Early Start Denver Model (ESDM) and Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that mainly affects socialization and communication. This condition does not have a definitive cure but tends to be managed with a combination of medication and therapies.

The Early Start Denver Model, or ESDM, is one of these behavioral therapies that is used. It is particularly important as it can be applied to target children between 1 year of age and 4 years old. This model can be used in multiple settings, which is part of the reason why it is a valuable therapeutic option.

While there are many therapeutic models available for children with autism, it is important to know about methods such as ESDM. It can help tackle the major symptoms of autism from a very early age.

This article will discuss this kind of therapy for autism management. It will also talk about the principles behind it, as well as organizations that provide this service and its efficacy.

What is the Early Start Denver Model?

The Early Start Denver Model is a behavioral therapy technique for young children with autism spectrum disorder. It provides a means of treatment for children between 12 and 48 months of age.

This therapy has a major benefit in that its therapeutic methods are entirely play-based. This provides an engaging means of improving the social and communicative skills of children with ASD.

Another advantage of the ESDM for autism treatment is that it can be used in multiple settings. Autistic children will spend a large fraction of their time between home and school and this therapy can be provided in either place. This improves the reach of the therapy.

By utilizing play, parents and educators are able to provide a means to improve deficits in autism.

Key features of the therapy

The Early Denver Model has two major elements that guide how it is executed in children with autism spectrum disorder. These are the following:

  1. An individualized set of developmental goals. This is important as each patient will have a different balance in the severity of symptoms. Personalizing it allows for more specific treatment per child. The ESDM checklist assists with this.
  2. The use of play-based therapeutic methods with an Applied Behavior Analysis (ABA) basis to them. ABA is the root of Early Denver Model therapy. As such, the specific exercises for teaching are based on this.

However, some of the other key features that make the ESDM for autism such a popular option are:

  • Play-based therapy
  • Shared activities between caretaker and child
  • Focus on parental interaction
  • Focus on interpersonal interactions
  • Therapy tailored to individual development

What does the ESDM involve?

In this therapy technique, the child will be assessed to determine the major deficits they have due to ASD. These may be in their communication, social, or cognitive functions. Once determined and the initial level documented, ESDM therapy can be commenced.

Following this, the interests of the child will be noted. For example, do they like playing with blocks or playing with balls? The actual process of this kind of therapy will leverage these interests to form joint play routines. These routines will have parents, teachers, or therapists, engaging with the child.

ESDM is a group play-based method of therapy. Teachers and parents can help improve deficits in children with autism.

The goal is to improve upon deficits by communicating and socializing with the child during these sessions. Not only does it target language and social skills, but cognition and motor function can also be improved upon.

Teachers and parents may require ESDM training in order to become perfectly conversant with the therapy. It can also be performed as part of a group, which can help teach a child how to interact with other children. This can be helpful for school settings, but it is also great as it is a therapy method that can be used at home.

What is the idea behind the Early Start Denver Model?

Applied Behavior Analysis, or ABA, is the major concept that lies at the heart of ESDM for autism. ABA focuses on the dynamics behind regular behaviors like communication and play. For instance, the way our environment affects these behaviors and how they change.

By understanding the principles that govern how we learn or change behaviors, they can be put to use in therapy. This is core to how ESDM utilizes joint play routines in order to improve on specific behaviors that show deficits.

Not only can it be used to improve existing deficits, but new skills and behavior can be taught by putting ABA to work too.

Who provides Early Start Denver Model services?

After special training, some of the professionals will be able to provide ESDM services. Being educated, professionals are allowed to call themselves ESDM therapists. It is recommended to only receive such therapeutic services from those appropriately certified.

Some of the professionals who may be ESDM therapists include:

  • Developmental pediatricians
  • Speech therapists
  • Occupational therapists
  • Psychologists
  • Educators
  • Behavior specialists
  • Early intervention specialists

What is Early Start Denver Model Autism Training?

It is important for those administering ESDM therapy to be properly trained in it. This is why Early Denver Model training and certification are integral. It ensures that the providers of this service are properly equipped for the task.

The training process for this therapy involves participants fulfilling a set of requirements. Once they do, they can then be appropriately certified. These requirements include:

  • Completing the ESDM manual
  • Attending training sessions for ESDM
  • Showing evidence of special techniques being used by them during therapy
  • Showing that they have an understanding of these techniques and their correct usage

What is the evidence that the Early Start Denver Model works?

There is clinical evidence that has proven the efficacy of ESDM for autism. These studies have been able to prove that the therapy improves deficits in children with ASD. This has led to it still being a mainstay of treatment in young children up to today.

One study from 2012 was able to show clear improvements in symptoms of autism in children between 18 and 30 months of age. This included improved language, IQ, and social skills after 2 years of therapy.

The ESDM therapy has been proven to improve multiple symptoms in children with ASD. This includes their social skills and language, among others.

In Japan, ESDM was proven to have noticeable effects, even after relatively short durations. Children received treatment for less than a year, showing language and socialization improvement.

Finally, one study showed that cognition, language, and motor ability, can be impacted by ESDM therapy. In this case, over a period of as little as 6 months.

Where do I find Early Start Denver Model services?

There are many services providers for ESDM therapy. However, it is understandable that it may be difficult finding those nearest to you. Fortunately, there are many resources that can make pinpointing providers around you much easier.

The official Early Start Denver Model website has an online list of certified service providers. It includes contact information and the city they reside in. This makes it very easy to get in contact. Autism Speaks also has a directory that contains all the information that one might need.

How stem cell therapy may increase the effect of ESDM

When treating ASD, the best improvements are seen when using multiple treatments. This can be a combination of medication and behavioral therapies, and even adding stem cell treatment to the mix. 

For years now, stem cell treatment has been an alternative for patients dealing with ASD. Each patient’s case and symptoms are different. Stem cell treatment may not produce the same degree of improvement in each patient. It is also not a cure-all for autism, and some patients may not notice changes. However, there is clinical evidence backing the efficacy of stem cell therapy for autism. One study noted improvements on three separate autism indices, 24 weeks following treatment.

Stem cell treatment and ESDM therapy have both been proven to be efficacious. Stem cell therapy achieves its effect by inducing regeneration and development of neurons in the brain. This can potentially improve the ease of administering ESDM therapy. It may improve how well-accepted the therapy is, and increase the magnitude of the improvements.

Get a free online consultation

Contact us to learn the expected results of stem cell therapy in autism for your personal case, the cost of the therapy, and its duration.

Dr. Aleksandra Fetyukhina, MD

Medical Advisor, Swiss Medica doctor


It should be kept in mind that the effectiveness of therapy depends on many factors: the initial state of the patient, the patient’s age, genetic predisposition, lifestyle, including nutrition, the availability of support of additional therapies, etc.

List of References

  1. Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, Donaldson A, Varley J. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics. 2010 Jan;125(1):e17-23. doi: 10.1542/peds.2009-0958.

  2. Devescovi, R., Colonna, V., Dissegna, A., Bresciani, G., Carrozzi, M., & Colombi, C. (2021). Feasibility and Outcomes of the Early Start Denver Model Delivered within the Public Health System of the Friuli Venezia Giulia Italian Region. Brain sciences, 11(9), 1191. https://doi.org/10.3390/brainsci11091191.

  3. Dawson G, Jones EJ, Merkle K, Venema K, Lowy R, Faja S, Kamara D, Murias M, Greenson J, Winter J, Smith M, Rogers SJ, Webb SJ. Early behavioral intervention is associated with normalized brain activity in young children with autism. J Am Acad Child Adolesc Psychiatry. 2012 Nov;51(11):1150-9. doi: 10.1016/j.jaac.2012.08.018. PMID: 23101741; PMCID: PMC3607427.

  4. Tateno, Y., Kumagai, K., Monden, R., Nanba, K., Yano, A., Shiraishi, E., Teo, A. R., & Tateno, M. (2021). The Efficacy of Early Start Denver Model Intervention in Young Children with Autism Spectrum Disorder Within Japan: A Preliminary Study. Soa–ch’ongsonyon chongsin uihak = Journal of child & adolescent psychiatry, 32(1), 35–40. https://doi.org/10.5765/jkacap.200040.

  5. Jinwei W., Dandan G., Yanyan S., Feiyong J., Honghua L. Efficacy analysis of early start Denver model in children with autism spectrum disorder. Chinese Journal of Behavioral Medicine and Brain Science ; (12): 684-688, 2019.

  6. Lv, YT., Zhang, Y., Liu, M. et al. Transplantation of human cord blood mononuclear cells and umbilical cord-derived mesenchymal stem cells in autism. J Transl Med 11, 196 (2013). https://doi.org/10.1186/1479-5876-11-196.

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