Early Start Denver Model

Domain II · Behavioural & cognitive · Sally Rogers, Geraldine Dawson · 2010 · Denver

What it is

ESDM is a comprehensive, manualised naturalistic developmental behavioural intervention (NDBI) for autistic children, or children showing early signs, aged roughly 12–48 months. It is a programme delivered by an interdisciplinary team (typically psychology/behaviour analysis, speech-language…

Format

• Step A — Assessment (week 0, then every 12 weeks). Play-based administration of the ESDM Curriculum Checklist (about 1–1.5 hours), plus parent report for skills not seen in session. Each item scored pass / inconsistent / fail. The Checklist is criterion-referenced, about 480 items in 4 levels…
• Step D — Daily teaching. Sessions alternate object-based joint activity routines and sensory social routines, each a few minutes, with many objectives targeted in each.

Who practises it, and how they are trained or regulated

• An objective is mastered when the behaviour meets its accuracy criterion and generalises across the specified people, settings and materials (example in training: imitates a modelled action within 5 seconds on 4 of 5 opportunities, across 3 activities and 2 people, on 3 consecutive sessions).
• Therapist fidelity: the 13-item Fidelity Rating System, each item scored 1–5; scores of 4–5 indicate the strategy is used usually/consistently. A commonly cited competence threshold is about 85% of the maximum with no item below 3.
• Version followed: Rogers & Dawson (2010) Early Start Denver Model for Young Children with Autism (1st ed. manual) and its 13-item Teaching Fidelity Rating System, as reported in training slides and trial records; parent-delivered ESDM (P-ESDM) as described in Rogers, Vismara & Dawson (2021) Coaching Parents of Young Children with Autism and trial protocols. The 2nd edition (Rogers & Dawson, 2025, Early Start Denver…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Rushing and doing it for the child. Working: increased independent steps at home.
• Long sentences, many questions. Working: the child imitates your words and phrases.
• Prompting every step at the same level. Working: more steps completed independently.
• Dead time, protest at endings. Working: smooth, quick changes without behaviour problems.
• Parents feeling evaluated. Working: parent brings their own examples and solutions to sessions.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.