Preliminary Outcome of the Early Start Denver Model for Young Children with Autism Spectrum Disorder in a Clinical Setting in Taiwan

Background: The Early Start Denver Model (ESDM) is a comprehensive and naturalistic behavioral development early intervention program that has been shown to positively affect key outcomes for toddlers and young children with Autism Spectrum Disorder (ASD) following over 12 months of high-intensity intervention. However, most studies have been conducted in Western countries, with few conducted in East Asian settings, such as Taiwan. In Taiwan, clinical settings are the main resources of intervention services for young children with ASD. Public health policy regarding early intervention in Taiwan stipulates that there should be a multidisciplinary team in the clinical setting and encourages team members to work collaboratively. Team members should include clinical psychologists, occupational therapists and speech-language pathologists. This policy’s focus on an interdisciplinary approach aligns with that of intervention programs such as the ESDM. Therefore, implementing the ESDM in clinical settings in Taiwan is pragmatic and important for young children with ASD.

Objectives: The purpose of this study was to preliminarily evaluate the effectiveness of an ESDM intervention based on Taiwanese public health policy for young children with ASD in the Greater Taipei area in Taiwan.

Methods: A total of 16 children with a DSM-5 diagnosis of ASD aged between 25 and 46 months (mean = 33.5 months) were recruited. Children received 9 hours per week of one-to-one ESDM intervention in clinical settings for 6 months. Interventions were delivered by clinical psychologists, occupational therapists, and speech-language pathologists trained by an ESDM accredited trainer. Outcome measures were administered pre- and post-intervention, comprising the Mullen Scales of Early Learning (MSEL) and Autism Diagnostic Observation Schedule (ADOS). The MSEL was used to measure nonverbal (visual reception and fine motor), verbal (receptive and expressive language) and overall cognitive performance assessed by standardized developmental quotients (DQ), and ADOS was used to measure the severity of ASD symptoms.

Results: The average overall cognitive performance at entry of children with ASD was moderately delayed (mean DQ = 53.6). However, after receiving 6-months of the one-to-one ESDM intervention, children made significant improvements in nonverbal, verbal and overall cognitive performance, and the developmental gains were 6.9, 10.0, and 8.5 months, respectively, which were in excess of what may have been expected due to maturation. The effect sizes of improvement in receptive language and overall cognitive performance were large (>.80). Moreover, children’s symptom severity of communication and play in ADOS were decreased significantly post-intervention, and the effect sizes were both nearly large (>.75).

Conclusions: This study provides preliminary findings on the implementation of ESDM in Taiwan. The results indicate that a low-intensity and short-term ESDM intervention directly delivered by a multidisciplinary team in a clinical setting may be a promising treatment for young children with ASD. The following steps in Taiwan are to incorporate a control group for comparison and follow up the 2 matched groups to determine the long-term effects.