Working with adults with intellectual disabilities by Nathalie Jones

by Nathalie Jones

I find that the steepest learning curves have been when I have “learned on the job.” This was never as true as when I started working with adults with intellectual disabilities (ID) where I soon found that a new set of communication skills were required.  I received a lot of help from experienced people and I also figured things out for myself.

Here are my “5 top tips,” for working directly with adults with ID and their communities in health settings.


  1. Everything takes more time and this time should be respected and not rushed

It takes time to make appointments.  Carer schedules vary and adults with ID often share accommodation and carers with others.  Putting dates in the diary a month in advance, means the necessary support can be arranged.  Reminder phone calls are also necessary closer to the time.

The appointments themselves require more time to allow for different communication methods such as talking mats and the use of images and game resources.  Breaks may be needed due to short attention span and distractions.

It takes longer to develop trust and rapport.  I have often found that it can take quite a few meetings before true and meaningful interaction is possible.

This time, getting to know the individual, is valuable and should not be rushed.  It may mean accepting a coffee, chatting about their day and taking their lead on how the session should progress in terms of pace and readiness.

  1. Communicate and adapt

Levels of ID clearly vary widely.  Over time, determine the level appropriate for each individual.  For example, as a dietitian, we often encourage people to keep food diaries.  Some adults with ID may be able to write, others may draw and others may tick off images of food.   Support need will vary.  The aim should be to reach the same goal (e.g. the goal of monitoring food intake), by whatever means the individual finds helpful.

  1. Link in with the diverse network of support

The most valuable advice I received, was from care staff.  Coming from a weight management, motivational interviewing style background where issues were explored and discussed, it took time to develop a more direct style of speech and questioning.

  1. Choose and create resources that fit the individual

There are ways to make written literature easier to understand for people with ID.  Using every day language, using bullet points and writing using Arial font in at least size 14 is recommended.  Useful links for information:

Department of Health

The National Equalities Partnership

There are also organisations that will help translate your information into easy read

For some people, interactive games to demonstrate your point can be more helpful than any kind of written information. It is sometimes helpful to leave resources with people so they can look at them between sessions.  It also acts as a reminder and link to you.


  1. Get the time and the place right

Meeting people at places familiar to them helps, in terms of accessibility and for them to feel settled and at ease.

Timing wise, mid morning or mid afternoon are often popular times as they allow for transport and avoid busy “getting ready” times first thing and lunch.  Evenings may also be popular for adults that attend day centre facilities.  As always, individuals differ and it is important to determine the best time for a person when they would be most receptive..  Some adults with ID have very structured lives; others due to factors such as medications or lifestyle choices, get up around midday and are awake though the night.