serve you and your special children.