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Therapy Decision Guide

Early Start Denver Model (ESDM) for Autism in Ontario

The Early Start Denver Model (ESDM) is a naturalistic developmental behavioural intervention for autistic children aged 12 to 48 months. Developed by Sally Rogers and Geraldine Dawson, ESDM integrates applied behaviour analysis with developmental relationship-based approaches. Randomized controlled trials published in Pediatrics (2010) demonstrated significant gains in IQ, adaptive behaviour, and reduced autism symptom severity.

Evidence review in progress · May be OAP-covered

Direct answer

The Early Start Denver Model (ESDM) is a naturalistic developmental behavioural intervention for autistic children aged 12 to 48 months. Developed by Sally Rogers and Geraldine Dawson, ESDM integrates applied behaviour analysis with developmental relationship-based approaches. Randomized controlled trials published in Pediatrics (2010) demonstrated significant gains in IQ, adaptive behaviour, and reduced autism symptom severity.

Dawson et al. (2010) · Dawson et al. (2012) · Rogers et al. (2012) · Verified 2026-08-20

Quick summary

In brief

ESDM, Quick Summary

  • This page is general information, not an individualized treatment recommendation.
  • Evidence labels summarize the page sources and should not replace clinical judgment.
  • Confirm provider credentials, coverage, goals, monitoring, alternatives, and fees before starting.

General information only, not a diagnosis, treatment plan, crisis service, or individual estimate. Confirm your next step with the linked source or a qualified professional.

At a glance

Evidence level
Evidence review in progress
OAP funding
Eligible under OAP core clinical services
Typical cost
Provider fees vary by setting; request a current written quote
Typical frequency
Individual plan varies; confirm the schedule with a qualified clinician
Target age range
Age suitability varies; confirm fit with a qualified clinician

OAP Coverage Note

OAP eligibility depends on current program rules, the funded service category, and the provider's credentials. Confirm coverage with AccessOAP or your service coordinator before committing to care.

Who provides this therapy

Provider credential check
Ask any prospective provider which of these credentials they hold, and confirm the credential with the relevant regulatory college before starting.
Credentials listed for this therapy
  • Board Certified Behavior Analysts (BCBA)
  • Registered Behaviour Technicians (RBT)
  • ESDM-certified therapists
  • Developmental psychologists

How ESDM Works

ESDM uses play-based activities embedded in natural routines to teach cognitive, language, social, and motor skills. Therapists follow the childs interests and motivation while systematically targeting developmental objectives from a curriculum checklist covering receptive communication, expressive communication, social skills, fine and gross motor skills, and personal independence.

Unlike traditional discrete trial training, ESDM sessions look like play. The therapist creates engaging interactions where learning opportunities emerge naturally. Each session targets multiple developmental domains simultaneously, reflecting how young children actually learn — through relationships and exploration rather than isolated drills.

In Ontario, ESDM is typically delivered in a combination of clinic-based and home-based sessions. Parents receive coaching to implement strategies throughout daily routines, which research shows amplifies therapy gains and supports generalization of skills across settings.

Research Evidence

The landmark 2010 randomized controlled trial by Dawson et al., published in Pediatrics, found that children receiving ESDM for two years showed significantly greater improvements in IQ (averaging 17.6 points), adaptive behaviour, and autism diagnostic scores compared to the community-intervention control group. Brain imaging studies also showed normalized patterns of neural activation in response to social stimuli.

A 2012 Dawson et al. paper reported changes in brain activity after early behavioural intervention. Claims about maintained gains and Australian or Canadian replications need source-level review before they are used here.

Evidence and sources

  1. Dawson et al. (2010)

    Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), e17-e23.

  2. Dawson et al. (2012)

    Early behavioral intervention is associated with normalized brain activity in young children with autism. Journal of the American Academy of Child & Adolescent Psychiatry, 51(11), 1150-1159.

  3. Rogers et al. (2012)

    Effects of a brief Early Start Denver Model (ESDM)-based parent intervention on toddlers at risk for autism. Journal of Autism and Developmental Disorders, 42(12), 2476-2485.

Before you commit

Questions worth asking any provider
  • What certification or regulatory college licenses you to deliver this therapy, and can I verify it?
  • How will you measure progress, and how often will you share results with our family?
  • What does a typical session look like, and can we observe one before committing?
  • How does this approach get adjusted if it is not working after a few months?
  • What happens to our data, our schedule, and our funding if you leave or the practice closes?
Signs to slow down
  • The provider cannot name a regulatory college or certifying body, or asks you not to check it.
  • You are asked to sign a long-term contract before seeing a session or meeting the therapist.
  • Progress is described only in general terms, with no way to see or measure it over time.
  • The provider discourages you from getting a second opinion or asking about other approaches.
  • Fees, cancellation terms, or what OAP funding covers are unclear or change after you sign up.

Frequently asked questions

ESDM-related services may be eligible under OAP when the service, provider, and goals meet current program rules. Confirm eligibility and provider credentials with AccessOAP before committing funds.

ESDM is designed for children aged 12 to 48 months, with research showing the strongest outcomes when started before age 2. The naturalistic play-based approach is specifically tailored to how toddlers learn through social interaction and exploration.

ESDM integrates ABA teaching principles into a naturalistic, play-based format rather than using structured discrete trials. It emphasizes relationship-building, child-led interactions, and targets multiple developmental domains simultaneously within each activity, more closely mirroring natural learning processes.

Where the waitlist stands

Families navigating autism services in Ontario face a documented multi-year wait. Here is the Ontario data — and a two-minute way to push back, when you are ready.

See where the waitlist standsEmail your MPP

Verified references and sources

Official Organizations

  • [2025]
    Autism Spectrum Disorders Fact Sheet (updated September 17, 2025)
    World Health Organization (WHO) • Official • 2025-09-17
    View

Peer-Reviewed Research

  • [2010]
    Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model
    Dawson G, Rogers S, Munson J, et al. (Pediatrics) • Academic • 2010-01-01
    View
  • [2018]
    Early intensive behavioural intervention (EIBI) for young children with autism spectrum disorders (ASD)
    Reichow B, Hume K, Barton EE, Boyd BA (Cochrane Systematic Review) • Academic • 2018-05-09
    View

About this page

Check the author’s context, review method, and how to report an error.

Written by

Founder & Autism Advocate

Lived experience: Parent of autistic child navigating OAP system