Predictors of Developmental and Adaptive Behaviour Outcomes in Response to Early Intensive Behavioural Intervention and the Early Start Denver Model
Kids who can already focus a little gain more non-verbal skills in group ESDM than in one-to-one EIBI.
01Research in Context
What this study did
Bent et al. (2023) compared two full-day preschool programs for kids with autism. One class used the group-based Early Start Denver Model (G-ESDM). The other used one-to-one Early Intensive Behavioral Intervention (EIBI).
Both groups got 20-plus hours a week for one year. The team tracked which kids gained the most in language, play, and daily-living skills.
What they found
Every child made gains, but the story changed when the team looked at baseline attention. Kids who could sit and focus for even short periods at intake shot ahead in non-verbal skills in G-ESDM. The same attention edge did not boost EIBI kids more.
In plain numbers: strong attention plus G-ESDM equaled the biggest non-verbal leap.
How this fits with other research
Yang et al. (2023) ran a large RCT the same year. They also saw ESDM beat mixed DTT in motor and social skills, but only for kids with severe symptoms. Bent’s quasi-experiment adds a new twist: attention, not severity, decides which program wins.
Laister et al. (2021) showed that kids who entered ESDM with richer gestures later talked more. Bent swaps the predictor—attention instead of gestures—and shows the payoff is in non-verbal IQ, not language.
Eldevik et al. (2026) will pool 15 studies and call EIBI a solid bet for most kids. Bent agrees, but flags one case where G-ESDM pulls ahead: when the child walks in already able to focus.
Why it matters
If a preschooler can sustain attention for table toys or circle time for even two minutes, think G-ESDM first. You will likely see faster non-verbal gains than in a traditional 1:1 EIBI room. For kids who can’t yet sit still, either program works—so choose based on staffing, cost, or family fit. Add a quick attention probe at intake; it takes five minutes and tells you which class to recommend Monday morning.
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02At a glance
03Original abstract
Many autistic children require support to meet their learning needs. Given the heterogeneity within the autism spectrum it is plausible that different types of support might be better suited to different children. However, knowledge on what interventions work best for which children is limited. We examined the outcomes of autistic preschool-aged children receiving one of two community early intervention approaches. Our main objective was to understand which baseline child characteristics might be associated with the degree of individual response to intervention—whether prognostically (i.e., irrespective of intervention received) or predictively (i.e., specifically in the context of one or other EI approach). Participants comprised two matched groups of preschool-aged autistic children receiving either Group-based Early Start Denver Model (G-ESDM; n = 42) delivered in a 1:3–4 staff:child ratio or an Early Intensive Behavioural Intervention (EIBI; n = 40) delivered in combination of 1:1 and 1:2 staff:child ratio. Over an approximate one-year follow-up period, children in both groups made significant gains in Developmental Quotient (DQ) scores, and trend-level gains in adaptive behaviour composite scores. Higher attention to a playful adult measured via an eye-tracking task was prognostically indicative of better verbal DQ and adaptive behaviour outcomes for the cohort overall. Moderation analyses indicated a single predictive effect—of pre-program sustained attention for subsequent NVDQ outcomes specific to those children receiving G-ESDM. These findings suggest that fine-grained measures of learning skills offer promise towards the selection and tailoring of intervention approaches to meet individual children’s learning needs. The online version contains supplementary material available at 10.1007/s10803-023-05993-w.
Journal of Autism and Developmental Disorders, 2023 · doi:10.1007/s10803-023-05993-w