Effectiveness and Feasibility of the Early Start Denver Model Implemented in a Group-Based Community Childcare Setting

Abstract

A recent study documented the efficacy of the Early Start Denver Model (ESDM) delivered in a 1:1 fashion. In the current study we investigated the effectiveness and feasibility of the ESDM in the context of a long-day care community service, with a child-staff ratio of 1:3. Outcomes of 27 preschoolers with ASD undergoing 15–25 h per week of ESDM over 12 months were compared to those of 30 peers with ASD undergoing a different intervention program delivered in a similar community long-day care service. Children in both groups made gains in cognitive, adaptive and social skills. Participants in the ESDM group showed significantly higher gains in developmental rate and receptive language.

This is a preview of subscription content, access via your institution.

References

  1. Anagnostou, E., Bear, M., & Dawson, G. (2011). Commentary: Future directions in the treatment of autism spectrum disorders. In D. Amaral, D. Geschwind, & G. Dawson (Eds.), Autism spectrum disorders (pp. 1259–1268). New York: Oxford University Press.

    Chapter  Google Scholar 

  2. Anderson, D. K., Liang, J. W., & Lord, C. (2013). Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 55(5), 485–494.

    PubMed  Article  Google Scholar 

  3. Australian Children’s Education and Care Quality Authority. (2014). National quality standard assessment and rating report. http://www.acecqa.gov.au/.

  4. Barbaro, J., & Dissanayake, C. (2010). Prospective identification of autism spectrum disorders in infancy and toddlerhood using developmental surveillance: The social attention and communication study. Journal of Developmental and Behavavioral Pediatrics, 31(5), 376–385.

    Article  Google Scholar 

  5. Barbaro, J., Ridgway, L., & Dissanayake, C. (2011). Developmental surveillance of infants and toddlers by maternal and child health nurses in an Australian community-based setting: Promoting the early identification of autism spectrum disorders. Journal of Pediatric Nursing, 26(4), 334–347.

    PubMed  Article  Google Scholar 

  6. Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., et al. (2009). How we design feasibility studies. American Journal of Preventative Medecine, 36(5), 452–457.

    Article  Google Scholar 

  7. Chasson, G. S., Harris, G. E., & Neely, W. J. (2007). Cost comparison of early intensive behavioral intervention and special education for children with autism. Journal of Child and Family Studies, 16(3), 401–413.

    Article  Google Scholar 

  8. 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.

    PubMed  Article  Google Scholar 

  9. Department of Family, Housing, and Indigenous Affairs. (2010). Autism Specific Early Learning and Care Centres, from http://www.fahcsia.gov.au/our-responsibilities/disability-and-carers/program-services/for-people-with-disability/helping-children-with-autism/autism-specific-early-learning-and-care-centres.

  10. Department of Family, Housing, and Indigenous Affairs. (2012). Report on the autism specific early learning and care centres. Unpublished report.

  11. Dingfelder, H. E., & Mandell, D. S. (2011). Bridging the research-to-practice gap in autism intervention: An application of diffusion of innovation theory. Journal of Autism and Developmental Disorders, 41(5), 597–609.

    PubMed Central  PubMed  Article  Google Scholar 

  12. Drahota, A., Aarons, G. A., & Stahmer, A. C. (2012). Developing the autism model of implementation for autism spectrum disorder community providers: Study protocol. Implementation Science, 7, 85.

    PubMed Central  PubMed  Article  Google Scholar 

  13. Dunn, D. (2013). Parent–professional partnership. In F. Volkmar (Ed.), Encyclopedia of autism spectrum disorders (pp. 2126–2127). New York: Springer.

    Chapter  Google Scholar 

  14. 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.

    PubMed Central  PubMed  Article  Google Scholar 

  15. Frost, L. A., & Bondy, A. S. (1994). The picture exchange communication system training manual. Cherry Hill, NJ: PECs Inc.

    Google Scholar 

  16. 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(4), 613–627.

    PubMed  Article  Google Scholar 

  17. Howlin, P. (2011). Review: Possible benefits from early intensive behavioural and developmental interventions in children with autism spectrum disorders, but more research needed. Evidence-Based Mental Health, 14(4), 102.

    Article  Google Scholar 

  18. Howlin, P., Magiati, I., & Charman, T. (2009). Systematic review of early intensive behavioral interventions for children with autism. American Journal on Intellectual and Developmental Disabilities, 114(1), 23–41.

    PubMed  Article  Google Scholar 

  19. Howlin, P., & Savage, S. (2013). Factors affecting outcomes. In F. Volkmar (Ed.), Encyclopedia of autism spectrum disorders (pp. 1243–1246). New York, NY: Springer.

  20. Howlin, P., Savage, S., Moss, P., Tempier, A., & Rutter, M. (2013). Cognitive and language skills in adults with autism: A 40-year follow-up. Journal of Child Psychology and Psychiatry, 55(1), 49–58.

    PubMed  Article  Google Scholar 

  21. Kaale, A., Smith, L., & Sponheim, E. (2012). A randomized controlled trial of preschool-based joint attention intervention for children with autism. Journal of Child Psychology and Psychiatry, 53(1), 97–105.

    PubMed  Article  Google Scholar 

  22. Kern, R. S., Glynn, S. M., Horan, W. P., & Marder, S. R. (2009). Psychosocial treatments to promote functional recovery in schizophrenia. Schizophrenia Bulletin, 35(2), 347–361.

    PubMed Central  PubMed  Article  Google Scholar 

  23. Lord, C., Risi, S., Lambrecht, L., Cook, E. H, Jr, Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.

    PubMed  Article  Google Scholar 

  24. Lord, C., Wagner, A., Rogers, S., Szatmari, P., Aman, M., Charman, T., et al. (2005). Challenges in evaluating psychosocial interventions for Autistic Spectrum Disorders. Journal of Autism and Developmental Disorders, 35(6), 695–708. (discussion 709–611).

    PubMed  Article  Google Scholar 

  25. Magiati, I., Charman, T., & Howlin, P. (2007). A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 48(8), 803–812.

    PubMed  Article  Google Scholar 

  26. Magiati, I., Tay, X. W., & Howlin, P. (2012). Early comprehensive behaviorally based interventions for children with autism spectrum disorders: A summary of findings from recent reviews and meta-analyses. Neuropsychiatry, 2(6), 543–570.

    Article  Google Scholar 

  27. Mandell, D. S., Stahmer, A. C., Shin, S., Xie, M., Reisinger, E., & Marcus, S. C. (2013). The role of treatment fidelity on outcomes during a randomized field trial of an autism intervention. Autism, 17(3), 281–295.

    PubMed Central  PubMed  Article  Google Scholar 

  28. Mullen, E. M. (1995). Mullen Scales of Early Learning manual (AGS ed.). Circle Pines, MN: American Guidance Service.

    Google Scholar 

  29. National Autism Center National Standards Report. (2009). Available from: http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf.

  30. Paynter, J., & Falvey-Henderson, F. (2011). AEIOU Foundation: A full-time early intervention service for children with autism spectrum disorders. Talkabout, 24(1), 15–19.

    Google Scholar 

  31. Paynter, J., Scott, J., Beamish, W., Duhig, M., & Heussler, H. (2012). A pilot study of the effects of an Australian centre-based early intervention program for children with autism. The Open Pediatric Medicine Journal, 6(2012), 7–14.

    Article  Google Scholar 

  32. Prior, M., Roberts, J., Rodger, S., Williams, W., & Sutherland, R. (2011). A review of the research to identify the most effective models of practice in early intervention for children with autism spectrum disorders. Australia: Australian Government Department of Families, Housing, Community Services and Indigenous Affairs.

    Google Scholar 

  33. Riosa, P. B., McArthur, B. A., & Preyde, M. (2011). Effectiveness of psychosocial intervention for children and adolescents with comorbid problems: A systematic review. Child and Adolescent Mental Health, 16(4), 177–185.

    Article  Google Scholar 

  34. Rogers, S. J., & Dawson, G. (2010). Early Start Denver Model for young children with autism: Promoting language, learning, and engagement. New York: Guilford Press.

    Google Scholar 

  35. Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., 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(10), 1052–1065.

    PubMed Central  PubMed  Article  Google Scholar 

  36. Rogers, S. J., & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child and Adolescent Psychology, 37(1), 8–38.

    PubMed Central  PubMed  Article  Google Scholar 

  37. Schopler, E. (1994). A statewide program for the treatment and education of autistic and related communication handicapped children (TEACCH). Psychoses and Pervasive Developmental Disorders, 3, 91–103.

    Google Scholar 

  38. Sparrow, S., Balla, D., & Cicchetti, D. (2005). Vineland adaptive behavior scales (2nd ed.). Circle Pines, MN: American Guidance Service.

    Google Scholar 

  39. Stahmer, A. C. (2007). The basic structure of community early intervention programs for children with autism: Provider descriptions. Journal of Autism and Developmental Disorders, 37(7), 1344–1354.

    PubMed Central  PubMed  Article  Google Scholar 

  40. Strain, P. S., & Bovey, E. H. (2011). Randomized, controlled trial of the LEAP model of early intervention for young children with autism spectrum disorders. Topics in Early Childhood Special Education, 31(3), 133–154.

    Article  Google Scholar 

  41. Vivanti, G., Dissanayake, C., Zierhut, C., Rogers, S. J., & ASELCC Victorian 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.

    PubMed  Article  Google Scholar 

  42. Vivanti, G., Prior, M., Williams, K., & Dissanayake, C. (2014). Predictors of outcomes in Autism Intervention: Why don’t we know more? Frontiers in Pediatrics, 2, 58. doi:10.3389/fped.2014.00058.

    PubMed Central  PubMed  Article  Google Scholar 

  43. Volkmar, F. R., Reichow, B., & Doehring, P. (2011). Evidence-based practices in autism: Where we are now and where we need to go. In Reichow B., Doehring P., Cicchetti D. V., Volkmar F. R. (Eds.), Evidence-based practices and treatments for children with autism (pp. 365–391). New York, NY: Springer.

  44. Weisz, J. R., & Kazdin, A. E. (2010). Evidence-based psychotherapies for children and adolescents (2nd ed.). New York: Guilford Press.

    Google Scholar 

Download references

Acknowledgments

The present research was supported by the Australian Government Department of Social Services. We thank Parise Gentikoglou, Jenny Mayes, Adriana Zoumbilis, 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, Kat Crea, 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. Thanks to James Scott, Helen Heussler, and Wendi Beamish, members of the AEIOU Research Advisory Group for their guidance in the initial stages of this project. Thank you also 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 information

Affiliations

Authors

Consortia

Corresponding author

Correspondence to Giacomo Vivanti.

Additional information

The Victorian ASELCC Team in alphabetical order: Kristy Capes, Jessica Feary, Carolyne Jones, Harpreet Kaur Ahluwalia, Liz Kirby, Benaaz Master, Dianna Pell, Katherine Pye, Harshinee Rajapakse, Jennifer Reynolds, Antonina Trifiletti, Shannon Upson, Cynthia Zierhut.

Appendix

Appendix

See Table 10.

Table 10 Cognitive outcomes using MSEL age equivalence scores

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Vivanti, G., Paynter, J., Duncan, E. et al. Effectiveness and Feasibility of the Early Start Denver Model Implemented in a Group-Based Community Childcare Setting. J Autism Dev Disord 44, 3140–3153 (2014). https://doi.org/10.1007/s10803-014-2168-9

Download citation

Keywords

  • Autism spectrum disorder
  • Early Start Denver Model
  • Effectiveness
  • Community implementation
  • Early intervention