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 of children who are 12 to 48 months old with an Autism Spectrum Disorder and is intended to impact parents and 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.  Results from a second quasi-experimental study reporting on school-age outcomes of children who received ESDM, compared to those who received community services, showed that both groups improved cognitive functioning and also experienced increased autism symptom severity with no differences between groups.  


ESDM is delivered at home or in a day care/preschool setting during normal play and daily routine activities by trained therapists and parents.  The curriculum uses a play-based approach to focus on the development of play skills, relationships, and language.  The key features of the program include the following:

  • Naturalistic applied behavioral analytic strategies;
  • Sensitivity to the course of normal development;
  • Heavy parent involvement;
  • Emphasis on interpersonal communication and positive affect;
  • Shared engagement through joint activities; and
  • Language and communication skills taught within a positive, affect-based relationship.
Previous Use 

Previous use information was not located; however, ESDM has been used in research in California.


This program is delivered by trained therapists who are certified in ESDM.  Therapists may be a psychologist, behaviorist, occupational therapist, speech and language pathologist, early intervention specialist, or developmental pediatrician.  Training includes a live or online introductory workshop and an advanced workshop.   The online introductory workshop costs $425 per person.  It is also possible to host an introductory or advanced workshop.  Please visit www.ucdmc.ucdavis.edu/mindinstitute/research/esdm/workshops.html or email esdmtraining@ucdmc.ucdavis.edu for more information on training options and costs.  


Considerations for implementing this program include recruiting facilitators with a suitable background, 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 not located.

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 the UCDavis Mind Institute by mail 2825 50th Street, Sacramento CA 95817, phone 1-916-703-0280, or visit http://ucdmc.ucdavis.edu/mindinstitute/contactus/index.html

References - Used For Placement 

Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., ... Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125, e17-e23. http://dx.doi.org/10.1542/peds.2009-0958

Estes, A., Munson, J., Rogers, S. J., Greenson, J., Winter, J., & Dawson, G. (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, 580-587. http://dx.doi.org/10.1016/j.jaac.2015.04.005

Vinen, Z., Clark, M., Paynter, J., & Dissanayake, C. (2017). School age outcomes of children with Autism Spectrum Disorder who received community-based early interventions. Journal of Autism and Developmental Disorders. http://dx.doi.org/10.1007/s10803-017-3414-8

Vivanti, G., Paynter, J., Duncan, E., Fothergill, H., Dissanayake, C., & Rogers, S. J. (2014). Effectiveness and feasibility of the Early Start Denver Model implemented in a group-based community childcare setting. Journal of Autism and Developmental Disorders, 44, 3140-3153. http://dx.doi.org/10.1007/s10803-014-2168-9

References - Not Used For Placement - Not Empirical 

Ryberg, K. H. (2015). Evidence for the implementation of the Early Start Denver Model for young children with Autism Spectrum Disorder. Journal of the American Psychiatric Nurses Association, 21, 327-337. http://dx.doi.org/10.1177/1078390315608165

References - Not Used For Placement - Adaptation/Revision 

Bono, V., Narzisi, A., Jouen, A., Tilmont, E., Hommel, S., Jamal, W., ... Muratori, F. (2016). GOLIAH: A gaming platform for home-based intervention in autism—Principles and design. Frontiers in Psychiatry, 7, 16. Retrieved from http://ezaccess.libraries.psu.edu/login?url=https://search.proquest.com/docview/1802210966?accountid=13158

Devescovi, R., Monasta, L., Mancini, A., Bin, M., Vellante, V., Carrozzi, M., & Colombi, C. (2016). Early diagnosis and Early Start Denver Model intervention in Autism Spectrum Disorders delivered in an Italian public health system service. Neuropsychiatric Disease and Treatment, 12, 5. Retrieved from http://ezaccess.libraries.psu.edu/login?url=https://search.proquest.com/docview/1845056838?accountid=13158

Diamond, G., Ofek, H., Aronson, B., Viner-Ribke, I., Dlugatch, Y., & Resnick, E. (2017). Hybrid therapy for treatment of newly diagnosed toddlers with Autism Spectrum Disorders. International Journal on Disability and Human Development, 16, 25-31. Retrieved from http://ezaccess.libraries.psu.edu/login?url=https://search.proquest.com/docview/1880370893?accountid=13158

Jouen, A., Narzisi, A., Xavier, J., Tilmont, E., Bodeau, N., Bono, V., ... Cohen, D. (2017). GOLIAH (gaming open library for intervention in autism at home): A 6‑month single blind matched controlled exploratory study. Child and Adolescent Psychiatry and Mental Health, 11, 14. http://dx.doi.org/10.1186/s13034-017-0154-7

Zhou, B., Xu, Q., Li, H., Zhang, Y., Wang, Y., Rogers, S. J., & Xu, X. (2018). Effects of parent‐implemented Early Start Denver Model intervention on Chinese toddlers with autism spectrum disorder: A non‐randomized controlled trial. Autism Research. http://dx.doi.org/10.1002/aur.1917

References - Not Used For Placement - Other 

Cidav, Z., Munson, J., Estes, A., Dawson, G., Rogers, S., & Mandell, D. (2017). Cost offset associated with Early Start Denver Model for children with autism. Journal of the American Academy of Child & Adolescent Psychiatry, 56, 777-783. http://dx.doi.org/10.1016/j.jaac.2017.06.007

Ogilvie, E., & McCrudden, M. T. (2017). Evaluating the social validity of the Early Start Denver Model: A convergent mixed methods study. Journal of Autism and Developmental Disorders, 47, 2899-2910. http://dx.doi.org/10.1007/s10803-017-3214-1

Penner, M., Rayar, M., Bashir, N., Roberts, S. W., Hancock-Howard, R., & Coyte, P. C. (2015). Cost-effectiveness analysis comparing pre-diagnosis Autism Spectrum Disorder (ASD)-targeted intervention with Ontario’s autism intervention program. Journal of Autism and Developmental Disorders, 45, 2833-2847. http://dx.doi.org/10.1007/s10803-015-2447-0

Vismara, L. A., & Rogers, S. J. (2008). The Early Start Denver Model: A case study of an innovative practice. Journal of Early Intervention, 31, 91-108. http://dx.doi.org/10.1177/1053815108325578

Vivanti, G., & Dissanayake, C. (2016). Outcome for children receiving the Early Start Denver Model before and after 48 months. Journal of Autism and Developmental Disorders, 46, 2441-2449. http://dx.doi.org/10.1007/s10803-016-2777-6

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