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Early Start Denver Model

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The Early Start Denver Model (ESDM) is a form of intervention directed at young children that display early signs of being on the autism spectrum proposed by American psychiatrists Sally J. Rogers and Geraldine Dawson. It is intended to help children improve development traits as early as possible so as to narrow or close the gaps in capabilities between the individual and their peers.

Development

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The American psychiatrists Sally J. Rogers and Geraldine Dawson began developing the Early Start Denver Model during the 1980s.[1] While working at the University of Colorado, in Denver, Rogers provided what was first called the "play school model" of intervention which was applied to children in preschool during their regular play activities.[2] The model was founded in Piaget's theory of cognitive development[2] and came to be described by Rogers and Dawson as the Denver Model.[3]

In 2010, the two researchers published Early Start Denver Model for Young Children with Autism: Promoting Language, Learning, and Engagement,[4] in which the ESDM is manualized and described in detail. It is generally cited to be directed towards children between 12 and 48 months of age,[5] and is closely related to Applied behavior analysis, influencing and being influenced by this field of work.[2][6]

Description

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The ESDM is aimed at using "joint activity routines" that explore the child's natural interests to explore their learning potential, shaping everyday activities between the child and their caregivers to maximize their development potential according to the child's assessment.[6]

Rogers and Dawson describe the core features of the ESDM as:[4]

  1. an interdisciplinary team that implements a developmental curriculum addressing all domains;
  2. focus on interpersonal engagement;
  3. development of fluent, reciprocal, and spontaneous imitation of gestures, facial movements and expressions, and object use;
  4. emphasis on both nonverbal and verbal communication development;
  5. focus on cognitive aspects of play carried out within dyadic play routines;
  6. partnership with parents.

Assessment

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The intervention begins with measuring the child's skill levels in language, social skills, imitation, cognition, play, and motor and self-help skills. The assessment serves as a baseline for future reassessments, which are rerun every 12 weeks,[7] and a model of it is presented in Rogers and Dawson's 2010 book,[1] being called the ESDM Curriculum Checklist.[8]

Intervention plan

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Results from the first assessment are used to draw an intervention plan, which describes the activities to be performed with the child by the parents and therapists. An interdisciplinary team oversees the progress and readjusts the plan with every new 12-week assessment.[4] The parents are also trained (or "coached") and play a role in the program, taking on some of the activities in the child's intervention plan or, in some cases, conducting it all together.[9]

Among the domains focused on by the intervention plan are of particular importance: imitation, nonverbal communication (including joint attention), verbal communication, social development (including emotion sharing), and play.[4]

Efficacy

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Several studies have been published in an effort to assess its efficacy in mitigating the developmental delays in young children diagnosed with autism. Research of this kind is inherently complex, since it involves comparing groups receiving different types of treatment and it is ethically questionable to set aside a control group that would receive no treatment; therefore it is challenging to perform the objective measurement of treatment effects.[1]

Rogers and Dawson have performed different trials of their methods. They published, with 6 other authors, a randomized controlled trial in 2012 that younger age and longer hours of weekly intervention hours positively correlate with improvements in most variables measured by the method.[10] They followed up with a study published in 2015 where they tried to gauge the method's long-term efficacy by examining children at 6 years of age, 2 years after the ESDM had ended. By comparing one group that had received traditional methods of treatment with another group receiving the ESDM treatment starting at between 18 and 30 months of age, they found no significant differences between the groups in core autism symptoms immediately after treatment ended (at 4 years of age); the ESDM group did show, however, significant improvements in core autism symptoms after 2 years, implying that the benefits of the treatment at a younger age affect developmental traits that only become noticeable in later stages of development. This was the first study that analyzed the efficacy of ESDM treatment starting at an age younger than 30 months.[11]

Meta-analyses and systematic reviews have shown that the ESDM is promising.[12] A meta-analysis of 12 individual studies with a total of 640 children published in 2020 concluded that, compared to control groups receiving traditional forms of treatment, children receiving the ESDM showed significant improvements in cognition and language abilities (G-test numbers of 0.412 and 0.408, respectively).[13] A separate meta-analysis using 11 studies described as high-quality randomized controlled trials analyzed results in four major domains related to ASD (autism symptoms, language, cognition, and social communication). The study found that children receiving the ESDM showed significant improvements in the cognition (g = 0.28), autism symptoms (g = 0.27), and language (g = 0.29) domains.[14]

Usage in countries

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The diagnosis of autism has undergone significant changes in recent decades, which means the forms of treatment have also changed.[15] Therefore, countries have incorporated treatment options in heterogeneous ways, meaning that the Denver Model has been adopted with different intensities throughout the world. The list below presents a brief description of how each country's healthcare system (public or private) deal with this form of treatment:

Australia

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The National Disability Insurance Scheme of the Australian government recognizes the ESDM as a form of "naturalistic developmental behavioural intervention" with enough scientific evidence to support it,[16] and will cover the costs of treatment and parent-training sessions if the child is eligible for this type of treatment.[17]

Brazil

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The Agência Nacional de Saúde Suplementar (ANS), Brazil's regulating body for private healthcare plan providers, recognizes different forms of ASD within the scope of pervasive developmental disorders. It lists ESDM as one of the forms of treatment that should be taken into consideration by healthcare providers for children with developmental disorders. Since July 1, 2022, healthcare providers are obligated to provide the form of treatment prescribed by the child's doctor, and this includes the ESDM.[18]

France

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Since 2012, the Haute Autorité de Santé of France recognizes ESDM's efficacy and recommends that public healthcare institutions consider it as one of their options when treating children with ASD.[19]

United States

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All 50 states in the USA have legislation requiring the coverage of autism spectrum treatments by private health insurance companies.[20] The Centers for Disease Control and Prevention (CDC) includes the ESDM as a developmental approach in the treatment of ASD.[21]

A study of applying the ESDM at an early age was conducted to assess the cost-effectiveness of applying the ESDM at an early age rather than using the traditional methods of treatment at later stages. The study indicates that the average increased cost of treatment at younger ages was significantly smaller than the total savings in treatments at older ages, with children needing fewer sessions of ABA/EIBI, occupational, physical and speech therapy services.[22]

References

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  1. ^ a b c "Is There Science Behind That?: Early Start Denver Model". Association for Science in Autism Treatment. Retrieved January 24, 2023.
  2. ^ a b c McGee, Gail (October 23, 2008). "What Is The Denver Model?". ABC News. Retrieved January 24, 2023.
  3. ^ Rogers, Sally J. (2013), "Early Start Denver Model", in Volkmar, Fred R. (ed.), Encyclopedia of Autism Spectrum Disorders, New York, NY: Springer, pp. 1034–1042, doi:10.1007/978-1-4419-1698-3_1821, ISBN 978-1-4419-1698-3
  4. ^ a b c d Rogers, Sally J.; Dawson, Geraldine (2010). Early Start Denver Model for young children with autism : promoting language, learning, and engagement. New York: Guilford Press. ISBN 978-1-60623-631-4. OCLC 406124029.
  5. ^ "Early Start Denver Model (ESDM)". Autism Speaks. Retrieved January 24, 2023.
  6. ^ a b Vivanti, Giacomo; Stahmer, Aubyn C. (March 2021). "Can the Early Start Denver Model Be Considered ABA Practice?". Behavior Analysis in Practice. 14 (1): 230–239. doi:10.1007/s40617-020-00474-3. ISSN 1998-1929. PMC 7900312. PMID 33732593.
  7. ^ Rogers, Sally J. (2010). Early Start Denver Model curriculum checklist for young children with autism. Geraldine Dawson. New York: Guilford. ISBN 978-1-60623-633-8. OCLC 502315907.
  8. ^ Rogers, Sally J. (2010). Early Start Denver Model curriculum checklist for young children with autism. Guilford. ISBN 978-1-60623-633-8. OCLC 502315907.
  9. ^ Rogers, S. J.; Estes, A.; Vismara, L.; Munson, J.; Zierhut, C.; Greenson, J.; Dawson, G.; Rocha, M.; Sugar, C.; Senturk, D.; Whelan, F.; Talbott, M. (September 10, 2018). "Enhancing Low-Intensity Coaching in Parent Implemented Early Start Denver Model Intervention for Early Autism: A Randomized Comparison Treatment Trial". Journal of Autism and Developmental Disorders. 49 (2): 632–646. doi:10.1007/s10803-018-3740-5. ISSN 0162-3257. PMID 30203308. S2CID 254571081.
  10. ^ Rogers, Sally J.; Estes, Annette; Lord, Catherine; Vismara, Laurie; Winter, Jamie; Fitzpatrick, Annette; Guo, Mengye; Dawson, Geraldine (October 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 & Adolescent Psychiatry. 51 (10): 1052–1065. doi:10.1016/j.jaac.2012.08.003. ISSN 0890-8567. PMC 3487718. PMID 23021480.
  11. ^ Estes, Annette; Munson, Jeffrey; Rogers, Sally J.; Greenson, Jessica; Winter, Jamie; Dawson, Geraldine (July 1, 2015). "Long-Term Outcomes of Early Intervention in 6-Year-Old Children With Autism Spectrum Disorder". Journal of the American Academy of Child & Adolescent Psychiatry. 54 (7): 580–587. doi:10.1016/j.jaac.2015.04.005. ISSN 0890-8567. PMC 4475272. PMID 26088663.
  12. ^ Waddington, Hannah; van der Meer, Larah; Sigafoos, Jeff (June 1, 2016). "Effectiveness of the Early Start Denver Model: a Systematic Review". Review Journal of Autism and Developmental Disorders. 3 (2): 93–106. doi:10.1007/s40489-015-0068-3. ISSN 2195-7185. S2CID 256406831.
  13. ^ Fuller, Elizabeth A.; Oliver, Kelsey; Vejnoska, Sarah F.; Rogers, Sally J. (June 12, 2020). "The Effects of the Early Start Denver Model for Children with Autism Spectrum Disorder: A Meta-Analysis". Brain Sciences. 10 (6): 368. doi:10.3390/brainsci10060368. ISSN 2076-3425. PMC 7349854. PMID 32545615.
  14. ^ Wang, Zhi; Loh, Sau Cheong; Tian, Jing; Chen, Qian Jiang (2022). "A meta-analysis of the effect of the Early Start Denver Model in children with autism spectrum disorder". International Journal of Developmental Disabilities. 68 (5): 587–597. doi:10.1080/20473869.2020.1870419. ISSN 2047-3877. PMC 9542560. PMID 36210899.
  15. ^ Lordan, Ronan; Storni, Cristiano; De Benedictis, Chiara Alessia (2021), Grabrucker, Andreas M. (ed.), "Autism Spectrum Disorders: Diagnosis and Treatment", Autism Spectrum Disorders, Brisbane (AU): Exon Publications, ISBN 978-0-6450017-8-5, PMID 34495618, retrieved February 14, 2023
  16. ^ "Naturalistic developmental behavioural interventions | NDIS". www.ndis.gov.au. Retrieved February 14, 2023.
  17. ^ "ESDM for parents and carers - University of Wollongong – UOW". www.uow.edu.au. Retrieved February 14, 2023.
  18. ^ "ANS amplia regras de cobertura para tratamento de transtornos globais do desenvolvimento". Agência Nacional de Saúde Suplementar (in Brazilian Portuguese). Retrieved February 14, 2023.
  19. ^ "ESDM early start denver model". info (in French). Retrieved February 14, 2023.
  20. ^ "Using Health Insurance for Autism Therapy". Soar Autism Center. Retrieved February 14, 2023.
  21. ^ CDC (March 9, 2022). "Treatment and Intervention Services for Autism Spectrum Disorder". Centers for Disease Control and Prevention. Retrieved February 14, 2023.
  22. ^ Cidav, Zuleyha; Munson, Jeff; Estes, Annette; Dawson, Geraldine; Rogers, Sally; Mandell, David (September 2017). "Cost Offset Associated With Early Start Denver Model for Children With Autism". Journal of the American Academy of Child and Adolescent Psychiatry. 56 (9): 777–783. doi:10.1016/j.jaac.2017.06.007. ISSN 0890-8567. PMC 7007927. PMID 28838582.
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