Autism Spectrum Disorders and Social Communication Difficulties

Early Start Denver Model (ESDM)

What is Early Start Denver Model (ESDM)?

Early Start Denver Model (ESDM) is a comprehensive, behavioral early intervention program for young children with or suspected of having Autism. Children receiving ESDM are typically between 12-48 months of age. ESDM is a play-based intervention that focuses on communication, social attention, imitation and play skills. Gross and fine motor skills, as well as personal independence skills are also targeted. All skills are taught within enjoyable, social interactions.

The ESDM model includes a Curriculum Assessment that clinicians use to assess the child’s current performance in a variety of developmental domains. These domains are: expressive and receptive communication, social skills and joint attention, imitation, cognition, play skills, fine and gross motors skills and personal independence skills. Through the clinician’s observations and parent/caregiver’s report, a picture is built of the strengths and needs of the child in each developmental domain. The result of this assessment are used to create an individualized program for each child that incorporates goals from each domain.

There are four levels in the ESDM program. Each level corresponds roughly to a developmental period. Level 1 (12 – 18 months), Level 2 (18 – 24 months), Level 3 (24 – 36 months) and Level 4 (36 – 48 months).  Children’s goals tend to cluster into one (or two) levels.

What does an ESDM session look like?

An ESDM session should look like play. Together, the child and therapist engage in fun, age-appropriate activities that help facilitate communication and social interactions. In any ESDM interaction, the child and adult are both important and active participants. Both partners offer ideas, take turns and share the responsibility for initiating, playing and ending activities.

In order to make sessions fun and engaging, and to maintain the child’s motivation, the therapist will prepare the environment with a variety of developmentally appropriate activities that are specifically selected with each child’s interests, preferences and goals in mind.

ESDM sessions can take place in any environment that is part of the child’s daily life – home, clinic or day care. Any adult who spends time with the child can use ESDM strategies to make everyday activities, such as diaper changing and bath time, an opportunity for interaction and learning.

What happens in a Clinical Cycle?

The ESDM program is generally run in Clinical Cycles of approximately three months. At the start of each Clinical Cycle, the clinical team will do an assessment of the child’s skills using the ESDM Curriculum Checklist. Parent input and the clinician’s observations are used to determine which skills should be targeted for intervention.  Generally, two to three skills from each developmental domain are targeted per cycle. Parents are encouraged to provide input to the clinical team as these decisions are being made and their child’s clinical program is being written.

Throughout the Clinical Cycle, the team uses the goals in the child’s individual program to guide their sessions. Clinicians take regular data on the child’s progress on each goal. At the end of the cycle, the Supervising Therapist meets with the child’s parents to discuss the progress made and next steps.

What is the parents’ role?

A distinctive aspect of the ESDM model is the recognition that parents and other caregivers are integral parts of their child’s intervention team. As such, at 1to1 Therapy, we welcome parents/caregivers to be active participants in their child’s ESDM sessions. Some parents choose to take turns playing with their child so that their child’s Supervising Therapist can coach them how to enhance each interaction. Other parents prefer to watch and learn as their child interacts with his or her therapist during a session.

Who is on the ESDM team?

The Clinical Team is made up of the Supervising Therapist (ST) who is a Board Certified Behaviour Analyst and certified ESDM therapist, Instructor Therapists (IT), Occupational Therapist (OT) and Speech Language Pathologist (SLP).

The Supervising Therapist (a certified ESDM therapist and BCBA) is responsible for completing the ESDM assessment and writing the individual program plan for each child. Instructor Therapists are highly skilled therapists who have been trained in ESDM strategies and who implement the program on a daily basis. The Supervising Therapist observes, coaches and gives feedback and suggestions to the Instructor Therapists. The OT provides support regarding the motor and sensory development of the child and gives input into the fine and gross motor goals. The SLP helps evaluate and guide the speech, language, social and communication goals. The clinical team meet both formally and informally to ensure that children are progressing and learning in all areas of development.

How much does ESDM Therapy Cost?

ESDM is intensive in nature and requires an individualized curriculum assessment and treatment plan. In Ontario you may access therapy through funding or the Ontario Autism Program. All of 1to1’s programs are supervised by a Board Certified Behaviour Analyst and certified ESDM therapist.

  • ESDM at our ABA Centre in Markham: $60 per hour with an Instructor Therapist
  • ESDM at home or in the community: $65 per hour with an Instructor Therapist including travel
  • ESDM Supervision or Consultation at our ABA Centre in Markham: $130 per hour with a Board Certified Behaviour Analyst or Speech-Language Pathologist
  • ESDM Supervision or Consultation at home or in the community: $150 per hour with a Board Certified Behaviour Analyst or Speech-Language Pathologist including travel
  • Clinical Supervision by a Registered Psychologist: $200 per hour

To book your no cost consultation and receive an individualized quote contact our care coordinator today