Early Start Denver Model

Last updated

The Early Start Denver Model (ESDM) is a form of intervention directed at young children that display early signs of being on the autism spectrum proposed by American psychiatrists Sally J. Rogers and Geraldine Dawson. It is intended to help children improve development traits as early as possible so as to narrow or close the gaps in capabilities between the individual and their peers.

Contents

Development

The American psychiatrists Sally J. Rogers and Geraldine Dawson began developing the Early Start Denver Model during the 1980s. [1] While working at the University of Colorado, in Denver, Rogers provided what was first called the "play school model" of intervention which was applied to children in preschool during their regular play activities. [2] The model was founded in Piaget's theory of cognitive development [2] and came to be described by Rogers and Dawson as the Denver Model. [3]

In 2010, the two researchers published Early Start Denver Model for Young Children with Autism: Promoting Language, Learning, and Engagement, [4] in which the ESDM is manualized and described in detail. It is generally cited to be directed towards children between 12 and 48 months of age, [5] and is closely related to Applied behavior analysis, influencing and being influenced by this field of work. [2] [6]

Description

The ESDM is aimed at using "joint activity routines" that explore the child's natural interests to explore their learning potential, shaping everyday activities between the child and their caregivers to maximize their development potential according to the child's assessment. [6]

Rogers and Dawson describe the core features of the ESDM as: [4]

  1. an interdisciplinary team that implements a developmental curriculum addressing all domains;
  2. focus on interpersonal engagement;
  3. development of fluent, reciprocal, and spontaneous imitation of gestures, facial movements and expressions, and object use;
  4. emphasis on both nonverbal and verbal communication development;
  5. focus on cognitive aspects of play carried out within dyadic play routines;
  6. partnership with parents.

Assessment

The intervention begins with measuring the child's skill levels in language, social skills, imitation, cognition, play, and motor and self-help skills. The assessment serves as a baseline for future reassessments, which are rerun every 12 weeks, [7] and a model of it is presented in Rogers and Dawson's 2010 book, [1] being called the ESDM Curriculum Checklist. [8]

Intervention plan

Results from the first assessment are used to draw an intervention plan, which describes the activities to be performed with the child by the parents and therapists. An interdisciplinary team oversees the progress and readjusts the plan with every new 12-week assessment. [4] The parents are also trained (or "coached") and play a role in the program, taking on some of the activities in the child's intervention plan or, in some cases, conducting it all together. [9]

Among the domains focused on by the intervention plan are of particular importance: imitation, nonverbal communication (including joint attention), verbal communication, social development (including emotion sharing), and play. [4]

Efficacy

Several studies have been published in an effort to assess its efficacy in mitigating the developmental delays in young children diagnosed with autism. Research of this kind is inherently complex, since it involves comparing groups receiving different types of treatment and it is ethically questionable to set aside a control group that would receive no treatment; therefore it is challenging to perform the objective measurement of treatment effects. [1]

Rogers and Dawson have performed different trials of their methods. They published, with 6 other authors, a randomized controlled trial in 2012 that younger age and longer hours of weekly intervention hours positively correlate with improvements in most variables measured by the method. [10] They followed up with a study published in 2015 where they tried to gauge the method's long-term efficacy by examining children at 6 years of age, 2 years after the ESDM had ended. By comparing one group that had received traditional methods of treatment with another group receiving the ESDM treatment starting at between 18 and 30 months of age, they found no significant differences between the groups in core autism symptoms immediately after treatment ended (at 4 years of age); the ESDM group did show, however, significant improvements in core autism symptoms after 2 years, implying that the benefits of the treatment at a younger age affect developmental traits that only become noticeable in later stages of development. This was the first study that analyzed the efficacy of ESDM treatment starting at an age younger than 30 months. [11]

Meta-analyses and systematic reviews have shown that the ESDM is promising. [12] A meta-analysis of 12 individual studies with a total of 640 children published in 2020 concluded that, compared to control groups receiving traditional forms of treatment, children receiving the ESDM showed significant improvements in cognition and language abilities (G-test numbers of 0.412 and 0.408, respectively). [13] A separate meta-analysis using 11 studies described as high-quality randomized controlled trials analyzed results in four major domains related to ASD (autism symptoms, language, cognition, and social communication). The study found that children receiving the ESDM showed significant improvements in the cognition (g = 0.28), autism symptoms (g = 0.27), and language (g = 0.29) domains. [14]

Usage in countries

The diagnosis of autism has undergone significant changes in recent decades, which means the forms of treatment have also changed. [15] Therefore, countries have incorporated treatment options in heterogeneous ways, meaning that the Denver Model has been adopted with different intensities throughout the world. The list below presents a brief description of how each country's healthcare system (public or private) deal with this form of treatment:

Australia

The National Disability Insurance Scheme of the Australian government recognizes the ESDM as a form of "naturalistic developmental behavioural intervention" with enough scientific evidence to support it, [16] and will cover the costs of treatment and parent-training sessions if the child is eligible for this type of treatment. [17]

Brazil

The Agência Nacional de Saúde Suplementar (ANS), Brazil's regulating body for private healthcare plan providers, recognizes different forms of ASD within the scope of pervasive developmental disorders. It lists ESDM as one of the forms of treatment that should be taken into consideration by healthcare providers for children with developmental disorders. Since July 1, 2022, healthcare providers are obligated to provide the form of treatment prescribed by the child's doctor, and this includes the ESDM. [18]

France

Since 2012, the Haute Autorité de Santé of France recognizes ESDM's efficacy and recommends that public healthcare institutions consider it as one of their options when treating children with ASD. [19]

United States

All 50 states in the USA have legislation requiring the coverage of autism spectrum treatments by private health insurance companies. [20] The Centers for Disease Control and Prevention (CDC) includes the ESDM as a developmental approach in the treatment of ASD. [21]

A study of applying the ESDM at an early age was conducted to assess the cost-effectiveness of applying the ESDM at an early age rather than using the traditional methods of treatment at later stages. The study indicates that the average increased cost of treatment at younger ages was significantly smaller than the total savings in treatments at older ages, with children needing fewer sessions of ABA/EIBI, occupational, physical and speech therapy services. [22]

Related Research Articles

<span class="mw-page-title-main">Asperger syndrome</span> Neurodevelopmental diagnosis now categorized under autism spectrum disorder

Asperger syndrome (AS), also known as Asperger's syndrome, formerly described a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior, interests, and activities. The syndrome has been merged with other disorders into autism spectrum disorder (ASD) and is no longer considered a stand-alone diagnosis. It was considered milder than other diagnoses that were merged into ASD due to relatively unimpaired spoken language and intelligence.

Relationship Development Intervention (RDI) is a trademarked proprietary treatment program for autism spectrum disorders (ASD), based on the belief that the development of dynamic intelligence is the key to improving the quality of life for autistic people. The program's core philosophy is that autistic people can participate in authentic emotional relationships if they are exposed to them in a gradual, systematic way. The goal of treatment is to systematically build up the motivation and tools for successfully interacting in social relationships, to correct deficits in this area that are thought to be common to all autistic people.

Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, motor disorders, and autism spectrum disorders. In broader definitions ADHD is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.

<span class="mw-page-title-main">Controversies in autism</span> Controversies about both the cause of autism and the nature of the diagnoses themselves

Diagnoses of autism have become more frequent since the 1980s, which has led to various controversies about both the cause of autism and the nature of the diagnoses themselves. Whether autism has mainly a genetic or developmental cause, and the degree of coincidence between autism and intellectual disability, are all matters of current scientific controversy as well as inquiry. There is also more sociopolitical debate as to whether autism should be considered a disability on its own.

<span class="mw-page-title-main">Conditions comorbid to autism spectrum disorders</span> Medical conditions more common in autistic people

Autism spectrum disorders (ASD) are neurodevelopmental disorders that begin in early childhood, persist throughout adulthood, and affect three crucial areas of development: communication, social interaction and restricted patterns of behavior. There are many conditions comorbid to autism spectrum disorders such as attention-deficit hyperactivity disorder and epilepsy.

Discrete trial training (DTT) is a technique used by practitioners of applied behavior analysis (ABA) that was developed by Ivar Lovaas at the University of California, Los Angeles (UCLA). DTT uses mass instruction and reinforcers that create clear contingencies to shape new skills. Often employed as an early intensive behavioral intervention (EIBI) for up to 25–40 hours per week for children with autism, the technique relies on the use of prompts, modeling, and positive reinforcement strategies to facilitate the child's learning. It previously used aversives to punish unwanted behaviors. DTT has also been referred to as the "Lovaas/UCLA model", "rapid motor imitation antecedent", "listener responding", errorless learning", and "mass trials".

Irritability is the excitatory ability that living organisms have to respond to changes in their environment. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli.

<span class="mw-page-title-main">Autism therapies</span> Therapy aimed at autistic people

Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.

The epidemiology of autism is the study of the incidence and distribution of autism spectrum disorders (ASD). A 2022 systematic review of global prevalence of autism spectrum disorders found a median prevalence of 1% in children in studies published from 2012 to 2021, with a trend of increasing prevalence over time. However, the study's 1% figure may reflect an underestimate of prevalence in low- and middle-income countries.

The floortime or Developmental, Individual-differences, Relationship-based (DIR) model is a developmental model for assessing and understanding any child's strengths and weaknesses. This model was developed by Stanley Greenspan and first outlined in 1979 in his book Intelligence and Adaptation.

<span class="mw-page-title-main">Classic autism</span> Neurodevelopmental condition

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism,Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

<span class="mw-page-title-main">Autism spectrum</span> Neurodevelopmental disorder

Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder marked by deficits in reciprocal social communication and the presence of restricted and repetitive patterns of behavior. Other common signs include difficulties with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hyporeactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.

Geraldine Dawson is an American child clinical psychologist, specializing in autism. She has conducted research on early detection, brain development, and treatment of autism spectrum disorders (ASD) and collaborated on studies of genetic risk factors in autism. Dawson is William Cleland Distinguished Professor of Psychiatry and Behavioral Sciences and professor of psychology and neuroscience, former director, Duke Institute for Brain Sciences and founding director of the Duke Center for Autism and Brain Development at Duke University Medical Center. Dawson was president of the International Society for Autism Research, a scientific and professional organization devoted to advancing knowledge about autism spectrum disorders. From 2008 to 2013, Dawson was research professor of psychiatry at the University of North Carolina at Chapel Hill and was chief science officer for Autism Speaks. Dawson also held the position of adjunct professor of psychiatry at Columbia University and is professor emerita of psychology at University of Washington. She is a fellow of the American Psychological Society, American Psychological Association, International Society for Autism Research, and the Society of Clinical Child and Adolescent Psychology.

Sex and gender differences in autism exist regarding prevalence, presentation, and diagnosis.

Sally J. Rogers is professor of MIND Institute and department of Psychiatry and Behavioral Sciences at the University of California, Davis. She is a scientist working on early diagnosis and interventions methods for autism and other neurodevelopmental disorders. She is a pioneer in the field of autism treatment and pioneered the development of The Early Start Denver Model (ESDM). She has published nearly two-hundred papers on the field of autism, early diagnosis and treatments.

Autism is characterized by the early onset of impairments in reciprocal social interaction and communication and restricted repetitive behaviors or interests. One of the many hypotheses explaining the psychopathology of autism, the deficit in joint attention hypothesis is prominent in explaining the disorder's social and communicative deficits. Nonverbal autism is a subset of autism spectrum where the person does not learn how to speak. One study has shown that 64% of autistic children who are nonverbal at age 5, are still nonverbal 10 years later.

Jana Marie Iverson is a developmental psychologist known for her research on the development of gestures and motor skills in relation to communicative development. She has worked with various populations including children at high risk of autism spectrum disorder (ASD), blind individuals, and preterm infants. She is currently a professor of psychology at Boston University.

Daniel Messinger is an American interdisciplinary developmental psychologist, and academic. His research works span the field of developmental psychology with a focus on emotional and social development of children and infants, and the interactive behavior of children in preschool inclusive classroom.

The diagnosis of autism is based on a person's reported and directly observed behavior. There are no known biomarkers for autism spectrum conditions that allow for a conclusive diagnosis.

There is currently no evidence of a cure for autism. The degree of symptoms can decrease, occasionally to the extent that people lose their diagnosis of autism; this occurs sometimes after intensive treatment and sometimes not. It is not known how often this outcome happens, with reported rates in unselected samples ranging from 3% to 25%. Although core difficulties tend to persist, symptoms often become less severe with age. Acquiring language before age six, having an IQ above 50, and having a marketable skill all predict better outcomes; independent living is unlikely in autistic people with higher support needs.

References

  1. 1 2 3 "Is There Science Behind That?: Early Start Denver Model". Association for Science in Autism Treatment. Retrieved January 24, 2023.
  2. 1 2 3 McGee, Gail (October 23, 2008). "What Is The Denver Model?". ABC News. Retrieved January 24, 2023.
  3. ↑ Rogers, Sally J. (2013), "Early Start Denver Model", in Volkmar, Fred R. (ed.), Encyclopedia of Autism Spectrum Disorders, New York, NY: Springer, pp. 1034–1042, doi:10.1007/978-1-4419-1698-3_1821, ISBN   978-1-4419-1698-3
  4. 1 2 3 4 Rogers, Sally J.; Dawson, Geraldine (2010). Early Start Denver Model for young children with autism : promoting language, learning, and engagement. New York: Guilford Press. ISBN   978-1-60623-631-4. OCLC   406124029.
  5. ↑ "Early Start Denver Model (ESDM)". Autism Speaks. Retrieved January 24, 2023.
  6. 1 2 Vivanti, Giacomo; Stahmer, Aubyn C. (March 2021). "Can the Early Start Denver Model Be Considered ABA Practice?". Behavior Analysis in Practice. 14 (1): 230–239. doi:10.1007/s40617-020-00474-3. ISSN   1998-1929. PMC   7900312 . PMID   33732593.
  7. ↑ Rogers, Sally J. (2010). Early Start Denver Model curriculum checklist for young children with autism. Geraldine Dawson. New York: Guilford. ISBN   978-1-60623-633-8. OCLC   502315907.
  8. ↑ Rogers, Sally J. (2010). Early Start Denver Model curriculum checklist for young children with autism. Guilford. ISBN   978-1-60623-633-8. OCLC   502315907.
  9. ↑ Rogers, S. J.; Estes, A.; Vismara, L.; Munson, J.; Zierhut, C.; Greenson, J.; Dawson, G.; Rocha, M.; Sugar, C.; Senturk, D.; Whelan, F.; Talbott, M. (September 10, 2018). "Enhancing Low-Intensity Coaching in Parent Implemented Early Start Denver Model Intervention for Early Autism: A Randomized Comparison Treatment Trial". Journal of Autism and Developmental Disorders. 49 (2): 632–646. doi:10.1007/s10803-018-3740-5. ISSN   0162-3257. PMID   30203308. S2CID   254571081.
  10. ↑ Rogers, Sally J.; Estes, Annette; Lord, Catherine; Vismara, Laurie; Winter, Jamie; Fitzpatrick, Annette; Guo, Mengye; Dawson, Geraldine (October 2012). "Effects of a Brief Early Start Denver Model (ESDM)–Based Parent Intervention on Toddlers at Risk for Autism Spectrum Disorders: A Randomized Controlled Trial". Journal of the American Academy of Child & Adolescent Psychiatry. 51 (10): 1052–1065. doi:10.1016/j.jaac.2012.08.003. ISSN   0890-8567. PMC   3487718 . PMID   23021480.
  11. ↑ Estes, Annette; Munson, Jeffrey; Rogers, Sally J.; Greenson, Jessica; Winter, Jamie; Dawson, Geraldine (July 1, 2015). "Long-Term Outcomes of Early Intervention in 6-Year-Old Children With Autism Spectrum Disorder". Journal of the American Academy of Child & Adolescent Psychiatry. 54 (7): 580–587. doi:10.1016/j.jaac.2015.04.005. ISSN   0890-8567. PMC   4475272 . PMID   26088663.
  12. ↑ Waddington, Hannah; van der Meer, Larah; Sigafoos, Jeff (June 1, 2016). "Effectiveness of the Early Start Denver Model: a Systematic Review". Review Journal of Autism and Developmental Disorders. 3 (2): 93–106. doi:10.1007/s40489-015-0068-3. ISSN   2195-7185. S2CID   256406831.
  13. ↑ Fuller, Elizabeth A.; Oliver, Kelsey; Vejnoska, Sarah F.; Rogers, Sally J. (June 12, 2020). "The Effects of the Early Start Denver Model for Children with Autism Spectrum Disorder: A Meta-Analysis". Brain Sciences. 10 (6): 368. doi: 10.3390/brainsci10060368 . ISSN   2076-3425. PMC   7349854 . PMID   32545615.
  14. ↑ Wang, Zhi; Loh, Sau Cheong; Tian, Jing; Chen, Qian Jiang (2022). "A meta-analysis of the effect of the Early Start Denver Model in children with autism spectrum disorder". International Journal of Developmental Disabilities. 68 (5): 587–597. doi:10.1080/20473869.2020.1870419. ISSN   2047-3877. PMC   9542560 . PMID   36210899.
  15. ↑ Lordan, Ronan; Storni, Cristiano; De Benedictis, Chiara Alessia (2021), Grabrucker, Andreas M. (ed.), "Autism Spectrum Disorders: Diagnosis and Treatment", Autism Spectrum Disorders, Brisbane (AU): Exon Publications, ISBN   978-0-6450017-8-5, PMID   34495618 , retrieved February 14, 2023
  16. ↑ "Naturalistic developmental behavioural interventions | NDIS". www.ndis.gov.au. Retrieved February 14, 2023.
  17. ↑ "ESDM for parents and carers - University of Wollongong – UOW". www.uow.edu.au. Retrieved February 14, 2023.
  18. ↑ "ANS amplia regras de cobertura para tratamento de transtornos globais do desenvolvimento". Agência Nacional de Saúde Suplementar (in Brazilian Portuguese). Retrieved February 14, 2023.
  19. ↑ "ESDM early start denver model". info (in French). Retrieved February 14, 2023.
  20. ↑ "Using Health Insurance for Autism Therapy". Soar Autism Center. Retrieved February 14, 2023.
  21. ↑ CDC (March 9, 2022). "Treatment and Intervention Services for Autism Spectrum Disorder". Centers for Disease Control and Prevention. Retrieved February 14, 2023.
  22. ↑ Cidav, Zuleyha; Munson, Jeff; Estes, Annette; Dawson, Geraldine; Rogers, Sally; Mandell, David (September 2017). "Cost Offset Associated With Early Start Denver Model for Children With Autism". Journal of the American Academy of Child and Adolescent Psychiatry. 56 (9): 777–783. doi:10.1016/j.jaac.2017.06.007. ISSN   0890-8567. PMC   7007927 . PMID   28838582.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.