Early Start Denver Model effectiveness in young autistic children: a large multicentric randomised controlled trial in two European countries
Twelve extra hours of clinic ESDM on top of usual European services did not improve toddlers' developmental scores over two years.
01Research in Context
What this study did
Geoffray et al. (2025) ran a two-year trial in Europe. They added 12 hours of Early Start Denver Model to the usual services toddlers with autism already get. Kids were randomly placed in either the ESDM group or the usual-care group. The team then compared overall developmental scores after 24 months.
What they found
The extra ESDM hours did not raise the children's global developmental quotient. Scores at the end were the same for both groups. In short, more clinic ESDM did not beat regular European services alone.
How this fits with other research
Cook (2010) found the opposite in the U.S.: 20 hours of ESDM for two years gave big language gains. The two trials look like they clash, but dose and setting differ. Geoffray added only 12 hours inside mixed European systems; H used a full 20-hour center model.
Ouyang et al. (2024) pooled 32 trials and still call ESDM helpful. Their meta-analysis includes both center and parent-led forms, showing method and dosage shape results.
Malucelli et al. (2021) got gains with just 12 weeks of parent coaching, no extra clinic hours. This suggests brief, parent-driven ESDM can work when travel and culture fit.
Why it matters
If you work in Europe or similar public systems, do not assume more clinic ESDM will automatically boost scores. Check how many hours you can truly add and how parents are involved. Try starting with parent coaching or blend lower-dose ESDM into visits families already attend. Track each child's response; some may still need higher intensity, but the blanket 12-hour add-on is no sure win.
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02At a glance
03Original abstract
Evidence regarding early interventions based on the Naturalistic Developmental Behavioral Interventions framework, such as the Early Start Denver Model (ESDM), suggests efficacy for autistic children. However, the effectiveness of ESDM across diverse cultural contexts remains under-researched. To assess the effectiveness of ESDM compared with treatment as usual (TAU) on overall development in young children with autism spectrum disorder (ASD). This parallel, randomised controlled trial, using a modified Zelen design, was conducted in five Child and Adolescent Mental Health Services in France and Belgium. A total of 180 children aged 19–36 months, who met autism criteria and were referred by community professionals, were randomly assigned to either receive 12-hour weekly ESDM+TAU or TAU alone. The primary outcome was the change in developmental quotient (DQ) on the Mullen Scale of Early Learning, assessed blindly from baseline to 24 months post randomisation. From September 2015 to March 2019, 180 children were randomly assigned to either ESDM+TAU (n=61, girls=21.7%) or TAU alone (n=119, girls=15.4%). Three children dropped out immediately after randomisation. Compared with TAU alone, children in the ESDM+TAU group did not significantly improve global DQ (endpoint mean difference 3.82 (95% CI −1.25 to 8.89), p=0.14). Our findings suggest that ESDM+TAU cannot be universally recommended for young children with ASD. Further research is required to evaluate the long-term effectiveness of ESDM and identify subgroups that may benefit more, thereby guiding optimal implementation strategies. NCT02608333.
BMJ Mental Health, 2025 · doi:10.1136/bmjment-2024-301424