The existing research base for the ESDM comes from a variety of studies carried out using pre-post group designs for a large number of preschools enrolled in a specialized Denver Model preschool program in Colorado (e.g. Rogers and Lewis, 1989) and a recent single subject study of the Denver Model (Rogers et al, 2006). A strong existing research base for PRT has been built up over the past several decades, generally using individual delivery of PRT or parent training studies, and described in numerous papers by Laura Schreibman, Robert and Lynn Koegel, Brooke Ingersoll, Aubyn Stahmer, and others. Research work on the ESDM is now underway in a variety of studies.
The ESDM was designed to be delivered in various ways, including individual therapy sessions by various clinicians, intensive early intervention programs delivered individually at home or in preschool by parents and trained staff for 25 or more hours per week, and in inclusive preschool programs where children with autism participate in group educational experiences with their individual teaching needs embedded into the classroom structure and delivered by trained personnel. For many preschoolers, their interventions across the week contain a mix of parent delivered ESDM in natural routines at home, delivery in some group programs, delivery during speech/language therapy and/or OT sessions, and additional 1:1 teaching at home or at preschool from trained personnel. Our research program on ESDM is examining several different applications of ESDM to determine its efficacy and effectiveness in various delivery formats.
One primary study is continuing at the University of Washington, initiated under the leadership of Dr. Geraldine Dawson and now under the direction of Dr. Annette Estes. The study, funded by the National Institute of Mental Health, NIMH STAART #U54 MH66399, involves a randomized controlled trial of ESDM compared to ongoing community interventions for 48 children with ASD. These children began the study by 30 months of age and participated for a 24 month period. The children randomized to the treatment receive 20 hours per week of ESDM in their homes delivered by project staff, and an additional 5 or more hours per week of ESDM from their parents.
A second research project now getting underway involves a multisite replication of the University of Washington study, involving three sites, Seattle (University of Washington, Dr. Annette Estes) , Ann Arbor, Michigan (University of Michigan, Dr. Catherine Lord), and Sacramento (University of Davis, the MIND Institute, Dr Sally Rogers). Similar in design to the previous UW study, this also involves a randomized design, with 108 children to be enrolled across the three sites, between the ages of 12 and 24 months. This project will examine predictors and mediators of treatment response, and will seek to replicate the efficacy of ESDM in minimizing developmental impairment and severity of ASD.
A third research study, currently in press in the journal Autism, was conducted by Dr. Laurie Vismara here at the MIND Institute and examined the use of ESDM by parents. Toddlers with ASD and their parents attended 12 one hour sessions shortly after initial diagnosis. During the sessions the parents were taught to carry out the ESDM teaching techniques, one topic per week, and asked to carry out the particular technique at home during natural caretaking and play routines. Weekly data gathered during each session demonstrated that all parents acquired the teaching techniques, generally within 6 weeks or so, and that over the course of the treatment period and the 3 month follow up, children demonstrated steady increases in their spontaneous use of words, imitation of play and language, and their attention to and initiations with their parents.
A final study currently underway, again led by Dr. Vismara, is examining the success of teaching others to carry out ESDM and use it in typical community intervention programs – a study of treatment effectiveness. This study involves teams at four different sites across the country – a public school setting, a university clinic, a children’s hospital, and a specialized autism intervention center. We are piloting the use of telecommunications technology to determine whether personnel can be trained to fidelity in the model at long distance, and whether children and parents show the kinds of gains that occur in our university based settings.
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