Skip to main content
SpringerLink
Log in

Efficacy and moderating factors of the Early Start Denver Model in Chinese toddlers with autism spectrum disorder: a longitudinal study

  • Original Article
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Background

Several studies have shown the effectiveness of the Early Start Denver Model (ESDM), but few studies have explored the long-term efficacy of ESDM. This study aimed to explore the efficacy and moderating factors of ESDM in Chinese toddlers with autism spectrum disorder (ASD) in a longitudinal way.

Methods

A total of 60 toddlers with ASD were recruited and randomly divided into two groups: ESDM group all received 24 weeks intervention; Control group were waiting for intervention. Baseline assessment (T0) was conducted before intervention, including Gesell Developmental Scale (GDS) and Psycho-educational Profile-3rd Edition (PEP-3). All toddlers with ASD were examined in the first assessment (T1) at 6 months and in the second assessment (T2) at 12 months.

Results

In T1 assessment, the increments in speech and personal communication development quotient in GDS were significantly larger in the ESDM group than in the control group (P = 0.010, 0.047). In T2 assessment, the ESDM group had higher elevation in cognitive verbal/preverbal (CVP), social reciprocity and characteristic verbal behaviors assessed by PEP-3 (P = 0.021, 0.046, 0.014). In addition, the severity of stereotyped behavior was negatively associated with improvement in CVP. Family income was positively associated with improvement in speech and CVP (all P < 0.05).

Conclusions

ESDM can effectively improve speech and communication in toddlers with ASD after 24-week intervention. More importantly, ESDM can promote cognition and social interaction and can reduce stereotyped verbal behavior in toddlers with ASD in longitudinal observation. The severity of stereotyped behavior and family ecological factors may be considered as affecting the efficacy of ESDM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

All relevant raw data will be freely available to any researcher wishing to use them for non-commercial purposes, without breaching participant confidentiality. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Lai MC, Lombardo MV, Baron-Cohen S. Autism. Lancet. 2014;383:896–910.

    Article  PubMed  Google Scholar 

  2. Nevison C, Blaxill M, Zahorodny W. California autism prevalence trends from 1931 to 2014 and comparison to national ASD data from IDEA and ADDM. J Autism Dev Disord. 2018;48:4103–17.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Christensen DL, Maenner MJ, Bilder D, Constantino JN, Daniels J, Durkin MS, et al. Prevalence and characteristics of autism spectrum disorder among children aged 4 years—early autism and developmental disabilities monitoring network, seven sites, United States, 2010, 2012, and 2014. MMWR Surveill Summ. 2019;68:1–19.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Autism and Developmental Disabilities Monitoring (ADDM) Network 2020 Community Report on Autism. Atlanta: Centers for Disease Control and Prevention, 2020.

  5. Wang S, Deng H, You C, Chen K, Li J, Tang C, et al. Sex differences in diagnosis and clinical phenotypes of chinese children with autism spectrum disorder. Neurosci Bull. 2017;33:153–60.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Pan PY, Bölte S, Kaur P, Jamil S, Jonsson U. Neurological disorders in autism: a systematic review and meta-analysis. Autism. 2021;25:812–30.

    Article  PubMed  Google Scholar 

  7. Schoen SA, Lane SJ, Mailloux Z, May-Benson T, Parham LD, Smith Roley S, et al. A systematic review of ayres sensory integration intervention for children with autism. Autism Res. 2019;12:6–19.

    Article  PubMed  Google Scholar 

  8. Carruthers S, Charman T, El Hawi N, Kim YA, Randle R, Lord C, et al. Utility of the autism diagnostic observation schedule and the brief observation of social and communication change for measuring outcomes for a parent-mediated early autism intervention. Autism Res. 2021;14:411–25.

    Article  PubMed  Google Scholar 

  9. Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, et al. The lancet commission on the future of care and clinical research in autism. Lancet. 2022;399:271–334.

    Article  PubMed  Google Scholar 

  10. Rogers SJ, Dawson G. Early start denver model for young children with autism. Promoting language, learning and engagement. New York: Guilford Press; 2010.

    Google Scholar 

  11. Schreibman L, Dawson G, Stahmer AC, Landa R, Rogers SJ, McGee GG, et al. Naturalistic developmental behavioral interventions: empirically validated treatments for autism spectrum disorder. J Autism Dev Disord. 2015;45:2411–28.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Laister D, Stammler M, Vivanti G, Holzinger D. Social-communicative gestures at baseline predict verbal and nonverbal gains for children with autism receiving the Early Start Denver Model. Autism. 2021;25:1640–52.

    Article  PubMed  Google Scholar 

  13. Cidav Z, Munson J, Estes A, Dawson G, Rogers S, Mandell D. Cost offset associated with Early Start Denver Model for children with autism. J Am Acad Child Adolesc Psychiatry. 2017;56:777–83.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Whitehouse A. Examining parent use of specific intervention techniques during a 12-week training program based on the Early Start Denver Model. Autism. 2020;24:484–98.

    Article  PubMed  Google Scholar 

  15. Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, et al. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics. 2010;125:e17-23.

    Article  PubMed  Google Scholar 

  16. Colombi C, Narzisi A, Ruta L, Cigala V, Gagliano A, Pioggia G, et al. Implementation of the Early Start Denver Model in an Italian community. Autism. 2018;22:126–33.

    Article  PubMed  Google Scholar 

  17. Rogers SJ, Estes A, Lord C, Munson J, Rocha M, Winter J, et al. A multisite randomized controlled two-phase trial of the Early Start Denver Model compared to treatment as usual. J Am Acad Child Adolesc Psychiatry. 2019;58:853–65.

    Article  PubMed  Google Scholar 

  18. Vivanti G, Paynter J, Duncan E, Fothergill H, Dissanayake C, Rogers SJ, et al. Effectiveness and feasibility of the ESDM implemented in a group-based community childcare setting. J Autism Dev Disord. 2014;44:3140–53.

    Article  PubMed  Google Scholar 

  19. Zhou B, Xu Q, Li H, Zhang Y, Wang Y, Rogers SJ, et al. Effects of parent-implemented Early Start Denver Model intervention on Chinese toddlers with autism spectrum disorder: a non-randomized controlled trial. Autism Res. 2018;11:654–66.

    Article  PubMed  Google Scholar 

  20. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC: American Psychiatric Association; 2013.

    Book  Google Scholar 

  21. Lord C, Rutter M, DiLavore PC, Risi S. Autism diagnostic observation schedule: ADOS manual. Los Angeles: Western Psychological Services; 2002.

    Google Scholar 

  22. Maddox BB, Rump KM, Stahmer AC, Suhrheinrich J, Rieth SR, Nahmias A, et al. Concordance between a U.S. educational autism classification and the autism diagnostic observation schedule. J Clin Child Adolesc Psychol. 2020;49:469–75.

    Article  PubMed  Google Scholar 

  23. Tian Y, Zhang C, Yu G, Hu X, Pu Z, Ma L. Influencing factors of the neurodevelopment of high-risk infants. Gen Psychiatr. 2018;31:e100034.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Dong HY, Wang B, Li HH, Yue XJ, Jia FY. Correlation between screen time and autistic symptoms as well as development quotients in children with autism spectrum disorder. Front Psychiatry. 2021;12:619994.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Schopler E, Lansing MD, Reichler RJ, Marcus LM. Psychoeducational profile: TEACCH individualized psychoeducational assessment for children with autism spectrum disorders (PEP-3) 3. Austin: Pro-Ed; 2005.

    Google Scholar 

  26. Yu L, Zhu X, Shek DTL, Zou XB, Deng HZ, Au Yeung PWH. Validation of the simplified Chinese psychoeducational profile third edition in mainland China. J Autism Dev Disord. 2019;49:1599–612.

    Article  PubMed  Google Scholar 

  27. Chen KL, Chiang FM, Tseng MH, Fu CP, Hsieh CL. Responsiveness of the psychoeducational profile-third edition for children with autism spectrum disorders. J Autism Dev Disord. 2011;41:1658–64.

    Article  PubMed  Google Scholar 

  28. Rogers SJ, Estes A, Lord C, Vismara L, Winter J, Fitzpatrick A, et al. Effects of a brief Early Start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2012;51:1052–65.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Devescovi R, Monasta L, Mancini A, Bin M, Vellante V, Carrozzi M, et al. Early diagnosis and Early Start Denver Model intervention in autism spectrum disorders delivered in an Italian Public Health System service. Neuropsychiatr Dis Treat. 2016;12:1379–84.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Fuller EA, Oliver K, Vejnoska SF, Rogers SJ. The effects of the Early Start Denver Model for children with autism spectrum disorder: a meta-analysis. Brain Sci. 2020;10:368.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Contaldo A, Colombi C, Pierotti C, Masoni P, Muratori F. Outcomes and moderators of Early Start Denver Model intervention in young children with autism spectrum disorder delivered in a mixed individual and group setting. Autism. 2020;24:718–29.

    Article  PubMed  Google Scholar 

  32. Rogers SJ, Yoder P, Estes A, Warren Z, McEachin J, Munson J, et al. A multisite randomized controlled trial comparing the effects of intervention intensity and intervention style on outcomes for young children with autism. J Am Acad Child Adolesc Psychiatry. 2021;60:710–22.

    Article  PubMed  Google Scholar 

  33. Ogilvie E, McCrudden MT. Evaluating the social validity of the Early Start Denver Model: a convergent mixed methods study. J Autism Dev Disord. 2017;47:2899–910.

    Article  PubMed  Google Scholar 

  34. Waddington H, Van der Meer L, Sigafoos J. Effectiveness of the Early Start Denver Model: a systematic review. Rev J Autism Dev Disord. 2016;3:93–106.

    Article  Google Scholar 

Download references

Acknowledgements

We are grateful to all toddlers and parents participating in the study. We wish to thank the training guidance from Dr. Chao-Qun Cen, Dr. Chun Tang and Dr. Feng-Jing Liang. Especially, we gratefully acknowledge Prof. Sally J. Rogers for advising revision and supporting our work.

Funding

This study was supported by grants from the Scientific Research project of National Health Commission (No: 201302002), National Natural Science Foundation of China (No: 81873801), Technology Program of Guangzhou, China (No: 201903010040) and Science and Technology Program of Guangzhou (202007030011).

Author information

Authors and Affiliations

  1. Child Developmental and Behavioral Center, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, China

    Shi-Huan Wang, Hai-Tao Zhang, Yuan-Yuan Zou, San-Mei Cheng, Xiao-Bing Zou & Kai-Yun Chen

Authors
  1. Shi-Huan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hai-Tao Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuan-Yuan Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. San-Mei Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiao-Bing Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kai-Yun Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CRediT authorship contribution statement. SHW: drafting the article, and data analysis. HTZ: implementer of professional treatment. YYZ: implementer of professional treatment, and professional evaluation. SMC: professional evaluation. XBZ: final approval of the version to be published, revising it critically for important intellectual content. K-yC: concept and design, acquisition and interpretation of data.

Corresponding authors

Correspondence to Xiao-Bing Zou or Kai-Yun Chen.

Ethics declarations

Ethical approval

This study was approved by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University in Guangzhou (approval no: [2013]2-91). All caregivers of toddlers with ASD were informed of the associated benefits and risks, and then voluntarily signed informed consent before intervention.

Conflict of interest

None of the authors participated in the journal’s review of, or decisions related to this manuscript. No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, SH., Zhang, HT., Zou, YY. et al. Efficacy and moderating factors of the Early Start Denver Model in Chinese toddlers with autism spectrum disorder: a longitudinal study. World J Pediatr 19, 741–752 (2023). https://doi.org/10.1007/s12519-022-00555-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-022-00555-z

Keywords

Search

Navigation