Group Delivery of the Early Start Denver Model: Treatment Outcomes

Background: Research on the ESDM has been conducted with1:1 in-home delivery of moderate intensity (e.g., 15 - 20 hours per week consistent with recommendations for intervention for children with autism (National Research Council, 2001). The Margot Prior Wing Autism Specific Early Learning and Care Centre (MP Wing ASELCC) is one of only two sites worldwide currently implementing the ESDM in a group setting. This is the first study to examine the translation of the ESDM into community practice by investigating developmental change in children receiving the ESDM in a group setting.

Objectives: The first aim was to examine treatment progress for children who have received a moderate level of intensity of group-based ESDM for a period of at least one year. The second aim is to examine the predictors (i.e., cognitive ability, autism severity) of treatment progress after one year of group delivery of ESDM.

Methods: Participants comprised 21 toddlers and preschool aged children diagnosed with an ASD aged between 2- to 5-years. Autism diagnoses were confirmed with the Social Communication Questionnaire and the Autism Diagnostic Observation Schedule (ADOS; 17 met criteria for AD, and 4 met criteria for ASD), and cognitive ability was assessed using the Mullen Scales of Early Learning (MSEL). All children were also administered the ESDM Curriculum Checklist which is a developmentally sequenced tool utilized to assess all developmental areas, and which guides learning objectives on a quarterly basis. These measures were readministered after one year of treatment, and outcomes at one year post treatment was ascertained via change scores on each of these measures.

Results: Children showed significant treatment gains over the course of the year as evidenced by performance on all domains of the ESDM Curriculum Checklist, and all subscales of the MSEL, with the exception of the fine motor subscale, relative to baseline scores. The best predictors of treatment gains were symptom severity, cognitive level and receptive language abilities at baseline. Chronological age at baseline was not a predictor of treatment gains, suggesting that preschoolers might benefit from the treatment even if commenced after 36 months of age.

Conclusions: The findings suggest that children receiving ESDM in a group setting make considerable treatment gains with appropriate levels of intensity. This model, with its focus on very young children, is ideally suited for implementation within early learning settings such as childcare. Establishing the effectiveness of the EDSM in group settings represents an important endeavour, to underpin wider access to this evidence-based model of EIBI.