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Tracking Progress in ESDM Therapy: What Milestones to Expect

The Early Start Denver Model (ESDM) is an evidence-based, play-centered therapy designed to support young autistic kids in achieving key developmental milestones. By focusing on social, cognitive, language, and motor skills, ESDM promotes overall development and helps children learn in ways that are meaningful and natural. But how can parents and therapists effectively track progress in ESDM therapy, and what milestones should they expect?

This blog post provides an overview of how progress is monitored in ESDM and highlights important developmental milestones that both parents and practitioners can look for during therapy.


ESDM is designed for children between 12 to 48 months and involves a blend of behavioural principles with play-based, relationship-focused strategies. This model emphasises positive reinforcement, naturalistic teaching methods, and building the child’s ability to interact with others through play and everyday activities. Therapy sessions are tailored to meet each child's specific developmental needs, with the aim of advancing social, language, and cognitive skills.


Tracking progress in ESDM therapy involves close observation of the child’s abilities over time, collaboration between parents and therapists, and regular assessments to ensure that goals are being met. Here's how therapists and parents can monitor a child’s progress:

  1. Initial Assessment and Goal Setting The process starts with a detailed assessment to identify the child’s strengths, areas of need, and developmental delays. This helps create a baseline, allowing therapists to design a personalised treatment plan. Goals are set across multiple developmental domains, including social interaction, communication, imitation, play, fine and gross motor skills, and adaptive behaviors.

  2. Ongoing Data Collection During each therapy session, practitioners collect data on the child’s responses and behaviors. These observations help track the child’s ability to meet the specific targets set in their treatment plan. This data is crucial for identifying which strategies are effective and which may need to be adjusted.

  3. Parent Involvement Parents play a vital role in ESDM therapy by continuing strategies and practices at home. They help monitor progress by noting their child’s behavior and skill development outside of therapy sessions. Regular communication between therapists and parents is essential to ensure consistency across environments.

  4. Progress Reviews and Adjustments Regular reviews, often conducted every three months, assess how well the child is progressing toward the goals. During these reviews, practitioners may adjust the treatment plan to focus on new skills or refine strategies for areas that require more support. The therapy is flexible and dynamic, adapting to the child’s evolving needs.


Each child progresses at their own pace in ESDM therapy, but certain developmental milestones typically indicate that the therapy is working as intended. Here are the main domains to track and the corresponding milestones you might observe:


1. Social Interaction Milestones
  • Increased Eye Contact: One of the earliest signs of progress in ESDM therapy is improved eye contact with others during play or interaction.

  • Joint Attention: The child starts to share focus on objects or activities with another person, a crucial skill for learning from social interactions.

  • Turn-Taking: The child may begin to engage in simple back-and-forth exchanges during play, such as taking turns with toys or participating in social games.

  • Showing and Sharing: Expect to see the child initiate social interactions by showing toys or sharing activities with others.


2. Language and Communication Milestones
  • Use of Gestures: Before spoken language, many children begin to use gestures such as pointing, waving, or nodding to communicate their needs and interests.

  • Verbal Imitation: As the child progresses, they may start to imitate simple words and sounds during interactions.

  • Spontaneous Communication: Over time, children often begin to use words, phrases, or signs independently to request items or express their needs.

  • Understanding and Following Instructions: The ability to comprehend simple directions, like “come here” or “give me,” is a key language milestone in ESDM therapy.


3. Cognitive and Play Milestones
  • Imitation of Play Behaviors: Early on, children may begin to copy simple actions during play, such as stacking blocks or rolling a ball.

  • Pretend Play: The emergence of pretend or symbolic play, such as pretending to feed a doll or play with toy animals, is a sign of growing cognitive and social understanding.

  • Problem-Solving Skills: As therapy progresses, children develop the ability to solve simple problems, like figuring out how to fit shapes into a sorter or how to stack objects to reach a goal.


4. Motor Skills Milestones
  • Fine Motor Skills: Improvements in fine motor control, such as the ability to grasp small objects, hold a crayon, or manipulate toys, are often seen as early progress in therapy.

  • Gross Motor Skills: Therapists track the development of skills like walking, climbing, running, and balancing, which indicate the child is gaining better control over their larger muscle movements.


5. Adaptive Behavior Milestones
  • Self-Help Skills: ESDM therapy also targets adaptive behaviors, such as dressing, feeding, and toileting. Progress in this area might include putting on shoes, feeding with a spoon, or washing hands.

  • Independence: Gradual increases in the child’s ability to engage in activities independently, such as playing alone for short periods or following a simple routine, are key indicators of growth.


Recognising and celebrating even the smallest milestones can be incredibly motivating for both the child and their support team. Here’s how parents and therapists can celebrate progress:

  • Verbal Praise and Encouragement: Consistent, enthusiastic praise reinforces the child’s successes and encourages continued effort.

  • Documenting Progress: Keeping a progress journal, taking photos, or even making short videos of key moments can help visualize the child's development and give a sense of how far they’ve come.


Tracking progress in ESDM therapy requires close collaboration between parents and therapists, a commitment to data-driven methods, and an understanding of the milestones that signal growth. Remember, each child develops at their own pace, and progress may not always follow a linear path. By remaining flexible and focused on the child's individual needs, you can support meaningful developmental gains through ESDM therapy. Milestones in social interaction, communication, play, motor skills, and adaptive behavior give valuable insights into the child's progress. Celebrate these achievements along the way, no matter how small, as they are all important steps on the path toward greater independence and engagement with the world around them.

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