How do ESDM developmental targets compare with ABA skill targets for autism? 

Early years support for autistic children in the UK is framed around play, communication and everyday life, rather than specific brand-name programmes. According to the NHS, children are helped through communication support, routines, sensory adjustments and school input, while NICE recommends play-based social-communication interventions and functional behavioural support rather than endorsing particular packages like ABA or ESDM. 

This article looks at how the Early Start Denver Model (ESDM) and Applied Behaviour Analysis (ABA) differ in what they target, how they teach and what the research suggests, with a UK lens. 

Understanding the concept 

The NHS describes autism as a lifelong developmental difference affecting communication, social interaction, flexible thinking and sensory processing. It suggests families focus on helping children communicate, manage day-to-day life and feel comfortable at home and school, not on “curing” autism or following one branded programme. 

ESDM is a Naturalistic Developmental Behavioural Intervention (NDBI) designed for toddlers and preschool children. It combines developmental and relationship-based goals such as joint attention, shared affect, imitation and play with behavioural tools like prompting and reinforcement, but all embedded in play and everyday routines. The curriculum targets social engagement, language, play and adaptive skills in a way that follows the child’s developmental profile rather than a fixed list of behaviours. 

ABA, in contrast, is a broader behaviour-analytic framework. Programmes such as Early Intensive Behavioural Intervention (EIBI) use structured teaching, task analysis and reinforcement to build specific, observable skills: imitation, receptive and expressive language, self-care routines, academic readiness and reduction of “challenging” behaviour. Goals are often broken into small steps and taught through repeated practice. 

In simple terms: ESDM starts from developmental milestones and relationships, while ABA starts from measurable behaviours and skills. 

Evidence and impact 

ESDM and developmental outcomes 

The landmark ESDM trial by Dawson and colleagues randomised 48 toddlers aged 18 to 30 months to two years of intensive ESDM or community treatment. Children receiving ESDM showed larger gains in IQ, language and adaptive behaviour and reductions in autism symptom severity than those receiving usual community care. 

A later multisite trial found that ESDM again supported cognitive and language development, though effect sizes were smaller and more variable, which is more typical of real-world practice. Parent-implemented ESDM (P-ESDM) has been shown to improve parent synchrony and shared affect, with more mixed child-level effects when intensity is low. 

Umbrella and meta-analytic work that groups ESDM within NDBIs suggests moderate benefits for social communication and language, particularly in caregiver–child interaction, with more modest or mixed effects on broader IQ and adaptive composites. 

ABA and skill acquisition 

Meta-analyses of ABA-based early intensive programmes show consistent gains in composite scores such as IQ and adaptive behaviour. Eldevik and colleagues in PubMed reported large effects on IQ and moderate effects on adaptive behaviour when comparing EIBI with eclectic services. A Cochrane-style review found that EIBI improved IQ and adaptive behaviour by around 7 to 10 points on average, but rated the certainty of evidence as low because many studies were non-randomised and older. 

The NIHR Health Technology Assessment on ABA-based early interventions concluded that such programmes “may improve intelligence, communication, social and life skills more than standard approaches”, while stressing that evidence is heterogeneous and long-term outcomes remain uncertain. 

More recent RCT-only meta-analyses suggest that ABA-based interventions improve some aspects of socialisation, communication and expressive language, but findings are weaker or non-significant for receptive language and adaptive behaviour when lower-quality studies are excluded. 

Indirect comparisons 

Project AIM, a large meta-analysis of early autism interventions, categorised programmes into behavioural/EIBI, NDBIs (including ESDM) and developmental models. Behavioural interventions tended to show stronger effects on cognitive and adaptive outcomes, while NDBIs showed more reliable benefits for social communication and language, especially on the specific behaviours targeted. 

Direct head-to-head trials of full ESDM versus full EIBI are not yet available. Existing comparative work suggests naturalistic, developmental models can match or occasionally outperform highly structured ABA for social-communication goals, but the data are limited. 

Practical support and approaches 

In day-to-day life, families in the UK are more likely to be offered principle-based support than a labelled ESDM or ABA programme. 

The NHS recommends helping children by using simple language, visual supports, breaking tasks into steps, building in predictable routines and using play and everyday activities to support learning. Local NHS services often coach parents to follow the child’s lead in play, take turns, create natural reasons to communicate and stop when the child has had enough. 

NIICE guidance for children and young people recommends a “specific social-communication intervention” that uses play-based strategies with parents and teachers to increase joint attention, engagement and reciprocal communication, closely echoing ESDM-style developmental targets. 

At the same time, NICE recommends that behaviour that challenges is addressed with psychosocial interventions “based on behavioural principles and a functional assessment of behaviour”, with clear target behaviours and agreed outcomes and a schedule of reinforcement where appropriate. That aligns with ABA-style functional analysis, but embedded within a Positive Behaviour Support framework. 

The National Autistic Society (NAS) stresses that communication support should reduce barriers and enhance participation, and that play-based social learning should increase adults’ sensitivity to each child’s communication style rather than push them to appear “less autistic”. 

Challenges and considerations 

There are several important limitations. 

• Evidence quality and gaps. ESDM and other NDBIs have fewer RCTs than the broader ABA literature, and sample sizes are often modest. ABA/EIBI meta-analysis draw on more studies, but many are non-randomised, pre-CONSORT and clinic-based, which weakens confidence in the size and generalisability of effects. 

• Outcome focus. ABA research typically prioritises IQ, language test scores and adaptive behaviour composites, with less focus on emotional development, self-advocacy or long-term wellbeing. ESDM studies measure autism symptom severity and social-communication more closely, but long-term quality-of-life data and autistic-reported outcomes are still limited. 

• Ethical considerations. NICE and NAS emphasise that interventions should be person-centred, rights-respecting and aim to improve quality of life, not to erase autistic traits. Behavioural principles such as reinforcement can be helpful when used transparently and collaboratively, but many autistic adults have raised concerns about experiences of compliance-focused programmes. This is one reason UK guidance avoids endorsing any brand outright. 

How services can help 

Within UK pathways, the practical question is usually not “ESDM or ABA?” but what mix of developmental, communication and behavioural strategies will support this individual child and family. 

Under NICE and NHS guidance, families can expect: 

• Social-communication and play-based input that looks very similar in spirit to ESDM developmental targets: joint attention, engagement, shared play and natural communication in routines. 

• Functional behaviour support informed by behavioural principles, where specific behaviour goals are agreed together and linked to quality of life, not just compliance. 

• Communication-supportive, sensory-aware environments, and adjustments at home and school, as emphasised by the NHS and NAS. 

When families are offered programmes that look ABA-like or ESDM-like, helpful questions include: 

• What are the main goals social connection, communication, independence, behaviour reduction? 

• How are goals chosen and reviewed with the child and family? 

• How are play, joy and autonomy protected? 

• How is progress measured beyond test scores? 

Takeaway 

ESDM and ABA both draw on learning theory, but they point in different directions. ESDM focuses on developmental targets such as joint attention, shared affect and flexible play, aiming to move multiple areas of development forward together in everyday routines. ABA programmes tend to prioritise specific skills and behaviours, using structured teaching and reinforcement to raise IQ, language and adaptive scores. 

Within UK frameworks, NHS, NICE and the National Autistic Society all steer families toward person-centred, play-based social-communication support and functional, rights-based behaviour support rather than any single branded programme. The most important thing is that any intervention respects the child’s autonomy, supports their communication and comfort, and helps them participate in home, school and community life in ways that feel safe and meaningful to them. 

If you or someone you support would benefit from early identification or structured autism guidance, visit Autism Detect, a UK-based platform offering professional assessment tools and evidence-informed support for autistic individuals and families