AutismInsights
Back to Intervention Library

Behavioural

Early Start Denver Model (ESDM)

Limited Evidence15 linked studiesCompare with another

What is Early Start Denver Model (ESDM)?

Play-based early intervention combining developmental and behavioural approaches for toddlers.

Evidence Summary

The Early Start Denver Model is an intensive early intervention for young children with autism. Research includes 15 studies, with 5 showing moderate evidence and 8 with limited evidence quality. Two additional studies represent emerging findings. While these studies suggest the approach warrants continued investigation, current evidence remains mixed, and outcomes vary among individual children. Parents considering this intervention should discuss potential benefits and limitations with their healthcare provider.

Evidence last reviewed: 9 June 2026

Linked Studies (16)

EmergingReview

Neuroplasticity mechanisms of NDBIs in autism: a review from brain connectivity to behavioral improvement.

European journal of medical research2026

Yan Pan, Zhu Xiuqin, Tao Qian et al.

Plain-English summary

This study reviews how early autism interventions like the Early Start Denver Model work in the brain. It looks at brain scans to understand how these therapies help children's social skills by changing brain connections. The research shows these interventions can reshape how different brain areas work together, leading to better social communication. The timing, how often, and how long children receive these interventions affects how well they work.

Summary by AutismInsights from published abstract.

EmergingSystematic Review

Behavioral therapies for the treatment of autism spectrum disorder: A systematic review.

Clinics (Sao Paulo, Brazil)2025

Santos Clara Lucato Dos, Barreto Indyanara Inacio, Silva Ana Carolina Furian da et al.

Plain-English summary

This review looked at behavioral therapies for autism in healthcare settings. Studies showed that these therapies helped improve children's thinking skills, speech, and social abilities. Two main approaches worked well: cognitive-behavioral therapy (which helps with thoughts and behaviors) and the Early Start Denver Model (a play-based early intervention). One specific anxiety program called BIACA was better than another approach for reducing worry in autistic children. However, researchers need more studies comparing different therapy types to know which works best.

Summary by AutismInsights from published abstract.

Emerging

Impact of imitation abilities on social communication in autistic children: evidence from an Early Start Denver Model intervention study.

Molecular autism2025

Xiao Shihua, Li Jing

Plain-English summary

This study looked at how imitation skills connect to social communication in 52 autistic children aged 2-5. Children who received Early Start Denver Model therapy showed better improvement in copying others compared to standard treatment. The research found that children with better imitation skills also had stronger social communication abilities. Improvements in imitation predicted more than half of the gains in social communication. However, the intervention didn't show clear benefits for overall social communication skills, despite helping with imitation.

Summary by AutismInsights from published abstract.

Emerging

Developmental and Functional Outcomes Amongst Culturally and Linguistically Diverse Autistic Children.

Journal of autism and developmental disorders2025

Al Fahdawi Zehra, Dissanayake Cheryl, Abdullahi Ifrah et al.

Plain-English summary

This study followed 205 autistic preschoolers for one year during early intervention therapy. Both children from culturally diverse backgrounds and non-diverse backgrounds made significant improvements in thinking skills and daily living abilities. There were no differences in progress between the two groups, which is encouraging given previous concerns about poorer outcomes for children from diverse cultural backgrounds.

Summary by AutismInsights from published abstract.

EmergingCase Report

ESDM intervention in severe preschool autism: an Italian Case report, psychological and social medicine reflections.

Italian journal of pediatrics2024

Ferrara Rosaria, Damato Felice, Iovino Leonardo et al.

Plain-English summary

This study looked at one 3-year-old child with severe autism who received Early Start Denver Model therapy in Italy. The child initially had no eye contact, didn't speak, and had difficulty with movement and repetitive behaviors. Even with limited therapy sessions, the child showed improvements. The study shows this therapy can work in Italy and highlights how community organizations can help families access treatment when public services are limited.

Summary by AutismInsights from published abstract.

Emerging

Pediatric and psychiatric models of autism care in Mexico: Differences in diagnostic tools and prescribed interventions.

Clinical child psychology and psychiatry2024

Zavaleta-Ramírez Patricia, Rosetti Marcos, Albores-Gallo Lilia et al.

Plain-English summary

This study looked at autism services in two Mexican hospitals. It found big differences in how autism is diagnosed and treated. Nearly half of doctors didn't use proper diagnostic tools, and most children were given medications rather than behavioral therapies. The children's hospital offered more evidence-based therapies like ABA, while the psychiatric hospital focused more on life skills training. The study shows autism care varies widely across different healthcare settings in Mexico.

Summary by AutismInsights from published abstract.

EmergingClinical Trial

Study Protocol for a Cluster, Randomized, Controlled Community Effectiveness Trial of the Early Start Denver Model (ESDM) Compared to Community Early Behavioral Intervention (EBI) in Community Programs serving Young Autistic Children: Partnering for Autism: Learning more to improve Services (PALMS).

BMC psychology2024

Stahmer Aubyn C, Dufek Sarah, Rogers Sally J et al.

Plain-English summary

Researchers are planning a large study to test whether a play-based therapy called ESDM works better than usual behavioral therapy for young autistic children in community programs. The study will involve 300 families and compare how well children develop language and social skills with each approach. This is important because many current programs use very structured methods that may not be best for young children.

Summary by AutismInsights from published abstract.

Emerging

Predictors of Developmental and Adaptive Behaviour Outcomes in Response to Early Intensive Behavioural Intervention and the Early Start Denver Model.

Journal of autism and developmental disorders2024

Bent Catherine, Glencross Susan, McKinnon Karen et al.

Plain-English summary

Researchers studied 82 autistic preschoolers receiving two different early intervention programs over one year. Both programs helped children improve their development scores and daily living skills. Children who paid more attention to playful adults during testing had better language and behaviour outcomes overall. For one program (G-ESDM), children with better sustained attention showed greater non-verbal development improvements. This suggests that measuring attention skills might help choose the best intervention for each child.

Summary by AutismInsights from published abstract.

EmergingRandomised Controlled Trial

Randomized, controlled trial of a mixed early start Denver model for toddlers and preschoolers with autism.

Autism research : official journal of the International Society for Autism Research2023

Yang Yanyan, Wang Hongan, Xu Haiping et al.

Plain-English summary

Researchers compared two early intervention approaches in 249 young autistic children (2-4 years old). The Early Start Denver Model showed better results than Discrete Trial Teaching for movement skills, social skills, and language in some children. Both programs involved 25 hours per week for 12 weeks with one-on-one sessions, group activities, and parent training. The benefits varied depending on the child's age and autism severity level.

Summary by AutismInsights from published abstract.

Emerging

Does Treatment Fidelity of the Early Start Denver Model Impact Skill Acquisition in Young Children with Autism?

Journal of autism and developmental disorders2023

Zitter Ashley, Rinn Hezekiah, Szapuova Zofia et al.

Plain-English summary

This study looked at whether therapists following the Early Start Denver Model (ESDM) properly affects how much children learn. Researchers watched 40 therapy sessions and found that when therapists followed the ESDM guidelines more closely, children learned better during sessions. This helps explain why some children do better with ESDM than others - it might depend on how well their therapist sticks to the program.

Summary by AutismInsights from published abstract.

Emerging

Social and Behavioural Outcomes of School Aged Autistic Children Who Received Community-Based Early Interventions.

Journal of autism and developmental disorders2023

Vinen Zoe, Clark Megan, Dissanayake Cheryl

Plain-English summary

This study looked at how autistic children were doing at school age after receiving early intervention programs. Researchers compared children who had Group Early Start Denver Model therapy with those who had other community programs. Both groups had similar challenges with daily living skills, social skills, behaviour problems, and attitudes about school. The main difference was that children in the other programs had more disrupted play. All children still needed ongoing support at school, regardless of which early intervention they received.

Summary by AutismInsights from published abstract.

Emerging

Short-term low-intensity Early Start Denver Model program implemented in regional hospitals in Northern Taiwan.

Autism : the international journal of research and practice2023

Chiang Chung-Hsin, Lin Tzu-Ling, Lin Hsiang-Yuan et al.

Plain-English summary

Researchers tested a modified version of the Early Start Denver Model therapy in Taiwan hospitals with 45 children with autism aged 2-4 years. Children received 8-9 hours of one-on-one therapy weekly for 6 months. Results showed children in the therapy group improved more in overall development and nonverbal skills compared to a control group right after treatment ended. However, these improvements didn't last when checked 6 months later. This was the first study testing this therapy approach in Chinese culture.

Summary by AutismInsights from published abstract.

Emerging

Dissemination of Early Intervention Program for Preschool Children on the Autism Spectrum into Community Settings: An Evaluation.

International journal of environmental research and public health2022

Masi Anne, Azim Syeda Ishra, Khan Feroza et al.

Plain-English summary

This study looked at whether early intervention works just as well in regular preschools as it does in special autism centres. Researchers followed 47 young children with autism receiving the Early Start Denver Model program. They found that both settings worked well for most children. Kids in regular preschools had fewer behaviour problems, and children who received intervention for longer periods had better language skills. This suggests your child can benefit from early intervention whether they attend a special autism centre or a mainstream preschool.

Summary by AutismInsights from published abstract.

EmergingRandomised Controlled Trial

A Randomized, Community-Based Feasibility Trial of Modified ESDM for Toddlers with Suspected Autism.

Journal of autism and developmental disorders2022

Mirenda Pat, Colozzo Paola, Smith Veronica et al.

Plain-English summary

This study tested whether parent coaching helps toddlers who might have autism. Parents got 24 weeks of support from trained community workers who taught them skills based on a play-based early intervention approach. Children whose parents received coaching understood more words than children in the comparison group. Parents who got coaching also felt better about their quality of life and were more confident in their parenting skills.

Summary by AutismInsights from published abstract.

EmergingRandomised Controlled Trial

A Longitudinal RCT of P-ESDM With and Without Parental Mindfulness Based Stress Reduction: Impact on Child Outcomes.

Journal of autism and developmental disorders2022

Weitlauf Amy S, Broderick Neill, Alacia Stainbrook J et al.

Plain-English summary

This study looked at whether teaching mindfulness to parents would improve outcomes for their autistic toddlers receiving early intervention. 63 families received parent training in the Early Start Denver Model, with half also learning mindfulness techniques. All children showed some improvement in autism symptoms and development, but adding mindfulness training for parents didn't provide extra benefits for the children.

Summary by AutismInsights from published abstract.

EmergingRandomised Controlled Trial

Characteristics of children on the autism spectrum who benefit the most from receiving intervention in inclusive versus specialised early childhood education settings.

Autism research : official journal of the International Society for Autism Research2022

Vivanti Giacomo, Bent Catherine, Capes Kristy et al.

Plain-English summary

This study looked at 58 preschool children with autism who received early intervention in either mainstream classrooms (with typical children) or autism-only classrooms for one year. Overall, both settings worked similarly well. However, children who were already more interested in people and had stronger thinking skills showed better social communication progress in mainstream classrooms. This suggests some children might do better in inclusive settings based on their starting abilities.

Summary by AutismInsights from published abstract.

Related Interventions

AutismInsights presents published research for informational purposes only. This is not medical advice. Always consult your child's paediatrician, psychologist, or allied health team before making decisions about therapies or interventions.