Early Start Denver Model (ESDM) for Autism: What Parents and Teachers Should Know
Before I had children of my own, I worked at a university using the Early Start Denver Model, often shortened to ESDM, with autistic children between 1 and 4 years old. Of all the early autism intervention models I have worked with, it remains one of the approaches I found most appealing.
What I liked was the way it blended some of the foundational components of Applied Behavior Analysis (ABA) and other behavioral teaching methods with play-based and relationship-based approaches.
It did not treat learning, communication, play, and relationships as completely separate parts of a child's day. Teaching took place within enjoyable interactions and familiar daily routines.
The program where I worked also placed a strong emphasis on parent training and family involvement. I trained therapists who provided therapy in each child's home on a daily basis, along with weekly parent or family training. Goals were individualized around each family's needs, priorities, and hopes for their child.
Depending on the child and family, those goals could include:
Motor skills
Social-emotional development
Pre-academic skills
Speech and language
Self-help and everyday independence
I think the Early Start Denver Model may appeal to families who are interested in some of the structured, evidence-based teaching associated with ABA but feel nervous about concerns they have heard regarding autonomy, compliance, or whether ABA can be neuroaffirming.
It may also feel more familiar to preschool and special education teachers who are accustomed to teaching through play and routines—and who do not have the staff, space, or resources to create a traditional one-to-one ABA program.
However, ESDM is not simply “ABA with toys,” and the word play-based does not automatically make any intervention respectful or neuroaffirming. The quality of the goals, the therapist's responsiveness, and the way a child's communication, preferences, sensory needs, and boundaries are honored still matter enormously.
TL;DR: What Parents Should Know About ESDM
The Early Start Denver Model is an early intervention for young autistic children, generally beginning during the toddler or preschool years.
It is considered a Naturalistic Developmental Behavioral Intervention (NDBI) because it combines behavioral teaching strategies with knowledge of early childhood development.
Teaching happens mainly through play, shared activities, caregiving routines, and everyday interactions.
ESDM uses individualized goals and systematic progress monitoring, much like ABA.
It places more emphasis than many traditional, highly structured ABA programs on relationships, child interests, shared enjoyment, and natural rewards.
Parents and caregivers are active partners and may receive coaching to use strategies during ordinary family routines.
Goals may address communication, social-emotional skills, imitation, play, cognition, motor development, and self-help skills.
Research is promising but mixed. ESDM has shown benefits in some studies, especially for language and cognition, but it does not produce the same results for every child or every area of development.
Certified providers are not available everywhere. Insurance sometimes covers ESDM, but coverage varies by plan, state, provider, and how the service is authorized and billed.
📌 Quick Navigation
What is ESDM therapy?
What does ESDM look like?
Is ESDM the same as ABA?
How is ESDM different from ABA?
How does ESDM compare with relationship-based therapy?
Is ESDM neuroaffirming?
What does the research say?
Where can families find ESDM?
Does insurance cover ESDM?
Questions to ask a provider
Frequently asked questions
Research and further reading
What Is ESDM Therapy?
The Early Start Denver Model is a comprehensive early intervention approach created for young autistic children.
It combines:
Principles from ABA
Research on how infants and toddlers learn
Developmental teaching sequences
Play-based learning
Responsive, relationship-focused interaction
Family coaching and participation
Individualized goals and ongoing data collection
ESDM is commonly described as a Naturalistic Developmental Behavioral Intervention. That long name is easier to understand when separated into three parts:
Naturalistic: Teaching occurs during play and everyday activities instead of only at a table or in drills.
Developmental: Goals are selected with an understanding of how early skills build on one another across different developmental areas.
Behavioral: Adults intentionally arrange opportunities to practice skills, respond to the child's behavior, reinforce meaningful attempts, and collect information about progress.
Autism Speaks describes ESDM for children ages 12 to 48 months, while some research and ESDM publications describe its range as extending to 60 months. Generally, it is primarily an intervention for autistic toddlers and young preschoolers.
What Does Early Start Denver Model Therapy Look Like?
To someone watching a good ESDM session, it may look like the adult and child are simply playing. Underneath that play, however, the therapist is making many intentional teaching decisions.
Imagine that a child enjoys bubbles. The therapist might pause before blowing more bubbles, notice how the child communicates interest, model a gesture or word, reinforce any meaningful communication attempt by blowing the bubbles, practice taking turns, imitate the child's actions, add a simple direction, and create opportunities for shared attention—all within one enjoyable activity.
A session may include:
Following the child's interests and joining their play
Creating many short opportunities to communicate and learn
Reinforcing attempts with a natural result connected to the activity
Alternating between adult-led and child-led moments
Practicing several developmental skills during the same activity
Moving between floor play, songs, books, sensory activities, snacks, dressing, and other routines
Recording progress and adjusting goals over time
Coaching parents to use similar strategies without turning every family interaction into a therapy session
For example, if a child reaches toward a wind-up toy, the natural reward for communicating is access to the toy—not an unrelated candy or token.
If the goal is putting on shoes, practice may happen when the child is actually getting ready to go outside. This helps connect learning to its real purpose.
ESDM can be delivered one-to-one or in groups and may be used at home, in a clinic, in an early intervention program, or in a preschool setting.
The university program where I worked used daily home-based therapy with weekly family training, but not every ESDM program follows that exact schedule or service model.
If your child is developing early communication skills, you may also find these helpful:
Is the Early Start Denver Model the Same as ABA?
ESDM uses ABA principles, so it is accurate to place it within the broader family of ABA-based interventions. It uses planned teaching opportunities, prompting, reinforcement, task analysis when appropriate, data collection, and individualized measurable goals.
At the same time, ABA is an extremely broad field. Not all ABA looks like discrete-trial teaching at a table, and not all modern ABA programs are highly adult-directed. Therefore, comparing ESDM with “ABA” can be misleading unless we specify that we are comparing it with a more traditional, highly structured ABA program.
How ESDM Is Similar to Traditional ABA
Both approaches may:
Break complex skills into smaller teachable steps
Use observation and assessment to select goals
Create repeated opportunities for practice
Reinforce behaviors and skills the team wants to strengthen
Use prompting and gradually reduce help
Collect data and change teaching when progress is limited
Individualize intervention rather than use one identical plan for every child
Teach communication, play, social, learning, and independence skills
How ESDM May Look Different From Traditional ABA
More traditional, structured ABA | Early Start Denver Model |
Teaching may happen in separate trials or at a table. | Teaching is embedded primarily within play and daily routines. |
The adult may select most materials and direct the sequence. | The adult frequently follows the child's interests and shares control of the activity. |
One teaching trial may focus on one isolated response. | One play routine may address communication, imitation, motor, cognitive, and social goals together. |
Reinforcement may sometimes be separate from the task. | Reinforcement is usually naturally related to what the child is doing or requesting. |
Correct responding and skill acquisition may be especially visible priorities. | Engagement, shared enjoyment, communication, and the quality of the interaction are also central priorities. |
Skills may first be mastered in a structured setting and generalized later. | Skills are practiced in natural contexts from the beginning, although generalization still needs attention. |
Parent training varies greatly by provider. | Family participation and coaching are considered core parts of the model. |
These are general tendencies, not absolute dividing lines. A thoughtful modern ABA provider may use naturalistic teaching, child choice, assent, play, and caregiver coaching. An ESDM provider can also become overly adult-directed or compliance-focused if the model is implemented without enough attention to the individual child.
How Is ESDM Similar to Relationship-Based and Play-Based Therapies?
Like many developmental and relationship-based therapies, ESDM recognizes that young children learn through emotionally meaningful interactions with other people.
It emphasizes:
Joining the child in enjoyable activities
Following the child's attention and interests
Building warm, positive relationships
Using affect, facial expression, movement, and shared enjoyment
Encouraging back-and-forth interaction
Helping adults become responsive communication partners
Teaching during play rather than separating learning from relationships
For parents and early childhood teachers, this often feels more intuitive than running repeated adult-directed trials. The classroom does not need to become a therapy clinic.
Learning can happen while building a block tower, feeding a doll, opening a snack, playing outside, washing hands, or getting ready to leave.
How Is ESDM Different From Traditional Relationship-Based Therapy?
Traditional relationship-based approaches vary, but many begin primarily with the child's emotional regulation, connection, initiative, and capacity for increasingly complex interaction.
Progress may be described through developmental capacities or the quality of engagement rather than through a large set of individually measured behavioral objectives.
ESDM generally adds more explicit behavioral structure. It uses:
A detailed developmental curriculum
Clearly defined, measurable objectives
Planned teaching opportunities
Behavioral teaching procedures
Systematic data collection
Regular review of whether a child is progressing on each goal
Greater attention to creating repeated learning opportunities within an interaction
In other words, relationship-based approaches may ask, “How can I join this child and deepen our interaction?” Traditional behavioral approaches may ask, “How can I teach and measure this specific skill?” ESDM attempts to do both at the same time.
That combination was one of the things I valued most in the university program where I worked. We could remain responsive to the child and family while still being very clear about what we were teaching, why we were teaching it, and whether our approach was working.
Is the Early Start Denver Model Neuroaffirming?
ESDM was not originally developed using all of today's neurodiversity language, so I would not automatically label every ESDM program neuroaffirming. No therapy model earns that description based only on its name.
However, ESDM contains features that can support more respectful, child-centered intervention:
Following the child's interests
Using natural reinforcement
Prioritizing positive relationships and shared enjoyment
Including families in goal selection
Teaching in meaningful daily contexts
Treating communication attempts as important
Adjusting activities to keep the child engaged
Whether a particular program respects children's autonomy depends on how those features are used. Families may want to ask:
Does the provider notice and respect signs that my child wants to stop or take a break?
Are goals connected to communication, access, safety, relationships, independence, or the child's own quality of life?
Are harmless autistic behaviors being targeted simply because they look different?
Are all forms of communication honored, including gestures, signs, pictures, AAC, movement, and speech?
Is eye contact required, or can the child show attention in other ways?
Does the provider adapt to sensory needs rather than treating distress as noncompliance?
Are parents genuine partners in choosing goals?
Is the child allowed to say no?
Play alone does not guarantee autonomy. A session can use toys and still be coercive. The more useful question is not simply, “Is ESDM neuroaffirming?” but “How does this specific provider respond to my child's communication, interests, distress, sensory needs, and boundaries?”
What Does Research Say About the Early Start Denver Model?
ESDM has a fairly extensive research base, considering the treatment being developed recently.
A frequently cited randomized controlled trial published in 2010 compared ESDM with community intervention for autistic toddlers. Children receiving ESDM showed greater improvements in IQ, language, and adaptive behavior during the two-year study.
A 2020 meta-analysis combined 12 studies involving 640 children. It found a statistically significant moderate overall effect favoring ESDM, driven largely by improvements in cognition and language.
However, the researchers did not find significant pooled effects for autism characteristics, adaptive behavior, social communication, or restricted and repetitive behaviors.
Research on parent-implemented ESDM also suggests that parents can learn many of the strategies. However, results across brief or lower-intensity parent-coaching studies have not always shown that ESDM produces better child outcomes than high-quality community intervention. Parent coaching may still be valuable because it can help strategies fit ordinary routines and strengthen collaboration between families and professionals.
Most recently, a large 2025 randomized trial in France and Belgium compared 12 hours per week of ESDM plus treatment as usual with treatment as usual alone. The researchers did not find a statistically significant improvement in the study's primary outcome, overall developmental quotient, and concluded that ESDM could not be universally recommended for all young autistic children based on those findings.
The most reasonable conclusion is that ESDM is a promising, well-developed option with evidence of benefit in some areas and for some children, not a guaranteed outcome or the only valid early intervention. Families should consider the child's needs, the quality of the provider, the fit with family priorities, the burden of the schedule, and the child's actual response over time.
Where Can Families Get Early Start Denver Model Therapy?
Finding a provider may be harder than finding a general ABA, speech, occupational therapy, or early intervention program. ESDM requires specialized training, and certified providers are not evenly distributed across the United States or in other countries.
Good places to begin include:
The official ESDM provider directory: The UC Davis MIND Institute ESDM Training Program maintains listings for certified therapists and parent coaches.
Your state's early intervention program: Children under age 3 may qualify for services under Part C of the Individuals with Disabilities Education Act. Ask whether any local providers are trained in ESDM or another Naturalistic Developmental Behavioral Intervention.
University autism or early-childhood clinics: Training programs and research centers sometimes offer ESDM directly or know which community providers use it.
Developmental pediatricians and autism evaluation clinics: These professionals may know local programs, although families should still verify the provider's specific training.
ABA agencies: Some agencies use ESDM or ESDM-informed naturalistic teaching even when the service is listed or billed under ABA.
Speech-language pathologists, occupational therapists, psychologists, and early intervention specialists: Professionals from several disciplines may become certified in ESDM, provided they meet the program's requirements.
Parent coaching or telehealth: Where local direct therapy is unavailable, a certified parent coach may be another route. Families should ask how coaching works, whether it is appropriate for their child, and whether it is covered.
The official directory distinguishes among certified therapists, parent coaches, and trainers. A professional who has attended an introductory workshop is not necessarily a certified ESDM therapist, so it is reasonable to ask exactly what training and supervision the person has completed.
Does Insurance Cover ESDM Therapy?
The most accurate short answer is: sometimes.
One drawback to this therapy is that ESDM can be difficult to locate and fund.
Insurance coverage may depend on:
The family's state and its autism coverage requirements
Whether the plan is fully insured or self-funded
Whether the child has an autism diagnosis
Whether the service is considered medically necessary
The provider's professional license or credential
Whether the provider is in network
Whether the service is billed as ABA, behavioral health treatment, parent training, speech therapy, occupational therapy, or another covered service
Prior authorization requirements
The child's age and plan-specific limits
Some insurers may cover an ESDM-based program when it is delivered by an eligible provider and authorized under the plan's ABA or autism-treatment benefit, even if “ESDM” is not listed as its own benefit. In other situations, a family may find a certified ESDM provider who is out of network or cannot bill the family's plan.
Children under 3 may also receive ESDM or related services through their state's early intervention program, often free or at reduced cost depending on state policies and family income. However, at this time, it is often difficult to find qualified providers that are trained in this method.
Before beginning services, ask both the provider and insurer:
Is this provider in network?
Under what benefit and billing codes will ESDM be submitted?
Is prior authorization required?
What diagnosis and documentation are needed?
Are parent-coaching sessions covered?
Are home-based services covered?
Are there hour, visit, age, or location limits?
What will our deductible, copay, or coinsurance be?
Can we receive the coverage decision in writing?
Questions to Ask an ESDM Provider
Are you a certified ESDM therapist or parent coach? What training have you completed?
Who will work directly with my child each day, and how are they trained and supervised?
How will our family help choose goals?
How do you include my child's interests and preferred ways of communicating?
How do you respond when a child turns away, refuses, becomes distressed, or asks to stop?
Do you require eye contact or work to eliminate harmless stimming?
How are sensory and motor needs included?
How often will we review data and change goals?
What parent or family coaching is included?
Can strategies be practiced within routines that matter to our family?
How many hours are recommended, and what evidence supports that recommendation for my child?
How will you coordinate with early intervention, preschool, speech therapy, occupational therapy, and other providers?
What insurance plans do you accept, and under what service category do you bill?
Frequently Asked Questions About ESDM
Is ESDM a form of ABA?
Yes. ESDM uses ABA principles and behavioral teaching procedures, but it combines them with developmental science, play-based learning, relationship-focused interaction, and family involvement. It is often categorized as a Naturalistic Developmental Behavioral Intervention.
What age is ESDM for?
ESDM is intended for very young autistic children. Autism Speaks describes it for ages 12 to 48 months, while some research publications describe children up to 60 months. Availability and eligibility vary by program.
Does a child need an autism diagnosis to receive ESDM?
That depends on the program and funding source. Some research and early intervention programs may work with toddlers who show signs of autism or are awaiting a diagnosis. Insurance-funded autism treatment is more likely to require a formal diagnosis and documentation of medical necessity.
How many hours of ESDM does a child need?
There is no single number that is right for every child. Research programs have used different intensities, and community programs vary. Recommendations should consider the child's needs, family capacity, other services, opportunities for ordinary play and rest, and whether the child is benefiting—not simply the maximum number of hours a provider offers.
Can parents use ESDM strategies at home?
Yes. Parent participation is central to the model, and parent-coaching versions of ESDM have been studied. Coaching should help families use strategies naturally during play and routines rather than make parents feel responsible for providing therapy every waking hour.
Can teachers use ESDM in a preschool classroom?
ESDM can be delivered in group and preschool settings, and many of its general principles—following children's interests, embedding goals in play, using natural reinforcement, and creating repeated communication opportunities—fit early childhood classrooms. However, accurately calling a classroom program “ESDM” implies appropriate training and use of the model, not simply using play-based ABA strategies.
Is ESDM better than ABA or relationship-based therapy?
There is no universal best choice for every autistic child. ESDM may be a good fit for families who want systematic teaching and progress monitoring within play, routines, and responsive relationships. Provider quality, respectful goals, family fit, child wellbeing, and meaningful progress are more important than a label alone.
Final Thoughts
The Early Start Denver Model appeals to me because it does not force a choice between intentional teaching and responsive relationships. In the university program where I worked, therapists could systematically teach communication, motor, social-emotional, pre-academic, and self-help skills while playing with a child in the child's own home.
Families were not placed on the sidelines. Their priorities helped shape the goals, and weekly coaching gave them practical ways to support learning during real life.
For families who are curious about ABA but concerned about autonomy or overly compliance-focused treatment, ESDM may be worth exploring. For teachers who already believe young children learn through play but want a clearer way to individualize goals and measure progress, its blended approach may also make sense.
The model's name, however, is not a guarantee. Look closely at what the adults actually do: Do they enjoy the child? Follow the child's interests? Honor communication and boundaries? Choose useful goals with the family? Notice distress? Adjust when something is not working? Measure skills that genuinely improve the child's access, independence, relationships, and quality of life?
Those questions tell us far more about the quality of an intervention than whether it is described as behavioral, developmental, relationship-based, play-based—or all four.
Related Resources
Have you used ESDM as a parent, therapist, or teacher? I would love to hear what the model looked like in your program and what parts were—or were not—a good fit for your child, family, or classroom.
Research and Further Reading
Autism Speaks. Early Start Denver Model (ESDM). Includes a plain-language overview, provider information, and general insurance guidance. https://www.autismspeaks.org/early-start-denver-model-esdm
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., & Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), e17–e23. https://doi.org/10.1542/peds.2009-0958
Fuller, E. A., Oliver, K., Vejnoska, S. F., & Rogers, S. J. (2020). The effects of the Early Start Denver Model for children with autism spectrum disorder: A meta-analysis. Brain Sciences, 10(6), 368. https://doi.org/10.3390/brainsci10060368
Geoffray, M.-M., et al. (2025). Early Start Denver Model effectiveness in young autistic children: A large multicentric randomised controlled trial in two European countries. BMJ Mental Health, 28(1), e301424. https://doi.org/10.1136/bmjment-2024-301424
Schreibman, L., Dawson, G., Stahmer, A. C., et al. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 2411–2428. https://doi.org/10.1007/s10803-015-2407-8
Rogers, S. J., Estes, A., Lord, C., et al. (2019). A multisite randomized controlled two-phase trial of the Early Start Denver Model compared to treatment as usual. Journal of the American Academy of Child & Adolescent Psychiatry, 58(9), 853–865. https://doi.org/10.1016/j.jaac.2019.01.004
Rogers, S. J., Estes, A., Vismara, L., et al. (2012). Effects of a brief Early Start Denver Model-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. https://doi.org/10.1016/j.jaac.2012.08.003
UC Davis MIND Institute ESDM Training Program. Find a certified ESDM therapist, parent coach, or trainer. https://www.esdm.co/find-a-provider
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