What are the recommended interventions, such as Early Start Denver Model (ESDM) and Early Intensive Behavioral Intervention (EIBI), for children with Autism Spectrum Disorder (ASD) or significant developmental delays?

Early Intervention for Children with Autism Spectrum Disorder

Yes, both ESDM (Early Start Denver Model) and EIBI (Early Intensive Behavioral Intervention) are strongly recommended evidence-based interventions for young children with autism spectrum disorder, and treatment should begin immediately upon suspicion or diagnosis of ASD with 20-30 hours per week of intensive intervention. 1

Core Recommendation: Start Immediately with High Intensity

Begin intensive intervention as soon as ASD is suspected or diagnosed—do not wait for formal diagnostic completion. 1 The American Academy of Pediatrics emphasizes that interventions initiated before age 3 years have significantly greater impact than those begun after age 5. 1

Treatment Intensity Requirements

• Deliver 20-30 hours per week of child-directed intervention for comprehensive programs like ESDM or EIBI. 1, 2
• Include 5 hours per week of parent education and training as an essential component, enabling parents to function as co-therapists and promote skill generalization across home and community settings. 1, 3
• Treatment intensity significantly contributes to changes across all outcome measures—higher intensity correlates with better outcomes. 2

Evidence Supporting Both ESDM and EIBI

ESDM (Early Start Denver Model)

• ESDM is a comprehensive naturalistic developmental behavioral intervention that integrates Applied Behavior Analysis with developmental science, considered best practice for young autistic children. 1, 4
• ESDM demonstrated significantly improved outcomes in randomized controlled trials, with large effect sizes after 6-8 weeks for joint attention skills and moderate effect sizes after 12 months for expressive language growth. 1
• Recent 2023 research shows ESDM significantly outperformed discrete trial teaching in enhancing gross motor, personal-social skills, and language abilities in toddlers and preschoolers. 5
• ESDM dramatically reduced severity of autistic symptoms in toddlers with severe ASD. 5

EIBI (Early Intensive Behavioral Intervention)

• EIBI (including the UCLA/Lovaas model) showed significantly improved outcomes in randomized controlled trials with therapeutic durations of 2-3 years. 1
• A 2026 meta-analysis of 341 children receiving EIBI demonstrated effect sizes of 0.66 for adaptive behavior, 0.87 for intellectual functioning, and 1.36 for reductions in ASD severity. 2
• Number Needed to Treat ranges from 4.1 to 6.9, meaning for every 4-7 children treated with EIBI, one additional child achieves clinically significant improvement compared to comparison groups. 2
• EIBI should currently be considered the preferred treatment for children with ASD based on broad, substantial effects. 2

Choosing Between ESDM and EIBI: Predictors of Response

Children Who Respond Better to EIBI:

• Higher baseline IQ represents the strongest predictor of positive response to EIBI. 6
• EIBI is more structured and therapist-driven, utilizing discrete trial training approaches. 6

Children Who Respond Better to ESDM:

• Social cognitive skills including intention to communicate, receptive and expressive language, and attention to faces most consistently predict response to ESDM. 6
• ESDM is more naturalistic and child-driven, making it particularly appropriate for very young children. 6, 4

Implementation Framework

Delivery Format Options

• Home-based (parent-managed), center-based (clinic or school), or combination approaches are all acceptable depending on resources and child needs. 1
• Programs for children under 3 years are more likely to use developmental approaches, more intensively involve parents, and target social communication compared to preschool-aged programs. 1

Target Areas for Intervention

Focus on core ASD deficits: 1, 3

• Joint attention skills (large effect sizes achievable after 6-8 weeks) 1
• Social communication and emotional reciprocity 1
• Language skills (receptive and expressive) 1
• Imitation skills 1

Integration of Approaches

Combine developmental and behavioral strategies—the distinction between them is not very helpful as most effective programs blend features of both approaches. 1 Behavioral intervention curricula should be developmentally informed and based on developmental sequences, while developmental programs can use behavioral techniques to teach curriculum. 1

Monitoring and Adjustment

• Reassess within 4-8 weeks of initiating intervention to determine response and adjust intensity and focus based on which specific deficits show improvement. 3
• Individual responses vary—participants who demonstrate gains in some endpoints may continue to show impairment in others. 1
• Continue intensive intervention for at least 12 months, though optimal duration is typically 2-3 years. 1, 2

Critical Pitfalls to Avoid

• Do not delay intervention waiting for formal diagnosis completion—begin as soon as ASD is seriously considered. 1
• Do not provide low-intensity intervention—evidence supports 20-30 hours per week, and treatment intensity significantly contributes to outcomes. 1, 2
• Do not exclude parent training—5 hours per week of parent education is essential for skill generalization. 1, 3
• Do not assume one intervention addresses all deficits—comprehensive programs must target multiple core ASD deficits simultaneously. 3
• Do not overlook that reported group differences may not reflect the range of individual responses—some children show gains in certain endpoints while continuing impairment in others. 1

Recent Evidence (2023-2026)

Both 2023 research demonstrating ESDM superiority over discrete trial teaching 5 and the 2026 meta-analysis showing EIBI's substantial effects 2 support that both models are highly effective when delivered with appropriate intensity (20-30 hours per week). The choice between them should be guided by child characteristics: higher baseline IQ favors EIBI, while stronger social cognitive skills favor ESDM. 6