The following document was written by Dr Swapnil Palod, ST5 in Psychiatry of Learning Disabilities (St. George’s Higher Training Scheme, London) and Dr Meetiksha Malhotra, ST5 in Child and Adolescent Psychiatry (St Mary’s Higher Training Scheme, London) September 2010
You may use the information here for personal use but if you intend to publish or present it, you must clearly credit the author and
This site is not intended to be used by people who are not medically trained. Anyone using this site does so at their own risk and he/she assumes any and all liability. ALWAYS ASK YOUR SENIOR IF YOU ARE UNSURE ABOUT A PROCEDURE. NEVER CONDUCT A PROCEDURE YOU ARE UNSURE ABOUT.


“To effectively communicate, we must realize that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others”.
- Anthony Robbins

Communication is important in all the aspects of life. It has a crucial role in the field of medicine. It would be difficult to diagnose and treat patients if we are unable to communicate with them. Good communication skills amongst doctors may lead to identification of problems more accurately, greater satisfaction amongst patients and less work stress amongst doctors.

Various methods of communication:

Why communicate with people with intellectual disabilities?

Some clinicians may think “Why should I talk to him/ her (person with ID) and waste time? It will take forever.” But if they think carefully, they’ll realise that how important it is to communicate with the individual with ID using various creative methods and also listen to people’s families and carers. This may take more time than usual, but it is ‘better to get it right rather than to get it fast’. Who else would be able to inform you about their problem other than the patients themselves?

People with ID have higher prevalence of various medical conditions including epilepsy, hypothyroidism, dementia, poor dental hygiene, sensory problems, etc5. Hence it is essential to have appropriate skills to communicate effectively with them in order to effectively diagnose and treat these conditions.

The General Medical Council in the guidance Good Medical Practice states that the clinicians should share the information in a way that the patients can understand. The guidance also adds that “You must make sure, wherever practical, that arrangements are made to meet patients' language and communication needs”.

Effective communication can be helpful to develop:

How to communicate with people with ID?

“True sign of intelligence is not knowledge but imagination”.
- Albert Einstein

It is essential to involve the person with ID at every stage of consultation as much as possible. However, it may be a challenging task to communicate with them. This may be due to several factors including unfamiliarity, anxiety, stigma, etc. Hence, we need to be creative in dealing with people with ID. This article aims to provide tips and creative ways to communicate with people with ID.

Mahrabian and Ferris found that words (verbal) account for only 7% of communication, the voice tone (vocal) accounts for 38% and general body language (visual) accounts for 55% of the communication, thus showing that the body language has a great impact in terms of communicating with others.

The following tips are only guidelines rather than strict rules. Some of them may work but some may not. So the important thing is to be creative and grab opportunities as they arise. These approaches may take a longer time but are useful to identify the person’s needs and addressing them in a better manner.

Even minor things like what you wear can sometimes make a difference. There was a person with ID who did not like blue jumpers and I remember wearing the colour on a visit to see him. He was upset on seeing me and repeatedly said “Don’t like you. Blue.” I did not understand but the carer helped me solve the puzzle. The easy solution then was to remove the jumper and talk to the patient. That’s what I did!

Books Beyond Words

The series of Books Beyond Words9 is a very useful resource in helping people with learning and communication difficulties, edited by Prof Sheila Hollins. These titles can be used with people who understand pictures better than words. The books deal with some difficult issues and events in a simple and understandable way using pictures. The titles include ‘Going to the doctor’, ‘Getting on with Epilepsy’ and ‘When Mum Died’.

Speech and Language Therapists

Speech and Language Therapists play a crucial role to play in assessing and treating speech, language and communication problems in people with ID. This helps them to reach their full potential in terms of communication. The therapists also work with people having eating and swallowing problems.


  1. Maguire P, Pitceathly C. Key communication skills and how to acquire them. BMJ 2002; 325:697-700.
  2. Bondi AS, Frost LA. The Picture Exchange Communication System. Focus on Autism and Other Developmental Disabilities 1994; 9(3):1-19.
  3. Walker M, Armfield A. What is Makaton vocabulary? Spec Educ Forward Trends 1981; 8(3):19-20.
  4. Mencap. Treat me right! Better healthcare for people with a learning disability. Mencap, 2004.
  5. Fraser W, Kerr M. Seminars in the Psychiatry of Learning Disabilities. Royal College of Psychiatrists. 2nd Edition, 2003.
  6. General Medical Council. Good Medical Practice. GMC, 2006.
  7. Mencap. Death by Indifference: Following up the Treat me right! report. Mencap, 2007.
  8. Mehrabian A and Ferris SR. Inference of Attitudes from Nonverbal Communication in Two Channels. Journal of Consulting Psychology 1967; 31(3):248-25.
  9. Hollins S et al. Books beyond Words. Royal College of Psychiatrists.


The authors of this document have attempted to provide information that is medically sound and up-to-date. The authors nor cannot take any reponsibility for the accuracy or completeness of this article. The reader should confirm the statements made in this website before using the information outside this website.