Early Start Denver Model (ESDM)

What is the Early Start Denver Model?

The Early Start Denver Model (ESDM) is a behavioral therapy for children with autism between the ages of 12-48 months. It is based on the methods of applied behavior analysis (ABA).

Parents and therapists use play to build positive and fun relationships. Through play and joint activities, the child is encouraged to boost language, social and cognitive skills.

  • Based on understanding of normal toddler learning and development
  • Focused on building positive relationships
  • Teaching occurs during natural play and everyday activities
  • Uses play to encourage interaction and communication

ESDM therapy can be used in many settings, including at home, at a clinic, or in school. Therapy is provided in both group settings and one-on-one.

It has been found to be effective for children with a wide range of learning styles and abilities. ESDM can help children make progress in their social skills, language skills, and cognitive skills. Children who have significant learning challenges can benefit just as much as those without learning challenges.

Parent involvement is a key part of the ESDM program. Therapists should explain and model the strategies they use so that families can practice them at home.  

Who provides Early Start Denver Model services? 

An ESDM therapist may be any of the following:

  • Psychologist
  • Behavior specialist (BCBA)
  • Occupational therapist
  • Speech and language pathologist
  • Early intervention specialist
  • Developmental pediatrician

All therapists must have specific training and certification in EDSM. This process requires them to:

  • Attend a training workshop
  • Submit video showing them using ESDM techniques in therapy sessions
  • Demonstrate they can use these techniques correctly and reliably

This ensures that a certified professional has the knowledge and skills to successfully use the teaching strategies with children with autism.

Details on training qualifications and the certification process can be found here. You can also visit the Early Start Denver Model website to learn more.

What is the evidence that the Early Start Denver Model works? 

Over a dozen studies have demonstrated the benefits of ESDM as an early intervention for autism among children as young as 18 months. These studies included children across a wide range of learning abilities.

Many of these studies looked at ESDM delivered by trained therapists in one-on-one sessions with the child. One looked at ESDM delivered to groups of children in childcare. Others looked at the benefits of training parents to deliver ESDM therapy at home.

Benefits include improved learning and language abilities and adaptive behavior and reduced symptoms of autism. Research using brain scans suggests that ESDM improves brain activity associated with social and communication skills. 

Is Early Start Denver Model covered by insurance? 

Sometimes. Many types of private health insurance are required to cover services for autism. This depends on what kind of insurance you have, and what state you live in.

All Medicaid plans must cover treatments that are medically necessary for children under the age of 21. If a doctor recommends ESDM and says it is medically necessary for your child, Medicaid must cover the cost.

Some young children receive ESDM through their Early Intervention program. Early intervention is offered in each state to children under age 3 who are not growing and developing at the same rate as others. These services are free or low-cost based on your family income. 

Please see our insurance resources for more information about insurance and coverage for autism services. 

You can also contact the Autism Response Team if you have difficulty obtaining coverage, or need additional help.

Where do I find Early Start Denver Model services? 

Visit the Autism Speaks Directory to search for providers near you.

The UC Davis Mind Institute maintains a list of certified ESDM therapists.

What questions should I ask?

The following questions can help you learn more about ESDM before you begin. It can also help you learn whether a particular therapist is a good fit for your family:

  1. Who will be working with my child?
  2. What training will you offer to parents?
  3. Where do you hold therapy sessions?
  4. How do you determine program goals?
  5. Are you trained to offer ESDM therapy?
  6. Can parents participate in therapy sessions?
  7. Will sessions be one-on-one, or held in a group?
  8. How do you handle challenging behavior?
  9. How do you measure progress?
  10. What type of progress should we expect?

For more information

Early Start Denver Model training manual for parents: An Early Start for Your Child with Autism

This book provides useful tips and hands-on strategies that parents can use in their daily activities and play. Parents can even use this information while waiting for your child to be enrolled in therapy.

For more information on the Early Start Denver Model, see:

  1. Rogers SJ and Dawson G. (2009) Play and Engagement in Early Autism:  The Early Start Denver Model. Volume I: The Treatment. New York:  Guilford Press. Also available in Japanese, Italian, Dutch, French, Spanish, and Arabic.
  2. Rogers SJ and Dawson G. (2009) Play and Engagement in Early Autism:  The Early Start Denver Model. Volume II:  The Curriculum. New York:  Guilford Press. Translated into Japanese, Italian, Dutch, French, Arabic, and Spanish.
  3. Rogers SJ, Dawson G, and Vismara L. (2012). An Early Start for your Child with Autism. New York:  Guilford Press.

For information on professional training in the ESDM, see Steps to ESDM Certification and UC Davis Mind Institute - Early Start Lab.