Early Start Denver Model (ESDM)

Placement on the Continuum of Evidence Promising Download icon Download PDF
Target Population: 
Communication, Early Intervention, Emotional Competency, Relationships, Social Competency
Target Audience 

This program is delivered to parents with children who are 12 to 48 months old with an Autism Spectrum Disorder and is intended to impact children.


The Early Start Denver Model (ESDM), a community- and family-based early intervention, is designed to enhance children's social, emotional, cognitive, and language capabilities and decrease autism symptoms.  


Results from a randomized controlled trial (RCT) found that children in the ESDM intervention showed significant improvements in IQ, adaptive behavior, and autism diagnosis compared to a control group.  More specifically, the ESDM group maintained its rate of growth in adaptive behavior as compared to a normative sample of typically developing children.  In a follow-up that was conducted 2 years after the end of this intervention, the ESDM group showed improved core autism symptoms and adaptive behavior compared to the control group.  A quasi-experimental external evaluation showed that participants in the ESDM group had significantly greater gains in developmental rate and receptive language, compared to a control group, after approximately 12 months of treatment.  


The ESDM is delivered at home or in a daycare/preschool setting by trained therapists and parents.  The program combines elements of two other intervention approaches:

  • The Denver Model:  An intervention grounded in positive relationships and normative developmental sequences and
  • Pivotal Response Training:  An approach centered on applied behavior analysis that uses incidental teaching and a systematic approach to encourage language, communication, and play skills development and create behavioral contingencies for reinforcement.

The program's first phase involves a trainer delivering ESDM training techniques, and the second phase includes parent training.  Parents are taught how to deliver ESDM interventions at home, and they meet with a trainer to discuss goals and progress once a month.

Previous Use 

Previous use information was unavailable; however, ESDM has been used in research in California.


Required training to become certified in ESDM includes a 1-day introductory workshop that costs $495 per person and a 3-day advanced workshop that costs $2,195 per person.  It is also possible to host an introductory or advanced workshop.  Please contact Dr. Cynthia Zierhut using her information in the Contact section or visit www.ucdmc.ucdavis.edu/mindinstitute/research/esdm/workshops.html


Considerations for implementing this program include ensuring facilitators receive training and become certified in ESDM and acquiring parent buy-in.

The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu


If you are interested in implementing ESDM, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu


The first phase of ESDM usually lasts 5 weeks.  Implementation of the second phase will vary by individual.


Implementation costs were unavailable.

Evaluation Plan 

To move ESDM to the Effective category on the Clearinghouse Continuum of Evidence at least one external RCT must be conducted that demonstrates positive outcomes. This study must be conducted independently of the program developer.

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu


Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu

You may also contact Dr. Cynthia Zierhut by phone 1-916-703-04656 or email esdmtraining@ucdmc.ucdavis.edu or contact Deeniece Hatten by phone 1-916-703-0468, email dchatten@ucdavis.edu, or visit www.ucdmc.ucdavis.edu/mindinstitute/research/esdm/

*Resources and associated costs reflect those identified at the time of fact sheet publication.