How does ESDM work

The Early Start Denver Model (ESDM) is a structured yet flexible and individualised early intervention designed to meet the unique developmental needs of young children with autism. We deliver ESDM therapy through engaging, naturalistic play-based interactions, aiming to foster growth in all ten developmental areas which are:

Expressive communication skills
Receptive communication skills
Social skills
Play skills
Cognitive development
Joint attention
Behaviour
Personal independence
Gross motor skills
Fine motor skills

Scaffolding Approach to Capacity Building

ESDM supports children’s development with a scaffolding approach whereby more basic skills are first taught and mastered before more advanced skills are taught on the foundation of the skills the child has already mastered.

The four levels of goals in the Early Start Denver Model (ESDM) correspond approximately to typical developmental milestones for children, ranging from infancy to early childhood. However, because children with autism may experience developmental delays, the age ranges are flexible and adapted to the child’s individual abilities rather than strict chronological age.

Level 1: Social Partner Stage

Generally, level 1 goals are for children aged 12 to 18 months old.

For this age group, our focus is on foundational social engagement skills. These are skills typically observed in infants, such as:

Making eye contact.
Responding to others’ voices and facial expressions.
Engaging in simple, non-verbal back-and-forth interactions (e.g., cooing or smiling in response to a caregiver).

Children at this level are working on building awareness of others and basic social connections.

Level 2: Joint Activity Stage

General, level 2 goals are for children aged 18 to 24 months.

This stage corresponds to the early toddler years, where children begin to:

Participate in simple, shared activities with others.
Follow basic instructions (e.g., “Give me the toy”).
Use gestures like pointing or waving to communicate needs and interests.
Engage in basic imitation of actions or sounds.

The goals at this level focus on encouraging participation and interaction in shared experiences.

Level 3: Beginning Communicator Stage

Level 3 goals correspond to children aged 24 to 36 months (2 to 3 years)

At this stage, children typically start to develop early communication and play skills, such as:

Saying first words or using signs.
Combining gestures with vocalisations to express needs or preferences.
Engaging in simple pretend play (e.g., pretending to drink from a cup).
Taking turns in basic conversations or play activities.

The focus shifts to developing more intentional and purposeful communication.

Level 4: Advanced Communicator Stage

Level 4 goals are advanced goals for children aged 36 to 60 months (3 to 5 years) and older.

This level aligns with the preschool years, where children are expected to:

Use sentences to express ideas, ask questions, and share experiences.
Participate in more complex pretend play and cooperative group activities.
Engage in conversations that involve multiple exchanges.
Demonstrate problem-solving skills and adapt to new social situations.

Goals at this level emphasise advanced communication, peer interactions, and preparation for school readiness.

Flexibility in Age Ranges

The above age ranges are approximate and based on typical developmental timelines. In ESDM, the focus is on the developmental progress of the individual child rather than chronological age so that goals are tailored to the child’s current abilities and skill progression. Children with autism may work on goals from different levels simultaneously, depending on their unique needs and strengths.

These levels provide a clear and structured framework for tracking progress and tailoring interventions to each child’s needs. By tracking the child's progress through data, we ensure that the child’s learning feels manageable and appropriate.

Focus on Social and Communication Skills

The primary goal of ESDM is to enhance a child’s ability to interact with others and communicate effectively.

Social Skills: Activities are designed to teach children to respond to others, make eye contact, share toys, and recognise emotions.
Communication Skills: Therapists focus on helping children communicate in ways that suit their developmental level, from using gestures and sounds to forming words and sentences.
Example: If a child shows interest in a toy but doesn’t ask for it, the therapist might guide them to point or vocalize their request before handing it over. This encourages communication in a meaningful context.

Play-Based and Naturalistic

Therapy is delivered through play and everyday activities to make learning enjoyable and engaging.

Why it works: Young children naturally learn through play. By integrating therapy into fun and familiar activities, ESDM keeps the child motivated.
Example: A therapist might use a toy car to teach turn-taking by rolling it back and forth, or use building blocks to encourage imitation and problem-solving.
Natural Settings: Therapy can take place at home, in a clinic, or during daily routines, ensuring that learning happens in real-world contexts.

Individualised for Each Child

Every child is unique, and ESDM tailors therapy to their specific needs, strengths, and interests.

Custom Goals: Each child’s developmental profile is assessed to create personalized learning objectives.
Flexible Methods: Therapists adapt their strategies to suit the child’s preferred learning style, whether visual, auditory, or kinesthetic.
Example: If a child loves trains, the therapist might incorporate a train set into activities to teach skills like turn-taking or naming objects.

Positive Reinforcement

Children are encouraged and rewarded for their efforts and achievements to build confidence and motivation.

How it works: Therapists and parents provide immediate and specific praise, smiles, or access to favourite toys when the child makes progress or tries something new.
Example: If a child successfully says “ball,” they might receive a cheer and a chance to play with the ball. This makes learning enjoyable and rewarding.

Family Involvement

Parents and caregivers are essential partners in ESDM therapy.

Training and Support: Parents learn strategies to reinforce their child’s learning during everyday routines, like mealtime or bedtime.
Why it matters: Consistent practice across different settings helps children generalize skills.
Example: A parent might learn to encourage their child to say “up” before being picked up, reinforcing communication at home.

Focus on Joint Attention and Shared Engagement

Joint attention is the ability to share focus on something with another person, like pointing to a toy or looking at a book together. This is a foundational skill for learning and interaction.

How it works: Therapists design activities that encourage the child to notice and respond to others, fostering shared moments of engagement.
Example: A therapist might hold up a toy and wait for the child to look at it or reach for it before playing, teaching them to interact socially.

Use of Data to Track Progress

Therapists regularly monitor the child’s progress to ensure the therapy is effective and goals are being met.

How it works: Therapists use detailed notes and checklists to track which skills the child is mastering and where they may need additional support.
Adjustments: If a child struggles with a particular skill, therapists break it into smaller steps or try a different teaching approach.
Example: If a child is having difficulty learning to wave, the therapist might first practice lifting their hand and then gradually build up to the full motion.

Emphasis on Relationships

Building positive relationships between the child and their caregivers is central to ESDM.

Why it helps: A strong, trusting relationship motivates the child to engage and learn. Positive interactions also create a supportive environment for development.
Example: A therapist might spend time simply playing and laughing with the child to build rapport before introducing new learning activities.

Evidence-Based Practices

ESDM is grounded in research and combines principles from developmental psychology and applied behaviour analysis (ABA).

Why it works: Studies have shown that ESDM can significantly improve cognitive, social, and language skills in young children with autism.
Example: A study might demonstrate how children receiving ESDM show greater improvement in their ability to communicate compared to children receiving other interventions.

Autism aged 1 to 6 years. Combining play-based teaching, naturalistic therapy, and the science-backed principles of applied behaviour analysis (ABA), ESDM takes a developmental approach, focusing on enhancing overall growth rather than just addressing behaviours. Its primary goal is to improve communication, social engagement, and cognitive skills through enjoyable, interactive sessions between the therapist and the child.

Developed by Dr Sally Rogers and Dr Geraldine Dawson, ESDM is a highly flexible approach that can be delivered in various settings, including clinics, homes, childcare centres, and schools. It not only helps children reach their developmental potential but also fosters stronger parent-child relationships, empowering families to actively participate in their child’s progress.