Journal of Autism and Developmental Disorders

, Volume 49, Issue 2, pp 632–646 | Cite as

Enhancing Low-Intensity Coaching in Parent Implemented Early Start Denver Model Intervention for Early Autism: A Randomized Comparison Treatment Trial

  • S. J. RogersEmail author
  • A. Estes
  • L. Vismara
  • J. Munson
  • C. Zierhut
  • J. Greenson
  • G. Dawson
  • M. Rocha
  • C. Sugar
  • D. Senturk
  • F. Whelan
  • M. Talbott
Original Paper


Short-term low intensity parent implemented intervention studies for toddlers with autism spectrum disorder (ASD) have found it difficult to demonstrate significantly improved developmental scores or autism severity compared to community treatment. We conducted a randomized comparative intent-to-treat study of a parent implemented intervention to (1) test the effects of an enhanced version on parent and child learning, and (2) evaluate the sensitivity to change of proximal versus distal measures of child behavior. We randomized 45 children with ASD, 12–30 months of age, into one of two versions of parent-implemented Early Start Denver Model (P-ESDM), the basic model, in which we delivered 1.5 h of clinic-based parent coaching weekly, and an enhanced version that contained three additions: motivational interviewing, multimodal learning tools, and a weekly 1.5-h home visit. We delivered the intervention for 12 weeks and measured child and parent change frequently in multiple settings. We found a time-by-group interaction: parents in the enhanced group demonstrated significantly greater gains in interaction skills than did parents in the non-enhanced group. Both interventions were associated with significant developmental acceleration; however, child outcomes did not differ by group. We found a significant relationship between degree of change in parental interaction skill and rate of children’s improvement on our proximal measure. Parents in both groups reported satisfaction with the intervention. These findings suggest that parent skills improved more in the enhanced group than the comparison group. Children in the two groups showed similar improvements. Rate of individual parent learning was associated with greater individual child progress on a measure quite proximal to the treatment, though not on standardized assessments.


Early intervention Parent-implemented intervention Autism Toddlers ESDM 



This study was supported by Autism Speaks Grants #8089 (Rogers) #8376 (Estes) and by the Children’s Miracle Network (Rogers). Conflicts of interest for Rogers, Dawson, and Vismara involve royalties from publications and lectures related to the Early Start Denver Model. Thanks to children and families involved and to Gayna Guidici, Diane Larzelere, and Ehoua Vue for formatting the manuscript.

Author Contributions

SJR, LV, AE, and GD conceived of the study, participated in its design and coordination and drafted the manuscript; CZ, LV, JG, MR, and SJR managed the treatment arm of the study and provide the interventions; JM, JG, and MT participated in the design of the study, and performed the measurement and data management; JM, DS, CS, and FW participated in the design of the study and performed the statistical analysis; All authors helped to draft the manuscript. All authors read and approved the final manuscript.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of California Davis MIND InstituteSacramentoUSA
  2. 2.University of WashingtonSeattleUSA
  3. 3.Duke UniversityDurhamUSA
  4. 4.University of California, Los AngelesLos AngelesUSA
  5. 5.Emory UniversityAtlantaUSA

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