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Does Treatment Fidelity of the Early Start Denver Model Impact Skill Acquisition in Young Children with Autism?

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Abstract

There is increasing evidence supporting the effectiveness of the Early Start Denver Model (ESDM) for children on the autism spectrum. However, substantial variability in response to the ESDM has been reported across participants. We examined the plausible yet untested hypothesis that variations in the fidelity level of therapists delivering the intervention contribute to variability in children’s response to the ESDM. Videotaped sessions (n = 40) of toddlers on the autism spectrum who received the ESDM from trained therapists were coded to obtain measures of therapist fidelity and children’s learning in response to the therapists’ instruction. Variations in overall fidelity, along with variations in most items included in the ESDM fidelity checklist, contributed to the children’s learning response during the sessions.

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Notes

  1. We are using “on the autism spectrum” as recent research has indicated that this expression is more acceptable and less polarizing in the autism community than alternative formulations (Botha et al., 2021; Bury et al., 2020).

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Acknowledgements

This research was supported by the National Institute of Mental Health and the National Institute of Child Health and Human Development (R01MH115715; R21HD090344). We thank our grant sponsors along with the research participants and their families for their participation in the study. We also thank Adreeja Guha Ray for her contribution with data collection, and all the therapists involved in the intervention sessions used for the study.

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Authors and Affiliations

  1. A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA

    Ashley Zitter, Hezekiah Rinn, Diana L. Robins & Giacomo Vivanti

  2. Lekárska Fakulta, UK Bratislava, Špitálska 24, 813 72, Bratislava, Slovakia

    Zofia Szapuova

  3. Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA

    Kirsty L. Coulter

  4. Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California, Davis, Sacramento, CA, 95817, USA

    Vanessa M. Avila-Pons & Aubyn C. Stahmer

  5. A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA

    Giacomo Vivanti

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  1. Ashley Zitter
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  2. Hezekiah Rinn
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  3. Zofia Szapuova
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  4. Vanessa M. Avila-Pons
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  5. Kirsty L. Coulter
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  6. Aubyn C. Stahmer
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  7. Diana L. Robins
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  8. Giacomo Vivanti
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Contributions

GV, HR, and AZ conceived and designed the research; AZ, HR, ZS completed behavioral coding; GV, AZ, and HR conducted statistical analyses and drafted the manuscript. All authors have read, edited and approved the final manuscript.

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Correspondence to Giacomo Vivanti.

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Conflict of interest

No royalties were received for any of the data presented in the current study. Dr. Robins is a co-owner of the M-CHAT in electronic products and sits on the advisory board of Quadrant Biosciences Inc. All other authors have indicated they have no financial relationships or potential conflicts of interests relevant to this article to disclose.

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Zitter, A., Rinn, H., Szapuova, Z. et al. Does Treatment Fidelity of the Early Start Denver Model Impact Skill Acquisition in Young Children with Autism?. J Autism Dev Disord 53, 1618–1628 (2023). https://doi.org/10.1007/s10803-021-05371-4

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