Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., & Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics, 125(1), e17-23. https://doi.org/10.1542/peds.2009-0958

Type of Study: Randomized controlled trial
Number of Participants: 48

Population:

• Age — 18–30 months
• Race/Ethnicity — 73% White, 15% Multiracial, 13% Asian, and 13% Latino
• Gender — Male-to-Female Ratio: 3.5:1
• Status — Participants were recruited through pediatric practices, Birth to Three centers, preschools, hospitals, and state and local autism organizations.

Location/Institution: Greater Seattle region

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of the Early Start Denver Model (ESDM). Participants were randomly assigned to 1 of 2 groups: (1) ESDM intervention or (2) referral to community providers for intervention commonly available in the community. Measures utilized include the Autism Diagnostic Interview-Revised, the Autism Diagnostic Observation Schedule (ADOS), the Mullen Scales of Early Learning (MSEL), the Vineland Adaptive Behavior Scales (VABS), and the Repetitive Behavior Scale (RBS). Results indicate that compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved compared to the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group. Limitations include lack of follow up and generalizability due to gender and ethnicity.

Length of controlled postintervention follow-up: None.

Dawson, G., Jones, E. J. H., Merkle, K., Venema, K., Lowy, R., Faja, S., Kamara, D., Murias, M., Greenson, J., Winter, J., Smith, M., Rogers., S. J., & Webb, S. J. (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. https://doi.org/10.1016/j.jaac.2012.08.018

Type of Study: Randomized controlled trial
Number of Participants: 48

Population:

• Age — 18-30 months
• Race/Ethnicity — 72.9% White, 14.6% Multiracial, 12.5 % Asian, and 12.5% Latino
• Gender — Male-to-Female Ratio: 3.5:1
• Status — Participants were children with a diagnosis of an autistic disorder or a pervasive developmental disorder (PDD) not otherwise specified.

Location/Institution: Not Specified

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Dawson et al. (2010). The purpose of the study was to report on a secondary outcome measurement from the Dawson et al. (2010) trial, EEG (electroencephalogram) activity. Participants were randomly assigned to receive the Early Start Denver Model (ESDM) or referral to community intervention for 2 years. After the intervention (age 48 to 77 months), EEG activity (event-related potentials and spectral power) was measured during the presentation of faces versus objects. Age-matched typical children were also assessed. Measures utilized include the Autism Diagnostic Interview–Revised, the Autism Diagnostic Observation Schedule (ADOS), the Mullen Scales of Early Learning (MSEL), the Vineland Adaptive Behavior Scales (VABS), the PDD Behavioral Inventory (BI) and an EEG assessment. Results indicate that the ESDM group exhibited greater improvements in autism symptoms, IQ, language, and adaptive and social behaviors than the community intervention group. The ESDM group and typical children showed a shorter Nc latency and increased cortical activation when viewing faces, whereas the community intervention group showed the opposite pattern (shorter latency event-related potential [ERP] and greater cortical activation when viewing objects). Greater cortical activation while viewing faces was associated with improved social behavior. Limitations include lack of follow up, small sample size, and lack of generalizability due to ethnicity and gender.

Length of controlled postintervention follow-up: None.

Estes, A., Munson, J., Rogers, S. J., Greenson, J., Winter, J., & Dawson, G. (2015). Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 54(7), 580–587. https://doi.org/10.1016/j.jaac.2015.04.005

Type of Study: Randomized controlled trial
Number of Participants: 39

Population:

• Age — 18–30 months at intake (current age: Mean=72.9 months)
• Race/Ethnicity — 72% Caucasian
• Gender — 30 Male and 9 Female
• Status — Participants were children diagnosed with an autism spectrum disorder (ASD).

Location/Institution: University of Washington

Summary: (To include basic study design, measures, results, and notable limitations)
The study used a subset of the sample from Dawson et al. (2010). The purpose of the study was to examine evidence for the sustained effects of early intervention based on a follow-up study of children with ASD who began participation in a study testing the effectiveness of the Early Start Denver Model (ESDM) at age 18-30 months. Participants were randomized to either ESDM or community-intervention-as-usual (COM). Measures utilized include the Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule-WPS (ADOS-WPS), Differential Ability Scales (DAS) School Age Level, the Mullen Scales of Early Learning (Mullen), the Vineland Scales of Adaptive Behavior (VABS), the Aberrant Behavior Checklist (ABC), and the Repetitive Behavior Scale-Revised (RBS-R). Results indicate that the ESDM group, on average, maintained gains made in early intervention during the 2-year follow-up period in overall intellectual ability, adaptive behavior, symptom severity, and challenging behavior. No group differences in core autism symptoms were found immediately posttreatment; however, two years later, the ESDM group demonstrated improved core autism symptoms and adaptive behavior as compared with the COM group. The two groups were not significantly different in terms of intellectual functioning at age 6. Limitations include the COM study design, children in both groups received non-randomly assigned intervention of differing types and intensities during the follow-up period, small sample size, and lack of generalizability due to gender and ethnicity.

Length of controlled postintervention follow-up: 18 and 30 months.