1. Woodbridge Autism Center, PLLC
Katherine S. Davlantis, Ph.D., LCSW, BCBA
Director, Woodbridge Autism Center, PLLC

2. Outline Introduction Autism Spectrum Disorder (ASD)
Early Start Denver Model (ESDM) Background and Treatment Practices
Research on ESDM
Our Center

3. I. Introduction

4. Introduction Education: Licensures and certifications:
Master’s degree in Social Work (USC)
Ph.D. in Human Development (UC Davis)
Licensures and certifications:
LCSW
BCBA
Primary experiences:
CARD
Therapeutic preschool
MIND Institute
Duke Center for Autism and Brain Development
Woodbridge Autism Center, PLLC

5. II. ASD

6. What is ASD?
General term for a group of complex disorders of brain development
Difficulties in social communication and social interaction
Restricted and repetitive behavior, interests, and/or activities

7. Prevalence Affects 1 out of 68 American children (CDC)
Ten-fold increase in prevalence in past 40 years
At least partly explained by improved diagnosis and awareness
4-5 times more common in boys than girls

8. Causes
No one cause
Some rare genetic mutations sufficient to cause ASD
Most cases caused by combination of ASD risk genes and environmental factors influencing early brain development
Advanced parental age at time of conception
Maternal illness during pregnancy
Certain difficulties during birth (e.g., oxygen deprivation)
Lack of prenatal vitamins and/or folic acid
Exposure to pesticides and air pollution
Only moderately increase risk in combination with genetic risk factors

9. DSM-5 Diagnostic Requirements
Social Communication and Social Interaction
Restricted, Repetitive Behavior, Interests, Activities
Deficits in social-emotional reciprocity
Deficits in nonverbal communication
Deficits in developing, maintaining, and understanding relationships
Stereotyped or repetitive motor movements, use of objects, or speech
Insistence on sameness or ritualized patterns of verbal or nonverbal behavior
Highly restricted, fixated interests
Hyper- or hyporeactivity to sensory input

10. III. ESDM Background and Treatment Practices
Will include overview, groundings, aims

11. Overview Comprehensive model designed for intensive delivery
Geared toward children months
Developmental approach with behavioral elements
Relationship- and play-based
Specific developmental curriculum and a specific set of teaching procedures
Specific developmental curriculum that defines the skills to be taught at any given time, and a specific set of teaching procedures used to deliver the curriculum.

12. Broad Goal ESDM seeks to:
Stop negative cascade of effects over time
Increase child’s social learning
Bring child into interactive social relations for most waking hours
Intensive teaching to fill in learning deficits
Shape brains and behaviors

13. Reaching the Goal Designed to…
Engage child in positive emotional experiences with another person
Draw child’s attention to social stimuli
Make social stimuli rewarding for child
Foster child’s motivation to continue such activities
Shape neural networks into patterns of greater sensitivity and responsivity to social partners than objects

14. Background Explosion of knowledge about how infants and toddlers learn
Infant-toddler years: great plasticity and change
Earlier diagnosis of ASD
ESDM uses knowledge about how a typical infant/toddler develops to facilitate a similar developmental trajectory in young infants/toddlers at risk for or with ASD

15. Logistics Teaching contexts Goals Materials
Setting
Specific, Yet Flexible
Can be used in many settings:
Group programs
Home programs
Preschools
Community
Clinic
Daycare
Can be delivered by:
Parents
Trained therapists across disciplines
Teaching contexts
Goals
Materials
Not tied to a specific delivery setting

16. Basic Treatment Practices
Teaching embedded inside play or caretaking activities
Multiple objectives across domains
High rate of teaching
Teaching practices melded together from ABA, PRT, and the Denver Model
Core teaching practices defined in fidelity system
High rate of teaching important because the children have a great deal of learning to do to fill in the gaps that have accumulated…limited window to do so

17. Joint Activity Routines
Activity in which two partners are engaged with each other in the same cooperative activity
Attending to same objects
Playing or working together on common activity
Partners may be…
Imitating each other
Building something together
Taking turns at same activity
Partners actively construct activity together
Frames for teaching in ESDM
Social element of JAR is the richest teaching tool
An ESDM treatment session involves a series of JARs.

18. Joint Activity Routines, Continued
What Happens?
Phases
Partners…
Look at each other
Give each other materials
Imitate each other
Communicate with each other
Share smiles and fun
Opening/set-up
Theme
Elaboration
Closing

19. Teaching Inside Joint Activity Routines
Teaching occurs in the adult response to the child initiation
Adult may provide a model, a word, a gesture, or some other cue that serves as the stimulus for the child behavior that will follow
Teaching occurs in prompts
If needed, to ensure that the child responds to the antecedent stimulus with a target behavior
Teaching occurs in the delivery of the positive consequence that follows the child response
Scenario: child approaches material (initiation) and may reach for it. Adult picks it up and labels it (language model) and then waits for a targeted communicative behavior (e.g., point, word). If needed, adult prompts. Child engaged in communicative behavior and then adult hands over material (reinforcement/positive consequence). Can repeat with each piece of material if multiple components.
Then move into jointly constructing play theme. Platform for several objectives to be targeted (play, motor, cognitive, imitation, etc.). Adult creates multiple learning opportunities within the child-led activity, providing antecedents, prompting when needed, and providing natural positive consequences when targeted act performed. Turn-taking and co-construction lead to elaboration and targeting of varied objectives.

20. IV. Research on ESDM

21. Efficacy of ESDM
Several studies demonstrating efficacy of Denver Model and ESDM
Earlier Denver Model studies used pre-post designs
More recent studies use highly-regarded experimental methods
Single-subject designs with efforts to establish causality (e.g., randomization)
RCTs

22. Dawson et al. (2010) National Institute of Mental Health-funded RCT
48 toddlers with autism, aged months
ESDM group: 25 hours per week for two years
Control group: community services

23. Dawson et al. (2010) Results
ESDM group showed significantly improved Mullen scores compared to control group (19.1 points vs. 7.0 points)
Growth in receptive and expressive language
ESDM group showed extra 10-point improvement on Vineland Adaptive Behavior Scales (0.5 point increase vs point decrease)
ESDM children significantly more likely to have improved diagnostic status

24. Dawson et al. (2012)
Same sample as previous study, plus age-matched typically-developing children
EEG activity during viewing of faces versus objects
ESDM group showed similar pattern as typical group
Increased activation to faces
Control group showed opposite pattern
Increased activation to objects
Greater cortical activation while viewing faces associated with improved social behavior
First study to demonstrate that early behavioral intervention associated with normalized patterns of brain activity, (which is associated with improvements of social behavior)

25. Additional Research Long-term follow-up of Dawson et al. (2010)
Estes et al. (2015)
Parent training and parent delivery of ESDM
E.g., Rogers et al., 2012
ESDM for infants
E.g., Rogers et al., 2014
ESDM in group settings
E.g., Vivanti et al., 2014
E.g., Eapen, Crnec, & Walter, 2013

26. V. Our Center

27. Our Mission
At Woodbridge Autism Center, PLLC, we are dedicated to improving the lives of individuals diagnosed with autism spectrum disorder through the provision and dissemination of high-quality early intervention services. We believe strongly in celebrating the talents and gifts that individuals with autism spectrum disorder offer, and we aim to recognize those gifts while working to maximize development. We ground our work in scientifically-sound approaches, and are proud to offer a variety of evidence-based early intervention services.

28. Our Services Current: Future: One-on-one child therapy Parent coaching
ESDM training for professionals
Future:
Diagnostic services
Internship programs

29. Contact Information