A large cohort study using data from national electronic records found that the rate of emergency admissions for adults with intellectual disabilities in England was nearly three times the rate for those without (182 per 1000 adults per year with intellectual disabilities versus 68 per 1000 per year without) (Hosking Reference Hosking, Carey and DeWilde2017). Similarly, a UK electronic health record study found that people with intellectual disabilities had 1.9 times more general practitioner consultations per year than those without intellectual disabilities (Tyrer Reference Tyrer, Morriss and Kiani2024). It is therefore vital that all doctors are equipped to effectively assess and manage individuals with intellectual disabilities and neurodevelopmental disorders.
At each stage of the consultation for a person with an intellectual disability, namely assessment, diagnosis and treatment, the doctor must communicate effectively, which often requires adjustments to their usual methods and style (Box 1). Consideration of mental capacity and consulting more widely to understand both the person’s needs and the impact of treatment choices before reaching a conclusion are also vital.
Adjustments to support effective consultations for patients with intellectual disabilities and neurodevelopmental disorders
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Try to find a calm, quiet environment the person is comfortable in
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Check if the person has a communication passport and read it before the consultation
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Check if the person uses a communication system (e.g. pictures, electronic device) and use it
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Speak in clear, concise language
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Allow the person additional processing time
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Use visual aids/accessible information/drawing if helpful
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Ask carers to help explain things to the person – this can include your questions
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Check understanding using methods like ‘teach back’ (Health Literacy Place 2026)
Consequently, the consultation process is often both complex and time-consuming, with differing views and competing demands at play, and a particular skill set is required to successfully negotiate it. There is therefore a need for comprehensive training on the approach to, and management of, people with intellectual disabilities and associated neurodevelopmental disorders from undergraduate level upwards so all medical practitioners are well equipped for this. Most postgraduate medical subspecialty training in the UK does not currently explicitly cover the needs of people with intellectual disabilities and neurodevelopmental disorders; consequences of this include doctors feeling underskilled and lacking confidence to assess and manage these patients, and an increased risk of diagnostic overshadowing, adversely affecting patients’ health outcomes.
The General Medical Council (GMC) recognised the challenge faced by doctors needing specialty-specific knowledge that they have not covered in their training and commissioned the Academy of Medical Royal Colleges to produce a framework to signpost doctors in these situations. The framework, named Shared Learning, has published specific guidance on several conditions to date, including intellectual disability and neurodevelopmental disorders (Academy of Medical Royal Colleges 2025). Box 2 highlights some key points of the principles of behaviour recommended in the Shared Learning framework. Embedding this learning at all stages of medical training and practice will support doctors to both develop and refine their skills as they progress through their career.
Key elements to consider when treating patients with intellectual disabilities and neurodevelopmental disorders
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Clear and accessible communication
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Flexibility, adaptability and reasonable adjustments
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Patient at centre
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Mental capacity, best interests and advocacy
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Holistic approach
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Comorbidity
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Diagnostic overshadowing
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Quality of life
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Services, signposting and safety netting
(Based on Academy of Medical Royal Colleges 2025: principles a–j)
A note on terminology
Intellectual disability is commonly known as learning disability in the UK, and many of the documents discussed here use that term. The Royal College of Psychiatrists (RCPsych) now prefers the term intellectual disability, and we have followed that preference (unless naming a specific curriculum).
Undergraduate medical education in psychiatry
Recent years have brought an increasing recognition of the need to educate medical students in intellectual disabiliy and neurodevelopmental disorders, leading to their integration across UK medical school curricula. Training should include introduction to intellectual disability and neurodevelopmental disorders, including diagnosis, degrees of intellectual disability, common neurodevelopmental disorders and clinical relevance. Students should also be trained in implementing reasonable adjustments, such as longer consultations, communication tools, quiet waiting areas, accessible environments and sensory adaptations. These measures improve healthcare experiences for patients and significantly reduce diagnostic overshadowing (Moloney Reference Moloney, Hennessy and Doody2021).
Methods of delivery vary across medical schools (Towson Reference Towson, Daley and Banerjee2023). Interactive, mixed approaches – combining seminars, role-play, real contact (Akbulut Reference Akbulut Zencirci, Metintas and Kosger2022), structured curriculum integration rather than optional modules (Donaldson Reference Donaldson, Hebditch and Arnesen2025), simulated encounters with ‘standardised patients’ (Thomas Reference Thomas, Courtenay and Hassiotis2014) and involvement of people with lived experience – are more effective than lecture-only teaching (Towson Reference Towson, Daley and Banerjee2023). However, owing to the intensive nature of the undergraduate curriculum, direct exposure to intellectual disability psychiatry remains limited, leaving many graduates with limited understanding of the specialty. Increased contact time is needed to address this gap.
Foundation training in psychiatry
The 2021 UK Foundation Programme Curriculum (foundationprogramme.nhs.uk/curriculum) requires all doctors to demonstrate basic mental health-related capabilities, including completing mandatory e-learning on intellectual disability and autism. The goal set by the Better Training Better Care Taskforce is for approximately 45% of all foundation doctors to have a psychiatry placement as part of their training, with 22.5% in Foundation Year 1 (FY1) and 22.5% in Foundation Year 2 (FY2) (NHS England 2014). Few programmes currently offer a specific placement in intellectual disability – a clear gap in provision and a missed opportunity to provide exposure to a holistic model of care for individuals with complex physical and mental health needs. Expansion of intellectual disability foundation placements is therefore a priority.
Core speciality training in psychiatry
The RCPsych’s Core Psychiatry Curriculum (RCPsych 2022a) includes specific capabilities for intellectual disability and neurodevelopmental disorders (Box 3) and recommends 6 months’ training in developmental psychiatry, namely psychiatry of intellectual disability and/or child and adolescent psychiatry. Such placements provide important opportunities to develop effective communication skills when working with people with intellectual disabilities/neurodevelopmental disorders. However, owing to limited availability, not all resident doctors undertake a developmental psychiatry placement, and fewer still experience both child and adolescent psychiatry and intellectual disability placements, which serve different patient cohorts and needs. It is therefore vital that resident doctors engage with patients with intellectual disability and neurodevelopmental disorders throughout core training to develop the required capabilities.
Royal College of Psychiatrists’ Core Psychiatry Curriculum: selected key capabilities specific to intellectual disability/neurodevelopmental disorders
Communication (from High Level Outcome 2.1)
‘Consistently demonstrate effective communication approaches with patients and relevant others, including those with neurodevelopmental disorders making reasonable adjustments and adaptations where appropriate, including the use of new technologies.’
Clinical skills (from High Level Outcome 2.2)
‘Demonstrate an appropriate understanding of learning and behavioural stages of human development through the lifespan including awareness of normative as well as variations in presentations, for example with neurodevelopmental conditions and across cultures.’
‘Receive a full psychiatric history from, perform a Mental State Examination (MSE) on, and assess capacity of, patients within a range of mental and neurodevelopmental disorders across the lifespan, in routine, urgent and emergency situations incorporating appropriate terminology.’
(Royal College of Psychiatrists 2022a)
Tailored opportunities might include neurodevelopmental disorder assessment clinics and specialist autism teams; however, routine exposure to individuals with intellectual disabilities and neurodevelopmental disorders within adult in-patient and community settings, liaison psychiatry and forensic psychiatry remains essential, highlighting the need for all psychiatrists to be conversant with intellectual disability and neurodevelopmental disorders to support both patients and resident doctor training.
Speciality training in psychiatry of intellectual disability
Psychiatry of intellectual disability is a recognised subspecialty in the UK; the training programme remains one of few opportunities in the world to gain such a specialist qualification. The Psychiatry of Learning Disability curriculum (RCPsych 2022b) sets out higher learning outcomes to be gained over a period of 3 years, towards gaining a certificate of completed training (CCT) in the subspecialty for independent practice as a consultant psychiatrist in the UK. Training in intellectual disability psychiatry supports a nuanced understanding of the challenges faced by people with intellectual disabilities and neurodevelopmental disorders and equips the doctor to adapt their interactions accordingly (Box 4).
Selected key capabilities from the Royal College of Psychiatrists’ Psychiatry of Learning Disability curriculum
Communication (from High Level Outcome 2.1)
‘Consistently communicate effectively with patients across the spectrum of cognitive ability, including those with neurodevelopmental disorders and relevant others, utilising a range of methods and adapting your style of communication to the patient’s needs, making reasonable adjustments as appropriate.’
‘Effectively explain to patients with learning disability, their families and their carers of all ages, the outcome of the assessment and the recommended care plan, considering their ideas, concerns and expectations.’
Clinical skills (from High Level Outcome 2.2)
‘Demonstrate proficiency in the assessment and diagnosis of mental and neurodevelopmental disorders in patients with learning disability across the spectrum of cognitive ability using classification systems as appropriate.’
Complexity and uncertainty (from High Level Outcome 2.3)
‘Manage divergent views about patient care leading to appropriate clinical interventions.’
(Royal College of Psychiatrists 2022b)
The curriculum also highlights the wider applicability of this skill set: ‘Trainees will also have transferrable skills and expertise in the diagnosis and management of neurodevelopmental disorders, including Autism and ADHD, which they can apply within the wider psychiatric population’ (RCPsych 2022b: p. 4). This is indeed the case, with many resident doctors taking up postings in mainstream neurodevelopmental disorders services after achieving their CCT. Although this is meeting a valuable service need in the general population, it does not help fill the significant gaps in specialist intellectual disability service provision for which the resident doctor was trained.
Wider psychiatric higher specialty training
The RCPsych’s Silver Guide (RCPsych 2022c) provides guidance for cross-specialty training, allowing higher trainees to undertake up to 12 months in another psychiatric specialty, such as psychiatry of intellectual disability. GMC-approved dual training in child and adolescent and intellectual disability psychiatry is well established; dual forensic and intellectual disability psychiatry was approved in August 2024, and dual adult and intellectual disability psychiatry is due to be piloted. These programmes are attractive to resident doctors, offering holistic training that enhances employment prospects and supports development of the specialist psychiatric workforce for people with intellectual disabilities and the wider neurodevelopmental disorders population.
However, several logistical challenges remain, including schemes’ willingness to offer National Training Numbers (NTNs) for longer durations (an NTN guarantees a continued place on a training programme, subject to acceptable progress and performance) and concerns about time spent in the counterpart specialty if there is no reciprocal arrangement, reducing the resident doctor workforce. Solutions such as paired NTNs across schemes may help address workforce concerns, but progression in parallel is difficult to predict, particularly with increasing ‘less than full-time’ (LTFT) working. Pressure on higher training scheme places is likely to increase further, as Core Psychiatry fill rates are now 100%. Despite these challenges, dual training offers clear benefits, producing skilled clinicians able to meet the needs of an increasingly complex patient population.
Wider medical subspecialty training
The UK paediatrics training programme provides opportunity to subspecialise in paediatric neurodisability during specialty level training (years ST5–ST7) (Royal College of Paediatrics and Child Health 2023). Learning outcomes include assessment and management of autism and attention-deficit hyperactivity disorder and recognition of associated comorbidities. On completion of training, some neurodisability paediatricians choose to subspecialise in neurodevelopmental disorders.
International training
Specific medical qualifications in intellectual disability remain uncommon in many countries; some UK courses may be available to an international audience – for example the Royal College of Physicians postgraduate certificate (PGCert) Medical Practice in Adult Learning Disability (Royal College of Physicians 2026), which is offered in partnership with Edge Hill University’s Medical School (in North West England). In line with UK medical school curricula, such programmes focus on communication, managing complex health needs, person-centred care and achieving health equity. These themes align with the United Nations Convention on the Rights of Persons with Disabilities, which includes non-discrimination, accessibility and freedom to make choices among its guiding principles. These courses tend to follow a blended learning approach, supporting translation of knowledge into practice, but their long-term impact is difficult to assess.
Conclusion
Although all doctors will encounter patients with intellectual disability and neurodevelopmental disorders in their clinical practice, medical education in intellectual disability and neurodevelopmental disorders remains an acknowledged gap in most subspecialty medical training programmes both in the UK and internationally. Key principles that need to be applied across all medical education in this field include good communication, understanding of complexity, person-centred care and health equity.
Specialist training in the psychiatry of intellectual disability is available in the UK, but this needs to be underpinned by appropriate medical training at all levels, from undergraduate upwards. Completion of specialist training is, however, far from the end of the journey – all psychiatrists, including intellectual disability specialists, will need to continue to hone their communication and clinical skills through both formal training and practical clinical application to achieve the best healthcare outcomes for people with intellectual disabilities and neurodevelopmental disorders.
Author contributions
M.B. wrote the first draft of this article. A.U. and A.B.B commented on the first draft and contributed to subsequent iterations of the manuscript.
Funding
This work received no specific grant from any funding agency, commercial or not-for-profit sectors.
Declaration of interest
A.B.B. is a member of the BJPsych Advances editorial board and did not take part in the review or decision-making process of this article.
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