The Early Start Denver Model in the Duke Autism Clinic

The Duke Autism Clinic has offered assessment and therapy services to families for over 10 years. The clinic serves many young children whose families are seeking diagnostic evaluation and therapy. One of the most commonly delivered services is a naturalistic developmental behavioral approach called the Early Start Denver Model (ESDM), where intervention strategies are included in play-based activities and daily routines to support growth in child social, communication and other abilities.

ESDM was co-developed by Geraldine Dawson, PhD, founding director of the Duke Center for Autism and Brain Development, and her colleague Sally Rogers, PhD, distinguished professor emeritus of Psychiatry and Behavioral Sciences at the MIND Institute at the University of California, Davis.

“A large majority of the young children who receive an autism diagnosis are a good fit for ESDM,” says Jill Howard, PhD, director of the Duke Autism Clinic, and an ESDM trainer. A child up to age five at nearly any developmental level can benefit from the strategies used in ESDM, since the approach is individually tailored to each child’s abilities and needs.

ESDM Coaching Empowers Caregivers

The ESDM approach offered in the clinic is more focused on supporting caregivers or parents through coaching than providing direct therapy to the child. The goal of the coach is to equip caregivers with approaches they can use with their child in everyday interactions and routines.

“Caregivers come to us with a lot of great strategies already – this is not ‘Parenting 101,’” said Howard, emphasizing that ESDM coaching offers clinically-proven strategies to support families who care deeply about their autistic children.

At the Duke Autism Clinic, most ESDM caregiver coaching is delivered by clinical psychology trainees. These trainees use ESDM principles in the clinic directly with children and also teach caregivers to incorporate ESDM strategies at home.

Duke clinical psychology doctoral students Armen Bagdasarov and Nicolas Camacho have assisted with autism evaluations for toddlers and young children.

“We look forward to supplementing these experiences by conducting ESDM-informed coaching with families. We have the opportunity, through ESDM, to empower caregivers with strategies to support their children’s development,” said Camacho.

A typical course of coaching is a one-hour session each week for 12 weeks. The clinician works with the caregiver, coaching them through interactions and play activities with their child.

“For the child, it feels like play, while these rich discussions are happening with the family around goals, suggestions, and support,” said Howard.

We have the opportunity, through ESDM, to empower caregivers with strategies to support their children’s development.

- Nicolas Camacho, Duke PhD student in clinical Psychology

The sessions may focus on social skills, communication, imitation, or daily routines such as meal time. The coaches get to know the child and family and identify realistic goals with the families' input.

 Anyone can use these strategies throughout a typical day. It’s meant to be a partnership, and the caregiver is meant to practice these strategies during their regular daily routine.
– Jill Howard, PhD, Director of the Duke Autism Clinic

Families Are Equipped for the Future

At the end of the 12 weeks, coaches have worked with the caregiver on a range of teaching strategies, leaving the family with a full toolkit. Families go home with written materials, book recommendations, and access to video modules that they can refer to later.

“We hope to help caregivers feel more confident in their ability to facilitate progress in their children’s development, and to integrate sustainable, evidence-based strategies into their daily routines. For us, this is really special because caregivers are already engaging in so many meaningful interactions with their children. We are excited to help them make the most out of these interactions based on what we know about child development,” said Bagdasarov.

ESDM therapy is often just one part of a comprehensive support approach. Many children are engaged in additional services including speech, occupational, and behavioral therapies in the community.

The reach of the Duke Autism Clinic’s impact expands when the trainees take the methods they learn here on to their future careers in clinical practice.

We are excited to help caregivers make the most out of these interactions based on what we know about child development.

– Armen Bagdasarov, Duke PhD student in clinical psychology