Randomized, controlled trial of a mixed early start Denver model for toddlers and preschoolers with autism.
Large RCT shows mixed-delivery ESDM beats mixed-DTT for motor, social, and some language skills in autistic toddlers and preschoolers, but only severe kids lose core symptoms.
01Research in Context
What this study did
Researchers randomly assigned toddlers and preschoolers with autism to two groups. One group got the mixed Early Start Denver Model. The other got mixed discrete-trial teaching.
Both groups received the same total hours. Therapists used table work and play in each session. Kids were tested before and after on language, motor, social, and autism symptoms.
What they found
The ESDM group scored higher in motor and personal-social skills. They also made bigger gains in some language areas.
Symptoms only dropped for the most severe toddlers. Kids with mild traits improved the same in both groups.
How this fits with other research
Han et al. (2025) pooled 25 studies and found small gains for ABA overall. Yanyan’s new trial shows bigger, clearer wins when ESDM is stacked against DTT.
Slater et al. (2020) saw that high-intensity DTT helps only mild toddlers. Yanyan agrees: severe kids need ESDM, not more DTT hours.
Vivanti et al. (2016) tracked kids getting standard ESDM and saw no drop in autism severity. Yanyan now shows severity can fall, but only for the severe group and only with mixed ESDM.
Bent et al. (2023) compared group ESDM to EIBI and found attention predicts success. Yanyan adds severity as a second key marker for choosing ESDM over DTT.
Why it matters
You now have an RCT to show funders why ESDM beats DTT for motor, social, and language goals in young clients. Check intake severity: if scores are high, push for ESDM; if mild, either program works. Track motor and social domains—they move first.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Score autism severity at intake; if severe, schedule mixed ESDM blocks and add extra motor and social targets.
02At a glance
03Original abstract
The early start Denver model (ESDM) has been extensively studied as a promising early intervention approach for young children with autism spectrum disorder (ASD). Various methodological drawbacks from earlier ESDM investigations must be rectified to expand the application scopes. For this purpose, the present study recruited a very large sample of 249 autistic children (aged 24-47 months), and used a randomized controlled design to compare outcomes from a mixed ESDM (M-ESDM) intervention with a mixed discrete trial teaching (M-DTT) intervention which remains one of the most commonly-used programming for early intervention. Over the course of a 12-week period, both groups (i.e., M-ESDM and M-DTT groups) received 25 h of intensive intervention per week using individual, group, and parent coaching techniques. Findings showed that: (i) the M-ESDM significantly outperformed the M-DTT in enhancing children's developmental abilities in gross motor and personal-social skills for toddlers and preschoolers, as well as in language for preschoolers with mild/moderate ASD and toddlers; and (ii) the M-ESDM dramatically reduced the severity of autistic symptoms in toddlers with severe ASD only, when compared to the M-DTT. However, the M-ESDM did not outperform the M-DTT in terms of improving children's developmental abilities in adaptability and fine motor for toddlers and preschoolers, as well as in language for preschoolers with severe ASD. In addition, when compared to the M-DTT, the M-ESDM did not show an advantage in reducing the severity of autistic symptoms in toddlers with mild/moderate ASD and preschoolers. Clinical Trial Registration: Chinese Clinical Trial Registry. Registration number ChiCTR200039492.
Autism research : official journal of the International Society for Autism Research, 2023 · doi:10.1002/aur.3006