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Using the Early Start Denver Model for Chilren with Austism Spectrum Disorders Ages 2-3 Years Old in Specialized Schools: Situation and Lession

Nguyen Thi Hien*, Do Thi Thao, Do Xuan Dung, Nguyen Thi Tuyet

Faculty of Special Education, Hanoi National University of Education, 136 Xuan Thuy Road, Cau Giay District, Hanoi, Vietnam

Abstract: Children with Autism Spectrum Disorders (ASD) between the ages of 2 and 3 years old are in the golden phase of early intervention, this is the stage when early interventionists will specify the appropriate intervention direction and intervention services for each child with ASD. The article, which surveyed the current situation of using the Early Start Denver Model (ESDM) to educate children with ASD from 2 to 3 years old in a specialized School with 87 teachers and 98 parents of children with ASD, discovered that: The majority of teachers and parents understood the significance and necessity of using the ESDM for children with ASD. Many instructors and parents, on the other hand, continue to struggle with choosing the most appropriate educational objectives, content, methods and forms. Furthermore, elements such as the educational atmosphere, facility conditions, equipment and family cooperation all have an impact on the educational process. We propose lessons learned based on the current status of using ESDM to help teachers and parents better prepare in the process of applying the model to early intervention for children with ASD.

Keywords: the Early Start Denver Model (ESDM), early intervention, autism spectrum disorder (ASD)

Received April 25, 2021; Revised June 13, 2021; Accepted June 15, 2021

Citation: Nguyen Thi Hien, Do Thi Thao, Do Xuan Dung, Nguyen Thi Tuyet, Using the Early Start Denver Model for Chilren with Austism Spectrum Disorders Ages 2-3 Years Old in Specialized Schools: Situation and Lession. American Journal of Educational Research, 9 (6). 347-357. January 2021. doi:10.12691/education-9-6-4

1. Introduction

Early intervention for children with ASD is a procedure in which educators exert a deliberate, planned, and methodical effect on children and their families in order to help them reach their full potential. This is the stage where the educator will specify the intervention direction and the appropriate intervention services for the children to achieve the optimum intervention effect. There are numerous early intervention programs, contents, and methods available today that bring positive effects to children with ASD, including the PEP program, Small Step program, ABA, TEACCH, ESDM... Many scientists have assessed the applicability and effectiveness of ESDM for children with ASD, including Dawson et al., 2010 [1], Colombi C. et al. (2018) [2], Erika M. et al. (2017) [3], Ryberg KH (2015) [4]. The curriculum checklist and tool description reveal the ESDM's focus. The checklist is divided into four skill stages, each corresponding to a different stage of child development: stages 1 (12-18 months), stages 2 (18-24 months), stages 3 (24-36 months), and stages 4 (36-48 months), includes crucial areas such as receptive communication, expressive communication, social skills, play skills, cognitive skills, gross motor skills, fine motor skills, personal self-care and adaptive behavior, Sally J.Rogers and Geraldine Dawson (2010) [5].

Many studies have been conducted around the world that demonstrate the importance of early detection in the intervention process, as well as the positive impact of ESDM on cognitive ability, language, and behavior of children with ASD: Dawson, et al., in 2010 was conducted on 48 toddlers (aged 18 to 30 months) who participated in the trial divided into two groups: (1) ESDM intervention and (2) community intervention The findings revealed that the children who received the ESDM intervention made significant gains in behavioral management and cognitive ability. After two years of intervention, the children in group (1) improved by 17.6 standard points (1 standard deviation: 15 points) compared to 7.0 points in group (2) and reaffirmed ESDM's superiority [6]. Vismara, LA, and SJ Rogers conducted a study on a 9-month-old infant with autism spectrum disorders in 2008. Parental education and intervention based on ESDM during 12 weeks, 1.5 hours per week. According to the findings of the study, parents who use the right strategies in the process of developing appropriate communication skills, social behavior, and behavioral indicators in their children have clearly improved [7]. Following that, the authors' research Estes, 2015 [8]; Rogers et al, 2012 [9]; Vivanti et al, 2019 [10]; Eapen et al, 2013 [11] was to confirm that ESDM is successful and has long-term effects on children's growth. “When using the ESDM for intervention, the study conducted evaluation on 6-year-old children (children who obtained ESDM intervention after 2 years) found that these children had the capacity to cognitive, affective expression, and interaction were higher than children who intervene in the community,” according to studies (Estes, 2015) [8]. In the group of the writers, studies evaluating the efficacy of ESDM have been conducted. Sinai-Gavrilov et al., 2020 [12]; Waddington, 2016 [13]; Vivanti, 2014 [14]; Zho et al., 2018 [15]. “Children who participate in ESDM have a higher ability to adapt, minimize serious disabilities induced by disorders, and have a higher ability to gain information than other children”, according to the report (Sinai-Gavrilov, 2020) [12]; Studies have shown that children who were treated with the ESDM grew at a faster pace and had better language and cognitive abilities. Waddington et al., 2019 [16]; Vismara et al., 2018 [17] are two studies that use ESDM to educate and assist parents so that they can intervene at home with their children. According to the findings of these studies, ESDM can train parents remotely so that they can develop educational skills and play activities with their children at home. In a joint study of the ESDM (which merges behavioral, developmental, and relationship-oriented intervention) and PROMPT (a neuro-developmental approach for speech production disorders) conducted by Rogers et al. in 2006, it was discovered that the use of ESDM and PROMT has a beneficial impact on children with ASD who do not talk yet.

Most parents often want to know if using ESDM is more costly than using other models and methods. Cidav et al., 2017 [18] examined 39 children with ASD aged between 18 to 30 months before they were 6 years old; these children were divided into two control groups: (1) children using ESDM and (2) community intervention (COM) with services such as ABA, EIBI,… According to the findings, children in the ESDM need less ABA, EIBI, physical therapy, and speech therepy after the intervention than children in the COM. For their families, this equates to around $19,000 in annual savings per child (Cidav et al., 2017) [19].

Thus, in the course of early intervention for children with ASD at the "golden stage" with core improvements in the child's development, ESDM plays an important role and has many positive effects. In Vietnam, there are still many drawbacks and difficulties in ESDM research and implementation. As a result, research is needed to develop measures for implementing ESDM in a realistic manner and achieving high educational effectiveness. Within the framework of this paper, we perform a survey on the current situation of teachers and parents using ESDM for children with ASD between 2 and 3 years old, then indicate the lessons learned in the process of educating children based on the above theoretical and practical issues.

2. Content

2.1. Survey Organization

- Survey purpose: Conduct a survey on the current state of using ESDM in special schools for children with ASD between the ages of 2 and 3 years old, as well as the findings of theoretical studies, to draw lessons learned in the process of teaching children with ASD using ESDM.

- Content of the survey: (1) An assessment of the meaning, goals, contents, approaches, and ways of using ESDM to educate children with ASD between the ages of 2 and 3 years old by teachers and parents; (2) Factors influencing the use of ESDM in the education of children with ASD between the ages of 2 and 3 years old.

- Survey tools: Two survey forms for teachers and parents of children with ASD are used in this paper. Each questionnaire contains closed and open questions designed to collect data, facts, and evaluations about the use of ESDM to educate children with ASD. The questionnaire includes: The teachers' and parents' perceptions of using ESDM to educate children with autism between the ages of 2-3 years old (meaning, goals, content, methods, form) and factors influencing and affecting the process of early intervention education for children with ASD between the ages of 2 and 3 years old.

- Survey method: Questionnaires, observations, interviews, and the data is processed using mathematical statistics.

- Survey location and subjects: The study surveyed 87 teachers and 98 parents of children with ASD who are studying at Anh Sao Mai Kindergarten and Anh Sao Center - Hanoi.

2.2. Survey Results on the Actual Situation of Using ESDM to Early Intervention Children with ASD between the Ages of 2 and 3 Years Old in Special Schools

2.2.1. The Role and Significance of Using ESDM to Early Intervention Children with ASD between the Ages of 2 and 3 Years Old

ESDM is one of the models highly appreciated by both teachers and parents, we conducted a survey of 87 teachers and 98 parents about the role and significance of using this model in early intervention for children with ASD. The results are as shown in Figure 1. We can see from the graph that both teachers and parents agree that ESDM has had a significant impact on the growth of children with ASD between the ages of 2 and 3 years old. For teachers, the model's most important purpose is to help children convey appropriate feelings and proper actions in daily situations, which accounts for 92.3 percent; next, helping children consciously communicate in two-ways in all situations, which accounts for 89.7 percent; helping children learn to play with objects appropriately and take the initiative, which accounts for 86.2 percent; 81.6 percent of the time was spent improving children's understanding and memory of the world around them, 80.5 percent was spent helping children develop communication skills and language, and 79.3 percent was spent helping children develop motor skills. “Although I am new to this program, I believe that it is a fairly effective and comprehensive program that extensively focuses on the development of children's emotions and experiences so that children can learn in all situations, any sense that a child can" - a teacher named H said.

Figure 1. Roles and significance of using ESDM in ealy intervention for children with ASD 2 - 3 years old (Note: 1. Consciously communicate in two-way in all situations. 2. Convey appropriate feelings and proper actions in daily situations; 3. Develop motor skills; 4. Develop communication skills and language; 5. Improving children's understanding and memory of the world around them; 6. Learn to play with objects appropriately and take the initiative)

On the part of parents, helping children consciously communicate in two-way in all situations accounting for 92.9 percent of the time; followed by help children convey appropriate feelings and proper actions in daily situations accounting for 86.7 percent of the time; helping children learn to play with objects appropriately and take the initiative accounting for 81.6 percent of the time; 79.6 percent was spent helping children develop communication skills and language, and 75.6 percent was spent helping children develop motor skills. "This is a reasonably thorough intervention model in all ways to improve children with all required skills in everyday life" Ms. L.A, a mother of children with ASD said.

As a result, both teachers and parents of children with ASD recognize the significance of ESDM. This is a critical foundation for making ESDM highly successful in early intervention for children with ASD.

2.2.2. The Goals of Using ESDM to Teach Children with ASD between the Ages of 2 and 3 Years Old

We conducted a survey of 87 teachers and 98 parents to learn more about the goals of using ESDM in educating children with ASD who are 2-3 years old, and the findings are shown in Figure 2.

Figure 2. The goal of using the ESDM in early intervention for children with ASD between the ages of 2 and 3 years old (Note: 1. Assist children in making significant gains in social interactions – communication, comprehension, and language – as well as reducing the shaping behaviors of autism; 2. Assist children in improving their imitation, social engagement, and appropriate actions. 3. Assist children in developing motor skills and playing games in the proper manner. 4. Encourage children to use active nonverbal and verbal communication techniques)

The goals that are highly valued by both teachers and parents can be seen in the chart above: ESDM assist children in making significant gains in social interactions – communication, comprehension, and language – as well as reducing the shaping behaviors of autism accounted for 62.3 percent of the total (of which teachers accounted for 63.7 percent and parents accounted for 61.2 percent), the target of assisted children in improving their imitation, social engagement, and appropriate actions with 27.4 percent (of which teachers accounted for 25.5 percent and parents for 29.1 percent), encourage children to use active nonverbal and verbal communication techniques accounted for 6.2 percent (of which teachers accounted for 5.9% and parents accounted for 6.3 percent), followed by assist children in developing motor skills and playing games in the proper manner accounted for 4.1 percent (of which teachers accounted for 4.9 percent and 3.4 percent). Ms. ET, a mother of children with ASD, expressed the following when asked about the goal of using ESDM: "This is a model that I admire greatly and that has aided children in developing the most comprehensive form of communication and social interaction possible. Limiting and mitigating the influencing of children's attitudes on physical, cognitive, and emotional levels".

As a result, only 62.3% of the teachers and parents who took part in the study correctly identified the purpose of adopting ESDM, which is "ESDM assist children in making significant gains in social interactions – communication, comprehension, and language – as well as reducing the shaping behaviors of autism" [5]; This implies that many teachers and parents are still perplexed about the precise objective of this model in intervention for children with ASD between the ages of 2 and 3 years old. To assist teachers and parents in selecting content and organizing educational activities that offer high efficiency to children with ASD between the ages of 2 and 3 years old, determining the specific purpose of utilizing ESDM to educate children with ASD between the ages of 2 and 3 years old is a precondition.

2.2.3. Content of Using ESDM in Early Intervention for children with ASD between the Ages of 2 and 3 Years Old

The ESDM includes clear therapeutic goals and an arrangement of intervention skills, demonstrated through curriculum checklists and tool descriptions. The checklist is divided into four skill stages, each corresponding to a different stage of child development: stages 1 (12-18 months), stages 2 (18-24 months), stages 3 (24-36 months), and stages 4 (36-48 months). This checklist is also tailored to children with ASD, includes crucial areas such as receptive communication, expressive communication, social skills, play skills, cognitive skills, gross motor skills, fine motor skills, personal self-care and adaptive behavior. Corresponding to each of these areas are four stages from easy to difficult according to the child's development sequence, in order to meet each child's respective development stage [5,6].

* Stages of ESDM

According to the survey results in Table 1, teachers believe ESDM is divided into four stages: Stages 1 (12-18 months), Stages 2 (18-24 months), Stages 3 (24-36 months), Stages 4 (36-48 months) accounting for 56.3 percent of the total and ranking first; according to 23 percent of teachers believe ESDM is divided into 5 stages: Stages 1 (0-12 months), Stages 2 (12-18 months), Stages 3 (18-24 months), Stages 4 (24-36 months), Stages 5 (36-48 months); 4 stages: Stages 1 (0-24 months), Stages 2 (24-36 months), Stages 3 (36-48 months), Stages 4 (48-60 months), according to 12.7 percent of teachers and 8 percent believe ESDM is divided into 3 stages: Stages 1 (0-24 months); Stages 2 (24-48 months); Stages 3 (48-60 months).

Parents believe that ESDM has 5 stages: Stages 1 (0-12 months), Stages 2 (12-18 months), Stages 3 (18-24 months), Stages 4 (24-36 months), Stages 5 (36-48 months), accounting for 49 percent; 30.6 percent believe that ESDM has 4 stages: Stages 1 (0-24 months), Stages 2 (24-36 months), Stages 3 (36-48 months), Stages 4 (48-60 months); 14.3 percent believe that ESDM has 4 stages: Stages 1 (12-18 months), Stages 2 (18-24 months), Stages 3 (24-36 months), Stages 4 (36-48 months) ; and 6.1 percent believe that ESDM has 3 stages: Stages 1 (0-24 months); Stages 2 (24-48 months); Stages 3 (48-60 months).

We can see that teachers and parents have quite different perspectives on the stages in the ESDM scorecard that correspond to each age. The reason for this difference is because "I only know that ESDM consists of levels corresponding to each stage of the child's development, but I don't know the specifics" - shared by Ms. HA, the child with ASD's mother. Thus, 56.3 percent of teachers and 14.3 percent of parents who participated in the study correctly identified the model's developmental level and age, indicating that the ESDM has four stages: Stages 1 (12-18 months), Stages 2 (18-24 months), Stages 3 (24-36 months), Stages 4 (36-48 months) [5]. These are teachers and parents who have studied and attended ESDM training courses. Furthermore, the remaining 85.7 percent of parents and 43.7 percent of teachers who participated in the survey were still unsure about the developmental stages associated with each ESDM level. Professionals and administrators should plan to organize seminars on ESDM for parents as well as teachers throughout the school.

Table 1. Teachers' and parents' perceptions of the stages of ESDM

Table 2. Teachers' and parents' perceptions about the field of ESDM

* ESDM's focus fields

Table 2 reveals that, on the part of teachers, ESDM includes 10 development areas: receptive communication, expressive communication, social skills, play skills, cognitive skills, gross motor skills, fine motor skills, personal self-care and adaptive behavior, accounting for 50.6%; 28.7% of teachers responded that ESDM includes 6 developmental Subtests (Cognitive Verbal/Preverbal; Expressive language; Reception language; gross motor, fine motor; Visual-Motor imitation) and 4 maladaptive behavior subtests (affective expression; social reciprocity; characteristic motor behaviors, characteristic verbal behaviors); 28.7% of teachers responded that ESDM includes 10 areas: Reception language; Expressive language; Society; Imitate; Percipient; Cognitive; Motor; Hand-eye coordination; Personal self-care and Adaptive behavior and finally ESDM includes 9 areas: Imitation; Perception; Gross motor; Fine Motor; Eye-hand intergration; Cognitive performance; Verbal performance; Self-help; Social performance, accounting for 5,8%. “In the process of participating in training sessions and researching through sources: books, newspapers, Internet... I learned that ESDM includes ten areas, with the goal of ensuring the full development of motor skills, language, communication, and behavior for children” teacher KL said when asked about the fields of ESDM.

On the part of parents, ESDM includes 6 developmental Subtests (Cognitive Verbal/Preverbal; Expressive language; Reception language; gross motor, fine motor; Visual-Motor imitation) and 4 maladaptive behavior subtests (affective expression; social reciprocity; characteristic motor behaviors, characteristic verbal behaviors), accounting for 41.8%; followed by 37.8% of parents who believe that ESDM includes 9 areas: Imitation; Perception; Gross motor; Fine Motor; Eye-hand intergration; Cognitive performance; Verbal performance; Self-help; Social performance; followed by 13.3% of parents who believe that ESDM includes 10 areas: receptive communication, expressive communication, social skills, play skills, cognitive skills, gross motor skills, fine motor skills, personal self-care and adaptive behavior and fnally, ESDM includes 10 areas: Reception language; Expressive language; Society; Imitate; Percipient; Cognitive; Motor; Hand-eye coordination; Personal self-care and Adaptive behavior, accounting for 7.1%.

As a result, the survey shows that 50.6% of teachers and 13.3% of parents who took part in the survey correctly understood the fields of ESDM, which include the following ten: receptive communication, expressive communication, social skills, play skills, cognitive skills, gross motor skills, fine motor skills, personal self-care and adaptive behavior [5]. Furthermore, 49.4% of teachers and 86.7% of parents surveyed still mistook the content of ESDM fields for PEP3 or TEACCH. They are perplexed because they have not been taught ESDM and have only heard about it.

2.2.4. Teachers' and Parents' Perceptions on the Methods Applied According to ESDM

The results in Table 3 show that, on the teacher's side, ESDM employs the approaches and teaching techniques of 3 intervention methodologies: ABA, PRT and Denver, accounted for 58.6% and ranked first; ranked second, ESDM employs the approaches and teaching techniques of 3 intervention methodologies: floortime, TEACCH and Denver, accounting for 21.9%; followed by, ESDM employs the approaches and teaching techniques of 3 intervention methodologies: TEACCH, PRT and Denver, accounting for 12.6% and finally, ESDM employs the approaches and teaching techniques of 3 intervention methodologies: ABA, TEACCH and PECS, accounting for 6.9%.

Table 3. Teachers' and parents' perceptions on the methods applied according to ESDM

On the part of parents, ESDM employs the approaches and teaching techniques of 3 intervention methodologies: floortime, TEACCH and Denver, accounted for 56.1% and ranked first; ranked second, ESDM employs the approaches and teaching techniques of 3 intervention methodologies: ABA, PRT and Denver, accounting for 32.7%; followed by, ESDM employs the approaches and teaching techniques of 3 intervention methodologies: TEACCH, PRT and Denver, accounting for 6.1% and finally, ESDM employs the approaches and teaching techniques of 3 intervention methodologies: ABA, TEACCH and PECS, accounting for 5.1%. When asked about the methods applied according to ESDM, a teacher named Y said the following: "ESDM employs the approaches and teaching techniques of 3 effective intervention methodologies: ABA, PRT and Denver. These teaching strategies and techniques not only assist teachers like me in knowing what I need to accomplish, but also assist the parents in being creative at home with parenting activities". Ms. K, the child's mother, explained "Personally, I'm still perplexed by ESDM's teaching methods and strategies. SoI'd want to have a course to attend".

As a resutl, approximately 58.6% of teachers and 32.7% of parents had accurate opinions of the methods applied according to ESDM, which is ESDM employs the approaches and teaching techniques of 3 intervention methodologies: ABA, PRT and Denver [7,20,21]. Understanding the approaches and techniques of ESDM will make an important contribution to the effectiveness of the early intervention process for children with ASD.

2.2.5. Forms to Organize Activities in Using the ESDM to Early Intervene for Children with ASD between the Ages of 2 and 3 Years Old

In order to effectively apply ESDM during the early intervention process, both teachers and parents collaborated closely in adopting a variety of flexible forms of education. We conducted a survey of the opinions of 87 teachers and and 98 parents in frequency of usage (5 levels: never used – 1 point; rarely used – 2 points; Occasionally – 3 points; Frequently – 4 points; Very often – 5 points) and effectiveness (5 levels: ineffective – 1 point; less effective – 2 points; Fairly effective – 3 points; effective – 4 points; Very effective – 5 points).

* Frequency of usage to organize activities in using the ESDM to early intervention

Table 4 shows that the form combination of individual classes, group classes and nature environments is the most commonly employed form by both teachers and parents, with M = 4.54; followed by, the form combination of individual classes and group classes with M = 4.52; Individualized classes with M = 4.42; Group classes with M = 4.37 and finally, use in nature environments and daily lìfe situation with M = 4.35. "With children between the ages of 2 and 3, most of the time I try to teach them in any environment or at any time of the day where children can learn, such as playtime, activity time, activity time, and especially during individual intervention" - Ms. HL, a teacher, said when asked how often she uses forms of organizing activities for children. As a result, the author agrees with 53.5 percent of teachers and teachers who participated in the study on the most common method of instruction, which is Combination of individual classes, group classes and nature environments, daily lìfe situation. Both research and reality demonstrate that children with ASD will be developed and learn abilities in individual classes with 1:1 interaction activities when they participate in ESDM; the child will then be able to exhibit that ability in a small group setting with other children of similar developmental levels. Finally, children can generalize skills to build approaches and apply them more flexibly through the natural environment and daily activities.

Table 4. Frequency of usage to organize activities in using the ESDM to early intervention

* Effectiveness to organize activities in using the ESDM to early intervention

Table 5 shows that, the form that is evaluated by both teachers and parents with the highest effectiveness is the combination of individual classes, group classes and nature environments with M = 4.59; followed by, individualized classes with M = 4.44; Combination of individual classes and group classes with M = 4.41; Group classes with M = 4.28 and finally, use in nature environments and daily lìfe situation with M = 4.23. "Actually, at home, I regularly teach my children in all scenarios such as eating, dressing, and so on – Mr K.D, the father of children with ASD remarked when questioned about the efficiency of various sorts of intervention - Even my wife and I attempt to alternate teaching like an individual class at school when I take a bath or play, and I feel quite effective; my child has memorized and focused more thanks to this style”.

Table 6 shows the findings of utilizing the correlation coefficient test to determine the association between the frequency of usage and the effectiveness of forms to the organization of activities using ESDM in early intervention for children with ASD.

Table 5. Effectiveness to organize activities in using the ESDM to early intervention

Table 6. Correlation between the frequency of usage and the effectiveness of forms to the organization of activities using ESDM

From the data Table 6, the level of use of the variable "Individualized Individualized classes" is positively associated with the efficacy of the variable "Individualized classes” with important parameters, such as r = 0.213, p < 0.01; With important parameters such as r = 0.319, p < 0.01, the frequency of use of the variable "Group classes" is positively associated with the efficacy of the variable “Group classes"; The effectiveness of the variable "Combination of individual classes and group classes" is positively correlated with the level of use of the variable "Combination of individual classes and group classes" with significant parameters such as r = 0.591, p < 0.01; the level of use of the variable "Use in nature environments and daily lìfe situation" is positively correlated with the effectiveness of the variable "Use in nature environments and daily lìfe situation" with significant parameters such as r = 0.482, p < 0.01; the level of use of the variable "Combination of forms as stated above" is positively correlated with the effectiveness of the variable "Combination of forms as stated above" with significant parameters such as r = 0.255, p < 0,01.

This demonstrates that the intervention facilities have collaborated to use versatile and effective forms in the implementation of ESDM for early intervention of children with ASD. This is the foundation for highly successful early intervention, and children with ASD have the ability to discover and generalize what they've learned.

2.2.6. Advantages and Disadvantages in Using ESDM into Early Intervention for Children with between the Ages of 2 and 3 Years Old

Both teachers and parents have advantages and disadvantages when using ESDM in early intervention, particularly with children aged 2-3 years.

* Advantages

We conducted a survey of 87 teachers and 98 parents to learn more about the advantages of using ESDM, and the findings are shown in Figure 3.

Figure 3. Advantages in using ESDM into early intervention for children with ASD between the ages of 2 and 3 years old (Note: 1. The system of facilities, the learning materials are fully equipped; 2. The centers that facilitate parents and teachers to participate in training sessions, professional training courses; 3. ESDM with activities that promote children's concentration and interest at the highest level; 4. ESDM has a detailed and easy checklist for both teachers and parents; 5. Combination of school and family)

The most favorable factor for teachers is that ESDM has a detailed and easy checklist for both teachers and parents, which accounts for 93.1 percent; followed by ESDM with activities that promote children's concentration and interest at the highest level, which accounts for 87.4 percent; followed by centers that facilitate parents and teachers to participate in training sessions, professional training courses accounted for 83.9 percent; The system of facilities, the learning materials are fully equipped, accounting for 80.5 percent and finally there is a combination of school and family, accounting for 74.7 percent. When asked about the advantages in the process of using ESDM, Ms. TX, an early intervention teacher for children with ASD shared “During the process of applying and implementing ESDM, I personally find that ESDM has a detailed and easy checklist. Clear and comprehensive supervision allows us, as teachers, to plan individual education as well as fairly assess children at each stage".

Figure 4. Disadvantages in using ESDM into early intervention for children with ASD between the ages of 2 and 3 years old (Note: 1. ESDM offers a limited number of rigorous training courses. 2. Neither teachers nor parents have a firm grasp on how to apply the model effectively. 3. Most of the documents are in English, so it is difficult to access. 4. Many families and schools have not yet chosen to apply the ESDM because they do not fully understand this model)

The most favorable factor for parents is that ESDM has a detailed and easy checklist for both teachers and parents, which accounts for 92.9 percent; followed by centers that facilitate parents and teachers to participate in training sessions, professional training courses accounted for 87.8 percent; the system of facilities, the learning materials are fully equipped, accounting for 82.7 percent; combination of school and family, accounting for 80.6 percent and finally there is ESDM with activities that promote children's concentration and interest at the highest level, which accounts for 72.4 percent. “Honestly, when I know this model, I feel like it is a pretty straightforward and comprehensive model, from evaluation to how to teach children in order to achieve the necessary goals - Mr. TH, a father of children with ASD, said - However, it's possible that in the process of teaching and reinforcing my kid at home, it's because my wife and I still don't have much experience gaining attention or arranging activities for our children, so letting our children practice concentrated and ready to engage in all of the activities that are still difficult”.

As a result, both teachers and parents agree that the most favorable factor is that the model has a detailed, clear and easy-to-apply checklist when performing activities as well as developing individual educational plans. Therefore, helping teachers and parents easily in the process of planning and educational activities to bring high effectiveness.

* Disadvantages

Aside from the advantages, teachers and parents face many obstacles when implementing the ESDM in early intervention for children with ASD. These challenges are depicted in Figure 4.

On the teachers' side, the main challenge they face in using the ESDM in early intervention for children with ASD is that ESDM offers a limited number of rigorous training courses, which accounts for 93.1 percent. Therefore, most teachers would learn about the model on their own from various sources. The second issue is that many families and schools have not yet chosen to apply the ESDM because they do not fully understand this model (90.8 percent); 88.5 percent of accessibility documents are written in English but have not been translated into Vietnamese, making access even more difficult. Next, 86.2 percent of teachers and parents do not have a good understanding of how to use the model in the most successful way.“While this is a very clear model from evaluation to intervention, access to as well as the organization of training courses to better understand this model is still limited” Ms. LH, early intervention teachers for children with ASD share.

The most daunting challenge for parents is that ESDM offers a limited number of rigorous training courses, accounting for 94.9 percent; followed by the fact that many families and schools have not yet chosen to apply the ESDM because they do not fully understand this model, accounting for 88.8 percent; 82.7 percent of accessibility documents are written in English but have not been translated into Vietnamese, making access even more difficult and finally, neither teachers nor parents have a firm grasp on how to apply the model effectively, which accounts for 79.6 percent.

As a result, both teachers and parents are now aware of the relevance of ESDM, as well as the current difficulties that teachers and parents are experiencing. This model requires professional training as well as the Vietnameseization of English documents. These are also the issues that researchers and special educators are interested in addressing in order to provide the most appropriate early intervention for children with ASD.

* Factors influencing the efficacy of using ESDM in early intervention for children with ASD between the ages of 2 and 3 years old.

ESDM's effectiveness is dependent on a number of influencing factors (subjective and objective factors - Table 7). Regarding the objective factor, both teachers and parents agreed that the family climate of each child with M = 2.76 (in which teacher have M = 2.78; parents have M = 2.75) has the greatest influence on the efficacy of ESDM use; The element related to facilities and educational conditions is ranked second, with M = 2.71 (teachers have M = 2.71; parents have M = 2.72); Teachers and parents can attend professional training sessions at early intervention centers if they are organized and provided with the necessary resources is ranked third, with M = 2.68 (teachers with M = 2.69; parents with M = 2.68);

Children with ASD themselves, teachers and collaborations are all subjective factors that influence the efficacy of using ESDM in early intervention. In which, according to both parents and teachers, the children with ASD themselves has the greatest influence on the success of the intervention with M = 2.78 (in which each child's cognitive skill and learning style account for M = 2.79; Each child's level of attention and behavioral expression account for M = 2.74); Next, the second subjective factor is the teachers with M = 2.70 (in which the teacher's knowledge of ESDM accounts for M = 2.71 and the teachers' knowledge of children with ASD, as well as their comprehension of each child's strengths and weaknesses, accounting for M = 2.68); Next, the third subjective factor is the collaboration with M = 2.66 (in which the collaboration between the school and the family accounts for M = 2.71 and coordination of family members, accounting for M = 2.68). When asked about the factors affecting the early intervention process, Ms. M, the mother of children with ASD said, "Personally, I think that early intervention is effective, not only depending on the ability to receive and my child's development, but also depends on the teacher - who directly intervenes for my child as well as the facilities and educational conditions in the intervention environment; At home, I also try to coordinate with the teacher to teach my child to review the knowledge that has been learned".

As a result, both teachers and parents have quite similar views on the factors affecting the effectiveness of the intervention process. Understanding and properly aware of this would assist both teachers and parents in mentally preparing themselves, as well as being able to collaborate and introduce appropriate early intervention for children with ASD.

Table 7. Factors influencing the efficacy of using ESDM in early intervention for children with ASD aged 2-3 years

2.3. Lessons Learnt from Using ESDM

Based on an overview of the current situation of using ESDM in early intervention for children with ASD between the ages of 2 and 3 years old in specialized schools, we draw some lessons in using the model to improve the effectiveness as follows

1. Both parents, caregivers and teachers need to understand the Early intervention for children with autism before the age of three is critical. It is necessary to promote and raise the awareness of teachers and parents about ESDM by regularly organizing training sessions on: goals, content, form and building successful individual classes. In addition, implementing activities to observe time and give professional suggestions to help teachers learn from the experiences and advantages of colleagues and overcome limitations self-regulation in the process of teaching for children with ASD.

2. At all stages of a child's development, the application of ESDM should be done in a consistent and synchronous manner. When early intervention is used, it should be done on a daily and ongoing basis. To make the change in the subsequent development of children with ASD, teachers must encourage the implementation of the model in practice and continuous evaluation.

3. Before beginning the early intervention process, each child with ASD should have a functional level evaluation based on the contents of the ESDM checklist. This is a critical foundation for teachers and parents to agree on learning styles, functional levels, and create an individual education plan that is appropriate for children with ASD. In addition, the child must be re-evaluated after each intervention period to assess his or her current functional level before moving on to the next phase of the intervention.

4. Individual lessons, group lessons, and learning in the natural environment are the most successful ways to use ESDM. When engaging in ESDM, children with ASD will learn and develop abilities in personalized lessons with 1:1 interactive activities; Children will then have the opportunity to practice and reinforce those abilities with other children of the same developmental level in a small group setting. Finally, children with ASD can generalize abilities to utilize flexibly and proactively through the natural environment and daily activities.

5. The use of the ESDM in early intervention for children with ASD 2-3 years old requires space structure, preparation of facilities and adequate equipment for individual classes. So that children can easily absorb knowledge, focus and pay the highest attention during intervention class.

6. Families, schools and social forces need to have a unified coordination on goals, contents, methods, forms and activities in the educational process in order to timely support children in all aspects, unify Education methods and general educational views to help children have the opportunity to practice, consolidate and generalize the skills learned in school.

3. Conclusion

Since the time between the ages of two and three years is called the "golden period” of development, it is critical to maximize resources in order to successfully influence and bring about noticeable improvements in children's development. In terms of dominance and efficacy, the use of ESDM has yielded promising results in the development fields, and it is quickly becoming one of the most common early intervention models in the world and in Vietnam. With the identification of educational goals that are to help children express appropriate emotions and correct behavior in daily circumstances, promote constructive two-way interaction in an educational context and content, impact on all areas to help children develop comprehensively, optimally and express emotions in the most positive way. As a result, teachers and parents must use ESDM extensively and efficiently, absorb lessons learned in the course of using ESDM to make a positive impact, and assist children with ASD have important prerequisites for their later development.

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