Journal of Autism and Developmental Disorders

, Volume 46, Issue 7, pp 2441–2449 | Cite as

Outcome for Children Receiving the Early Start Denver Model Before and After 48 Months

  • Giacomo VivantiEmail author
  • Cheryl Dissanayake
  • The Victorian ASELCC Team
Original Paper


The Early Start Denver Model (ESDM) is an intervention program recommended for pre-schoolers with autism ages 12–48 months. The rationale for this recommendation is the potential for intervention to affect developmental trajectories during early sensitive periods. We investigated outcomes of 32 children aged 18–48 months and 28 children aged 48–62 months receiving the ESDM for one year (approximately 20 h per week). Younger children achieved superior verbal DQ gains compared to their older counterparts. There were no group differences with respect to non-verbal DQ and adaptive behavior (with both age-groups undergoing significant change), or ASD severity (with neither age-group showing improvements on the ADOS). The association between verbal DQ gains and age at intake was moderated by baseline verbal level.


Autism Early Start Denver Model Early intervention Predictors of outcomes Minimally verbal children Effectiveness 



The present research was supported by the Australian Government Department of Social Services. We thank Jenny Mayes, Denise Williams and Anu Massey for their assistance in running the Victorian ASELCC program. We also thank Kristelle Hudry, David Trembath, Josie Barbaro, Wojciech Nadachowski, Elfriede Ihsen, Nusrat Ahmed, Heather Nuske, Megan Clark, Lisa Rumsey, Megan Grant, Carmela Germano, and Cathy Bent from the Olga Tennison Autism Research Centre for assistance with the assessment and data collection process. Thank you also to Prof Sally J. Rogers and to Prof. Margot Prior for constant encouragement and support. Finally, we thank all the children who took part in the project, as well as the parents who gave so generously of their time by filling forms and questionnaires.

Author Contributions

GV and CD designed research; GV and Victorian ASELCC Team performed research; GV analyzed data; and GV and CD wrote the paper. All authors read and approved the manuscript.


  1. Anderson, D. K., Liang, J. W., & Lord, C. (2014). Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 55, 485–494. doi: 10.1111/jcpp.12178.CrossRefPubMedGoogle Scholar
  2. Baker-Ericzen, M. J., Stahmer, A. C., & Burns, A. (2007). Child demographics associated with outcomes in a community-based pivotal response training program. Journal of Positive Behavior Interventions, 9, 52–60. doi: 10.1177/10983007070090010601.CrossRefGoogle Scholar
  3. Billstedt, E., Gillberg, I. C., & Gillberg, C. (2007). Asd in adults: Symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood. Journal of Child Psychology and Psychiatry, 48, 1102–1110. doi: 10.1111/j.1469-7610.2007.01774.x.CrossRefPubMedGoogle Scholar
  4. Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
  5. Dawson, G. (2008). Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Development and Psychopathology, 20(3), 775–803.CrossRefPubMedGoogle Scholar
  6. Dawson, G., & Bernier, R. (2007). Social brain circuitry in autism. In D. Coch, G. Dawson, & K. Fischer (Eds.), Human behavior and the developing brain. New York: Guilford Press.Google Scholar
  7. Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), e17–e23.CrossRefPubMedGoogle Scholar
  8. Eapen, V., Črnčec, R., & Walter, A. (2013). Clinical outcomes of an early intervention program for preschool children with Autism Spectrum Disorder in a community group setting. BMC pediatrics, 13(1), 3.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2002). Intensive behavioral treatment at school for 4-to 7-year-old children with autism: a 1-year comparison controlled study. Behavior Modification, 26(1), 49–68.CrossRefPubMedGoogle Scholar
  10. Eldevik, S., Hastings, R. P., Hughes, J. C., Jahr, E., Eikeseth, S., & Cross, S. (2010). Using participant data to extend the evidence base for intensive behavioral intervention for children with autism. American Journal on Intellectual and Developmental Disabilities, 115, 381–405. doi: 10.1352/1944-7558-115.5.381.CrossRefPubMedGoogle Scholar
  11. 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(7), 580–587.CrossRefGoogle Scholar
  12. Feldman, R. (2015). Sensitive periods in human social development: New insights from research on oxytocin, synchrony, and high-risk parenting. Development and Psychopathology, 27, 369–395.CrossRefPubMedGoogle Scholar
  13. Fenske, E. C., Zalenski, S., Krantz, P. J., & Mcclannahan, L. E. (1985). Age at intervention and treatment outcome for autistic-children in a comprehensive intervention program. Analysis and Intervention in Developmental Disabilities, 5, 49–58. doi: 10.1016/S0270-4684(85)80005-7.CrossRefGoogle Scholar
  14. Flanagan, H. E., Perry, A., & Freeman, N. L. (2012). Effectiveness of large-scale community-based Intensive Behavioral Intervention: A waitlist comparison study exploring outcomes and predictors. Research in Autism Spectrum Disorders, 6, 673–682. doi: 10.1016/j.rasd.2011.09.011.CrossRefGoogle Scholar
  15. Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The Autism Diagnostic Observation Schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37, 613–627. doi: 10.1007/s10803-006-0280-1.CrossRefPubMedGoogle Scholar
  16. Grindle, C. F., Hastings, R. P., Saville, M., Hughes, J. C., Huxley, K., Kovshoff, H. et al. (2012). Outcomes of a behavioral education model for children with asd in a mainstream school setting. Behavior Modification, 0145445512441199.Google Scholar
  17. Hardan, A. Y., et al. (2014). A randomized controlled trial of Pivotal Response Treatment Group for parents of children with autism. Journal of Child Psychology and Psychiatry,. doi: 10.1111/jcpp.12354.Google Scholar
  18. Harris, S. L., & Handleman, J. S. (2000). Age and IQ at intake as predictors of placement for young children with ASD: A four- to six-year follow-up. Journal of Autism and Developmental Disorders, 30, 137–142. doi: 10.1023/A:1005459606120.CrossRefPubMedGoogle Scholar
  19. Hayes, A. F., & Matthes, J. (2009). Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behavior Research Methods, 41(3), 924–936.CrossRefPubMedGoogle Scholar
  20. Herschensohn, J. R. (2007). Language development and age. Cambridge: Cambridge University Press.Google Scholar
  21. Johnson, M. H., & Munakata, Y. (2005). Processes of change in brain and cognitive development. Trends in Cognitive Sciences, 9(3), 152–158.CrossRefPubMedGoogle Scholar
  22. Kuhl, P. K. (2004). Early language acquisition: Cracking the speech code. Nature Reviews Neuroscience, 5, 831–843. doi: 10.1038/Nrn1533.CrossRefPubMedGoogle Scholar
  23. Kuhl, P. K., Conboy, B. T., Padden, D., Nelson, T., & Pruitt, J. (2005). Early speech perception and later language development: Implications for the” Critical Period”. Language Learning and Development, 1, 237–264.CrossRefGoogle Scholar
  24. Kuhl, P. K. (2014). Early language learning and the social brain. Cold Spring Harbor Symposia on Quantitative Biology, 79, 211–220. doi: 10.1101/sqb.2014.79.024802.CrossRefPubMedGoogle Scholar
  25. Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism diagnostic observation schedule: ADOS-2. CA: Western Psychological Services Los Angeles.Google Scholar
  26. MacDonald, R., Parry-Cruwys, D., Dupere, S., & Ahearn, W. (2014). Assessing progress and outcome of early intensive behavioral intervention for toddlers with asd. Research in Developmental Disabilities, 35(12), 3632–3644.CrossRefPubMedGoogle Scholar
  27. Magiati, I., Charman, T., & Howlin, P. (2007). A two-year prospective follow-up study of community-based early intensive behavioral intervention and specialist nursery provision for children with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 48, 803–812.CrossRefPubMedGoogle Scholar
  28. Moh, T. A., & Magiati, I. (2012). Factors associated with parental stress and satisfaction during the process of diagnosis of children with Autism Spectrum Disorders. Research in Autism Spectrum Disorders, 6, 293–303. doi: 10.1016/j.rasd.2011.05.011.CrossRefGoogle Scholar
  29. Mullen, E. M. (1995). Mullen scales of early learning. Anoka, MN: AGS Circle Pines.Google Scholar
  30. Nelson, C. A., Thomas, K. M., & De Haan, M. (2012). Neuroscience of cognitive development: The role of experience and the developing brain. New York: Wiley.Google Scholar
  31. Newport, E. L., Bavelier, D., Neville, H. J. (2001). Critical thinking about critical periods: Perspectives on a critical period for language acquisition. In E. Dupoux (Ed.), Language, brain and cognitive development: Essays in honor of Jacques Mehler. Cambridge, MA: MIT Press.Google Scholar
  32. Orinstein, A. J., Helt, M., Troyb, E., Tyson, K. E., Barton, M. L., Eigsti, I. M., et al. (2014). Intervention for optimal outcome in children and adolescents with a history of autism. Journal of Developmental and Behavioral Pediatrics, 35(4), 247–256.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Ratner, N., & Bruner, J. (1978). Games, social exchange, and the acquisition of language. Journal of Child Language, 5, 391–402.CrossRefPubMedGoogle Scholar
  34. Reichow, B., & Wolery, M. (2009). Comprehensive synthesis of early intensive behavioral interventions for young children with ASD based on the UCLA young autism project model. Journal of Autism and Developmental Disorders, 39, 23–41. doi: 10.1007/s10803-008-0596-0.CrossRefPubMedGoogle Scholar
  35. Rogers, S. J. (2013). Early Start Denver Model. In F. Volkmar (Ed.), Encyclopedia of autism spectrum disorders (pp. 1034–1042). Berlin: Springer.Google Scholar
  36. Rogers, S. J., & Dawson, G. (2010). Early start Denver model for young children with ASD: Promoting language, learning, and engagement. New York: Guilford Press.Google Scholar
  37. Rogers, S. J., & Pennington, B. F. (1991). A theoretical approach to the deficits in infantile ASD. Development and Psychopathology, 3(02), 137–162.CrossRefGoogle Scholar
  38. Rogers, S. J., et al. (2012). Effects of a brief Early Start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 1052–1065.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Rogers, S. J., & Vismara, L. (2014). Interventions for infants and toddlers at risk for autism spectrum disorder. In F. Volkmar, S. J. Rogers, R. Pelphry, & K. Paul (Eds.), Handbook of autism and developmental disorders (4th ed., pp. 739–769). Hoboken, NJ: Wiley.Google Scholar
  40. Rutter, M., Greenfeld, D., & Lockyer, L. (1967). A five to fifteen year follow-up study of infantile psychosis. II. Social and behavioural outcome. British Journal of Psychiatry, 113, 1183–1199.CrossRefPubMedGoogle Scholar
  41. Schreibman, L., et al. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders,. doi: 10.1007/s10803-015-2407-8.PubMedPubMedCentralGoogle Scholar
  42. Shonkoff, J. P., Phillips, D., & U.S. National Research Council Committee on Integrating the Science of Early Childhood Development. (2000). From neurons to neighborhoods: the science of early child development. Washington, DC: National Academy Press.Google Scholar
  43. Smith, I. M., Flanagan, H. E., Garon, N., & Bryson, S. E. (2015a). Effectiveness of community-based early intervention based on pivotal response treatment. Journal of Autism and Developmental Disorders, 45, 1858–1872. doi: 10.1007/s10803-014-2345-x.CrossRefPubMedGoogle Scholar
  44. Smith, T., Klorman, R., & Mruzek, D. W. (2015b). Predicting outcome of community-based early intensive behavioral intervention for children with ASD. Journal of Abnormal Child Psychology,. doi: 10.1007/s10802-015-0002-2.Google Scholar
  45. Sparrow, S., Cicchetti, D., Balla, D. (2005). Vineland II: A revision of the Vineland adaptive behavior scales: I. Survey/caregiver form. Circle Pines, MN: American Guidance ServiceGoogle Scholar
  46. Sullivan, K., Stone, W. L., & Dawson, G. (2014). Potential neural mechanisms underlying the effectiveness of early intervention for children with autism spectrum disorder. Research in Developmental Disabilities, 35(11), 2921–2932.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Tabachnick, B. G. & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston, MA: Allyn and Bacon.Google Scholar
  48. Vivanti, G., Dissanayake, C., Zierhut, C., Rogers, S. J., & Victorian ASELCC Team. (2013). Brief report: predictors of outcomes in the early start Denver model delivered in a group setting. Journal of Autism and Developmental Disorders, 43(7), 1717–1724.CrossRefPubMedGoogle Scholar
  49. Vivanti, G., Paynter, J., Duncan, E., Fothergill, H., Dissanayake, C., Rogers, S. J., & Victorian ASELCC Team. (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(12), 3140–3153.CrossRefPubMedGoogle Scholar
  50. Vivanti, G., & Rogers, S. J. (2014). Autism and the mirror neuron system: Insights from learning and teaching. Philosophical Transactions of the Royal Society B: Biological Sciences, 369(1644), 20130184.CrossRefGoogle Scholar
  51. Warren, Z., McPheeters, M. L., Sathe, N., Foss-Feig, J. H., Glasser, A., & Veenstra-VanderWeele, J. (2011). A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics, 127(5), e1303–e1311.CrossRefPubMedGoogle Scholar
  52. Webster, A., Feiler, A., Webster, V., & Lovell, C. (2004). Parental perspectives on early intensive intervention for children diagnosed with autistic spectrum disorder. Journal of Early Childhood Research, 2, 25–49.CrossRefGoogle Scholar
  53. Zwaigenbaum, L., Bauman, M. L., Choueiri, R., Kasari, C., Carter, A., Granpeesheh, D., et al. (2015). Early intervention for children with autism spectrum disorder under 3 years of age: Recommendations for practice and research. Pediatrics, 136(Suppl 1), S60–S81.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Giacomo Vivanti
    • 1
    • 2
    Email author
  • Cheryl Dissanayake
    • 2
  • The Victorian ASELCC Team
    • 3
  1. 1.AJ Drexel Autism InstituteDrexel UniversityPhiladelphiaUSA
  2. 2.Olga Tennison Autism Research Centre, School of Psychological ScienceLa Trobe UniversityMelbourneAustralia
  3. 3.Victorian Autism Specific Early Learning and Care CentreLa Trobe UniversityMelbourneAustralia

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