Does Treatment Fidelity of the Early Start Denver Model Impact Skill Acquisition in Young Children with Autism?
Ashley Zitter, Hezekiah Rinn, Zofia Szapuova and 5 others
PMID 34855051WHAT IT FOUND
Therapists who followed the Early Start Denver Model protocol more closely helped children with autism learn targeted skills better.
Ten of thirteen specific techniques predicted learning, but managing behavior and modulating arousal did not.
Key findings
01Overall therapist fidelity significantly predicted child learning response, explaining 30% of the variance beyond other factors.
02Ten of the thirteen fidelity techniques were associated with child learning, including managing attention, behavioral teaching, and joint activity routines.
03Three techniques (modulating affect/arousal, managing unwanted behaviors, and providing varied communicative opportunities) showed no significant association with child learning.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study used only the first four teaching episodes from each video, which may not represent the therapist's full skill set or the child's overall progress. The sample was small (16 children, 15 therapists), limiting the power to detect effects for individual techniques. Fidelity items were highly correlated with each other, making it difficult to determine which specific technique drove the learning outcomes. The study measured immediate response to cues during the session, not long-term skill acquisition or standardized outcome changes. Therapists were all newly trained in ESDM for this project, so results may not generalize to experienced ESDM clinicians.
Declared interests
The authors declared no conflicts of interest. The study was approved by the Drexel University Institutional Review Board.
The easy way to misread this
Do not conclude that the three non-significant techniques are unnecessary for ESDM success. The lack of association may be due to the brief video segments used, which might not capture low-frequency behaviors like managing unwanted acts, or the small sample size which limited statistical power for those specific items.