Practical Skills and Strategies for Supporting Communication Development for Those With Intellectual and Developmental Disabilities

Communication is at the heart of human connection. It allows us to express our needs, share our thoughts, and engage with the world around us. However, for individuals with intellectual and developmental disabilities (IDD), communication can present unique challenges that require thoughtful, tailored support.

Whether a person is a pre-intentional communicator expressing themselves through reflexive actions and behaviours, or an intentional communicator using gestures, signs, or alternative communication methods, understanding their needs is essential for fostering meaningful interactions.

This guide is designed for parents, caregivers, teachers, and practitioners who support individuals with profound intellectual disabilities.

We will explore what intellectual disabilities are, the common communication barriers that arise, and how they affect daily life. By distinguishing between pre-intentional and intentional communication, we will gain a clearer understanding of how these stages present and what strategies can be used to support individuals at different levels of communication development.

Most importantly, this article will provide you with practical, actionable skills that you can implement today. From simple adaptations in everyday interactions to structured approaches that encourage communication growth, these strategies aim to empower individuals with IDD to express themselves in ways that are meaningful to them.

Readers can also download Dolly Bhargava's guide Supporting and Guiding Communication Development of Students who are Pre-Intentional and Intentional Communicators which provides practical strategies for educators, caregivers, and therapists to support communication growth in these students.

By fostering a responsive and supportive communication environment, we can help those with intellectual disabilities develop confidence and independence in their interactions with the world. First let's take a look at what intellectual disabilities are and try to understand how intellectual disability affects communication.

What are Intellectual Disabilities?

Intellectual disability (ID) is a developmental condition that affects an individual's ability to learn, reason, problem-solve, and adapt to everyday life. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), intellectual disability is characterised by significant limitations in two key areas:

Intellectual Functioning

This refers to cognitive abilities such as reasoning, problem-solving, learning from experience, and abstract thinking. Individuals with intellectual disability may have difficulty with complex tasks such as understanding cause and effect, planning ahead, or processing new information efficiently.

Adaptive Functioning

This encompasses the skills necessary for independent daily living, including communication, social participation, and practical life skills. People with ID often struggle with managing daily routines, self-care, social interactions, and making safe decisions in unfamiliar situations.

For a diagnosis of intellectual disability, both intellectual functioning and adaptive functioning must be significantly impaired. These limitations must have appeared during the developmental period (before adulthood) and should not be due to temporary conditions, such as brain injuries or mental health disorders.

Levels of Intellectual Disability and Their Impact on Communication

Intellectual disability exists on a spectrum, ranging from mild to profound. Severe intellectual disability significantly affects an individual’s ability to communicate and engage with the world around them. The extent of these challenges depends on the severity of cognitive and adaptive impairments.

When classifying intellectual disability we use this scale:

Mild Intellectual Disability

Individuals with mild disability may develop basic communication skills and can often engage in conversations with support. They may require assistance with problem-solving and abstract thinking. Social interactions are possible but may be affected by difficulty understanding social cues.

Moderate Intellectual Disability

For individuals with moderate disability, communication is often limited to simple sentences or basic conversations.

Individuals may rely on structured routines and clear, repetitive communication methods and they may benefit from visual aids, simplified language, and alternative communication methods like sign language or picture-based systems.

Severe Intellectual Disability

Individuals with severe disability often have significant limitations in spoken language and may rely on pre-intentional or intentional nonverbal communication (e.g., gestures, facial expressions, vocalisations).

Communication is often facilitated through alternative and augmentative communication (AAC) systems, such as picture exchange communication systems (PECS) or speech-generating devices. Social interactions may be challenging, but with the right support, individuals can develop meaningful connections with caregivers and peers.

Profound Intellectual Disability

Individuals with profound disability typically have minimal or no verbal communication. They rely heavily on sensory-based communication such as touch, eye gaze, or body movements to express needs.

Supportive environments and highly individualised communication strategies are crucial for engagement and self-expression.

How Intellectual Disability Presents Communication Challenges

Communication is an essential skill that allows individuals to express their needs, interact socially, and navigate the world around them. However, for individuals with intellectual disability, communication can be significantly impacted depending on the intellectual disability severity, ranging from mild to profound. These challenges can affect not only spoken language but also nonverbal communication, comprehension, and social interactions.

In a typical child, communication development follows a predictable path, beginning with gestures and vocalisations in infancy, followed by the gradual development of words, sentences, and conversational skills. However, children with intellectual disability often experience delays in this process, requiring special education services and individualised support to develop effective communication. The amount of assistance needed varies widely based on the child's abilities and level of impairment.

Pre-Intentional and Intentional Communication

Communication is a developmental process that unfolds in stages, particularly for individuals with intellectual and developmental disabilities.

Many children and adults with severe intellectual disabilities communicate through pre-intentional or intentional means before they develop more advanced symbolic communication. Recognising these stages is crucial for caregivers, educators, and practitioners to provide the right level of support and encourage meaningful interactions.

This section explores the stages of communication development, focusing on pre-intentional and intentional communication.

Pre-Intentional Communication

At the pre-intentional stage, individuals do not yet understand that their actions can intentionally influence others. Instead, they communicate through involuntary behaviours and natural responses to internal and external stimuli.

Characteristics of Pre-Intentional Communication:

• Communication is reflexive or automatic, rather than deliberate.

• Expresses needs through facial expressions, muscle tension, breathing patterns, body movements, and eye gaze.

• Responses are linked to internal sensations (e.g., pain, hunger, discomfort) or external stimuli (e.g., sudden loud noises, bright lights, temperature changes).

• Individuals do not yet link their behaviours to specific responses from others.

For example, a child may cry when hungry, but they do not yet realise that crying causes someone to come and feed them. Instead, their crying is simply a response to discomfort.

Intentional Communication

At this stage, individuals begin to understand that their actions can have an effect on their environment and other people. They may still rely primarily on non-verbal communication but now demonstrate purposeful behaviours to get attention, express needs, or engage socially.

Characteristics of Intentional Communication:

• The individual recognises cause and effect—they begin to understand that their actions can elicit a response.

• Uses deliberate non-verbal behaviours such as facial expressions, reaching, pointing, vocalisations, or body movements.

• May repeat an action if it successfully gets attention or a desired response.

• Still benefits from structured, predictable interactions to strengthen communication.

For example, a child who reaches for a toy is intentionally communicating a request, even if they are not yet using words or symbols. Similarly, if a child cries when left alone, they may be signaling that they want company.

Symbolic Communication (Advanced Stage)

While this guide primarily focuses on pre-intentional and intentional communication, it is important to recognise that these skills lay the foundation for symbolic communication.

Characteristics of Symbolic Communication:

• The individual uses symbols (spoken words, signs, pictures, or objects) to represent specific meanings.

• Demonstrates a clear understanding of cause and effect in communication.

• Can use AAC systems, sign language, or verbal language to express wants and needs.

Not every individual with intellectual disability will reach this stage, but the strategies discussed earlier help pave the way for further communication development.

Practical Strategies for Supporting Communication

Supporting individuals at the pre-intentional and intentional stages of communication requires a combination of patience, consistency, and adaptability. Because communication is not just about words but also gestures, sounds, expressions, and actions, caregivers and educators must learn to recognise, interpret, and respond to a wide range of communicative behaviours.

For individuals with intellectual and developmental disabilities, communication can take many forms—some may rely on facial expressions and body language, while others may use gestures, pictures, or assistive technology to express themselves. Regardless of the method, the goal is to create an environment where communication is encouraged, understood, and valued.

Key Principles for Supporting Communication Development

Observe and Respond Consistently – Each individual has unique ways of expressing themselves. Identifying these cues and responding in a predictable manner helps reinforce communication.

Use Multisensory Approaches – Visual, auditory, tactile, and movement-based communication methods provide additional support for those who struggle with verbal expression.

Create Opportunities for Communication – Encourage interaction by offering choices, pausing for responses, and using everyday moments to reinforce communication.

Establish Predictable Routines – Routines provide structure, helping individuals feel secure and anticipate what comes next, reducing anxiety and encouraging participation.

Adapt the Environment for Success – Minimising distractions and ensuring individuals are physically comfortable improves engagement and responsiveness.

By implementing practical, individualised strategies, caregivers and educators can help individuals with intellectual disabilities develop meaningful communication —whether that means recognising and reinforcing subtle cues, encouraging intentional interactions, or guiding them toward more advanced communication methods.

The next sections will explore specific, evidence-based strategies to support communication development, focusing on how to recognise and respond to pre-intentional and intentional communication in a way that promotes growth and independence.

Personal Communication Dictionary

A Personal Communication Dictionary is a tool that helps caregivers recognise, interpret, and respond to an individual’s unique communication behaviours. By documenting these cues and their meanings, a communication dictionary ensures that everyone interacting with the individual provides a consistent response, reducing frustration and encouraging meaningful interactions.

A Personal Communication Dictionary is developed in four key steps:

Step 1: Identify Common Behaviours

Start by carefully observing the individual’s natural behaviours throughout the day. Look for patterns in:

• Facial expressions (e.g., smiling, frowning, squinting).

• Body movements (e.g., rocking, hand-flapping, turning away).

• Vocalisations (e.g., humming, clicking sounds, different tones of crying).

• Changes in breathing or muscle tension (e.g., holding breath, tensing shoulders).

• Eye gaze and gestures (e.g., looking toward an object, pointing, pushing things away).

Each person will have unique communication patterns, so it’s important to note which behaviours occur regularly.

Step 2: Determine Possible Meanings

Once behaviours are identified, consider what the individual might be trying to express when they display each one. Behaviours can communicate a variety of messages, such as:

• Discomfort or pain – Grimacing, stiffening the body, or withdrawing.

• Excitement or happiness – Smiling, clapping, vocalising joyfully.

• Frustration or distress – Increased vocalisations, rocking, hand-biting.

• Requesting something – Reaching out, making specific sounds, looking at a preferred item.

It's helpful to consult caregivers, teachers, and family members who interact with the individual regularly, as they may have insights into what certain behaviours mean.

Step 3: Decide on Consistent Responses

Consistency is key when responding to communication attempts. Each behaviour should have a clear and predictable response to help the individual understand that their actions have meaning.

For example:

By responding in the same way each time, caregivers reinforce cause and effect, helping the individual learn that their communication has an impact on their environment.

Step 4: Update the Dictionary Regularly

As communication develops, individuals may:

• Introduce new behaviours.

• Refine their ways of expressing needs.

• Transition from pre-intentional to intentional communication.

A communication dictionary should be a living document, regularly reviewed and updated to reflect new behaviours and interpretations. Sharing the updated dictionary with family members, teachers, therapists, and support staff ensures that everyone responds consistently, creating a more supportive and predictable communication environment.

Visual and Sensory Cues

Communication is often more effective when multiple senses are engaged. Many pre-intentional and intentional communicators rely on non-verbal cues, such as sights, sounds, and touch, to understand their environment and express their needs.

Using consistent and multisensory communication cues provides additional layers of support, helping individuals anticipate activities, recognise patterns, and connect meaning to their experiences. By integrating visual and sensory cues, caregivers and educators can enhance understanding, reduce anxiety, and encourage participation in communication interactions.

Types of Visual and Sensory Cues

There are various types of cues that can be used to support communication. Each method appeals to different senses and reinforces meaning through repetition and association.

1. Speech Cues – Pairing Words with Actions

Verbal communication is more effective when paired with a visual or physical cue that reinforces its meaning:

• Use simple, repetitive phrases with clear actions to create associations.

• Example: Saying "Time to eat" while holding up a spoon.

• Helps individuals recognise familiar words and associate them with specific routines.

2. Object Cues – Using Items to Represent Activities

Some individuals understand concepts better when they can see or touch an object that represents an activity or request.

• Present a physical object related to the next activity to provide a tangible cue.

• Example: Showing a brush before brushing hair, or placing a toothbrush in the hand before brushing teeth.

• Over time, the individual learns to associate objects with specific actions or routines.

3. Sound Cues – Associating Sounds with Actions

Certain sounds can serve as signals for upcoming activities, making transitions smoother and more predictable.

Use environmental sounds to indicate what is about to happen for example:

• Shaking a juice bottle before offering a drink.

• Tapping a spoon on a bowl to indicate mealtime.

• Rattling keys before leaving the house.

These cues can help individuals anticipate and prepare for the next step in their routine.

4. Touch Cues – Providing Predictable Physical Signals

For individuals who rely on tactile input, touch cues can provide an additional form of communication. Use gentle, intentional touch to indicate transitions or actions for example:

• A gentle tap on the shoulder before lifting the person.

• A light squeeze on the hand to signal attention or reassurance.

• A soft stroke on the arm before putting on a sleeve.

These cues can help individuals feel prepared for changes in their environment.

5. Movement Cues – Encouraging Participation Through Motion

Incorporating movement-based cues can engage the body in communication and promote participation in activities. Use gentle motion to indicate upcoming activities or encourage interaction. For example:

• Swaying back and forth before placing the child in a swing.

• Lifting arms gently before helping put on a shirt.

• Guiding hands toward a preferred object to encourage interaction.

This encourages active involvement in communication and daily routines.

Establish Predictable Routines

Routines provide structure, security, and predictability - key elements in communication development. When routines are consistent, individuals can anticipate what will happen next, reducing anxiety and increasing their ability to engage with caregivers and their environment.

Routines also support communication development by reinforcing patterns of interaction. Through repetition, individuals begin to associate specific cues with actions, strengthening their ability to recognise and respond to communication opportunities.

Why Are Predictable Routines Important?

Creates a Sense of Security – Knowing what to expect reduces stress and helps individuals feel more in control.

Encourages Participation – Familiar activities increase confidence in engaging with communication cues.

Reinforces Understanding – Repetition strengthens the link between actions, words, and responses.

Develops Communication – Routines provide natural opportunities to use and reinforce communication strategies.

How to Establish Effective Routines

Each routine should have a clear structure with a beginning, middle, and end to help reinforce understanding and build confidence in communication.

Introduce the Routine (Beginning):

• Gain the individual’s attention before starting.

• Use their name and a friendly greeting.

• Provide a visual, verbal, or sensory cue to signal what will happen next.

Guide Through the Activity (Middle):

• Keep steps clear, simple, and consistent.

• Use multisensory cues (e.g., showing an object, using gestures, or giving a gentle touch).

• Encourage small choices or participation where possible.

Provide Closure and Reinforcement (End):

• Clearly indicate that the routine is complete.

• Offer positive reinforcement (e.g., praise, a smile, or a preferred activity).

• If appropriate, preview what happens next to support smooth transitions.

Encouraging Communication Opportunities

Creating structured opportunities for communication helps individuals with intellectual disabilities engage more actively. Simple adjustments in daily interactions can motivate them to express needs, make choices, and participate socially.

1. Offer Choices

Giving individuals options encourages decision-making and expression.

• Hold up two items and name them ("Do you want a ball or a book?").

• Wait for a response—reaching, pointing, vocalising, or looking.

• Reinforce the choice ("You picked the ball! Great choice!").

2. Pause for a Response

Pausing naturally encourages individuals to initiate communication.

• Stop briefly during an activity (e.g., before pushing a swing).

• Look expectantly, waiting for a signal (sound, gesture, movement).

• Respond immediately when they attempt to communicate.

3. Withhold Briefly to Prompt Requests

Delaying access to a desired item encourages communication.

• Hold up an item but wait before giving it.

• Look for any attempt to communicate (reach, sound, eye contact).

• Label and reinforce the request ("You want juice! Here you go.").

4. Encourage Turn-Taking

Turn-taking builds social communication skills.

• Use interactive activities (rolling a ball, stacking blocks).

• Take a turn, then pause and wait.

• Reinforce participation ("Your turn! Great job!").

Adapting the Environment for Success

Creating a supportive environment is essential for encouraging effective communication. Minimising distractions, such as background noise and visual clutter, helps individuals focus and process interactions more easily.

Adjusting sensory input to meet individual needs can make a significant difference; some may require calming strategies like dim lighting and soft textures, while others benefit from stimulating activities such as gentle movement or music.

Positioning is also key - ensuring that the individual is seated comfortably and at an appropriate angle promotes engagement and makes communication more accessible. By making thoughtful adjustments, caregivers and educators can create an environment that fosters meaningful interaction and reduces barriers to communication.

Overcoming Communication Barriers

Even with structured support, individuals with intellectual disabilities may face challenges in communication. One common barrier is inconsistent responses from caregivers, where different interpretations of the same behaviour can lead to confusion and frustration. Using a communication dictionary ensures that everyone interacting with the individual responds in a predictable and supportive way, reinforcing understanding and trust.

Sensory factors can also impact communication. Overstimulation, such as excessive noise or bright lighting, may cause distress and withdrawal, while understimulation can lead to disengagement. Adjusting the environment by modifying lighting, reducing background noise, or introducing sensory-friendly activities helps create a space where individuals feel comfortable and ready to communicate.

Another challenge is learned helplessness, which occurs when individuals stop attempting to communicate because their efforts have not been recognised or reinforced in the past. Encouraging all forms of communication, whether through gestures, vocalisations, or body language, and providing immediate, positive reinforcement helps build confidence and motivation to interact. Addressing these barriers thoughtfully ensures that communication remains a meaningful and rewarding experience.