Early Start Denver Model

Reviewed by:
Hannah Andreasen

July 19, 2022

Early diagnosis and interventions for autism are essential for improving long-term symptoms and life skills. The Early Start Denver Model (ESDM) is an evidence-based, comprehensive, play-based behavioral therapy for children aged 12 to 48 months based on methods of applied behavior analysis (ABA).

What is the Early Start Denver Model?

ESDM was developed in the United States in 1981 by combining techniques from the Denver Model and Pivotal Response Training (PRT). This method uses joint activities and play to improve:

  • Social skills
  • Cognitive skills
  • Language skills 

PRT is a naturalistic, loosely structured intervention that relies on naturally occurring teaching opportunities and consequences. This method focuses on “pivotal” areas of the child’s development rather than just one specific behavior. 

ESDM uses understanding of brain development and behavior to provide children with autism spectrum disorder (ASD) the social skills that will help them to learn to communicate and build relationships throughout their life. 

Therapy with ESDM is flexible and can be applied in many different settings:

  • One-to-one intensive teaching
  • Group sessions
  • Specialized care settings
  • Preschool settings
  • At home

ESDM therapy is highly individualized. The therapist will begin the program with an assessment of the child’s skills. The skills assessed include:

  • Language
  • Social skills 
  • Motor skills
  • Independence
  • Joint attention
  • Behavior
  • Cognition 

How is ESDM different from ABA?

Although ESDM uses many techniques from ABA, there are some key differences between the two. 


ESDM uses social and motivational rewards, while ABA uses tangible rewards such as stickers or candy. 

Examples of rewards in ESDM are:

  • Praise
  • Smiles
  • Allowing the child to choose a toy or experience

Who leads

ESDM is child-led. Therapy follows the child’s motivation to increase the enjoyment of play and learning. ABA is therapist-led. A therapist usually chooses the experience for the child. 

Managing unwanted behavior

ESDM evaluates unwanted behavior closely to determine the cause. Often, this involves labeling an emotion and problem solving with the child. ABA ignores unwanted behavior. 


ESDM uses least to most prompting. The first prompt will be the least supportive when a child is given a task. Least to most prompting for a task like “give me blue” would look like the trainer using this command first and gradually increasing support to help the child take blue by hand.

ABA uses most to least prompting. The child will receive the most support the first time a task is performed. In the example above, the therapist will take the child's hand and guide them through the entire process so it is completed the first time correctly, and then decrease support the next time it is asked. 


Affect is the outward expression of a person's emotions. ESDM focuses on a positive affect in all interactions. 

A positive affect may include:

  • Warm tone of voice
  • Warm, open facial expressions
  • Open body language

ABA usually uses a neutral or “straight face” to request a task and only shows a positive affect for desired behaviors.

Who benefits from ESDM?

ESDM is most beneficial for young children between 12 and 48 months. When children are young, it is easier for their brains to change and adapt, known as neuroplasticity. Training behaviors early in life can change the trajectory of their development. 

Children with ASD on any part of the spectrum can benefit from ESDM. It can be used for children who only need help with subtle social cues and in nonverbal children who need help learning other ways to communicate. 

Children with ASD may find social interactions less rewarding than neurotypical children. 

ESDM aims to retrain the brain while the child is young by providing positive reinforcement for social behavior. By improving socialization skills early in life, children with ASD who participate in ESDM may be more successful in school, friendships, and transitioning into adulthood. 

ESDM is a time and cost-intensive therapy, but the cost may be offset after just a few years because the overall improvement of symptoms can lead to a reduction in other services. 

Does ESDM work?

Studies suggest that ESDM can decrease the severity of symptoms of ASD. There is even evidence from brain scans that brain activity relating to social behavior is more similar to a neurotypical child after early intervention. 

Studies show improvements in several areas, including:

  • Cognition
  • Language
  • Adaptive behavior 

Symptom improvement from ESDM is long-lasting. One study showed the gains from intensive ESDM therapy were maintained and even improved two years after the intervention ended.

Who provides ESDM services?

ESDM services can be provided by:

  • ABA therapists
  • Board-certified behavior analysts
  • Psychologists
  • Occupational therapists
  • Speech and language pathologist
  • Early intervention specialists
  • Developmental pediatricians

Professionals who provide ESDM services also receive specific training and certification that involves:

  • Attending a training workshop
  • A video submission that shows them using ESDM in therapy sessions
  • Demonstration of reliable and correct use of ESDM techniques

ESDM parent training

Parents and caregivers are an important part of this program because the children are so young. Ongoing play at home will help to reinforce the skills learned in therapy. 

Parents can become trained in ESDM by reading the ESDM manual and through strong communication with the providing therapists. 


The Early Start Denver Model can help young children with autism improve social skills, cognition, and language. 

‍Songbird Therapy is a technology-enabled provider setting a higher standard for children’s autism care. With a deeply passionate team and innovative technology, we’re building a world where every child can access world-class care at home, uniquely tailored to them.