Speech Therapy for Adults with Intellectual Disabilities: What It Works On and How It Helps
Speech therapy for adults with intellectual disabilities can help with understanding spoken language, expressing needs and ideas, and communicating more effectively in everyday life. Some adults with intellectual disabilities work on making their speech easier to understand. Others use pictures, signs, or a speech-generating device to help them communicate.
Speech therapy often ends when a student graduates or ages out of special education, but communication needs continue into adulthood. Adults need to communicate at work, at medical appointments, at home, and in the community. If an adult still has difficulty communicating, it is not too late to work on those skills. Adults can keep improving their communication, although progress looks different for each person.
In this article, you'll learn what speech therapy can address for adults with intellectual disabilities, how other forms of communication can help people who speak very little, and how families and support staff can help with communication in everyday life.
Key Takeaways
What it is: A speech and language therapist can help people with intellectual disabilities understand others, express needs and ideas, and engage with others at home, at work, and in the community.
What it works on: Goals for speech and language therapy often include understanding spoken language, putting thoughts into words (expressive language), speaking clearly, using social skills, and reading and writing for daily tasks.
Other ways to communicate: Gestures, picture boards, and speech-generating devices can help adults who have difficulty speaking communicate their needs, thoughts, and ideas.
Family and staff can support communication: The way family members, caregivers, and staff communicate with an adult can make everyday conversations easier and give the person more opportunities to participate.
What Is an Intellectual Disability?
What Communication Challenges Do Adults with Intellectual and Developmental Disabilities Face?
What Does Speech Therapy for Adults with Disabilities Work On?
How Can AAC Help Adults with Intellectual Disabilities Communicate?
How Can Families and Support Staff Help Communication Every Day?
What We See Working with Clients
Frequently Asked Questions About Speech Therapy for Adults with Intellectual Disabilities
What Is an Intellectual Disability?
An intellectual disability affects a person's ability to learn, reason, solve problems, and manage some aspects of everyday life. These are often described as intellectual functioning and adaptive behavior. According to the American Association on Intellectual and Developmental Disabilities, intellectual disabilities begin before age 22.
Some adults with intellectual disabilities also have conditions such as Down syndrome, autism, or cerebral palsy. Communication abilities vary widely from person to person. Some adults communicate using spoken language, while others use signs, pictures, a speech-generating device, or a combination of methods.
What Communication Challenges Do Adults with Intellectual and Developmental Disabilities Face?
Adults with intellectual disabilities may have difficulty understanding what others say, expressing their needs and ideas, or being understood. Some people speak in full sentences, while others use only a few spoken words or communicate in other ways.
Common communication challenges include:
Understanding spoken language, especially long sentences, fast speech, or words about time and abstract ideas
Saying what they want, need, or feel, or explaining what happened
Being understood by people outside the family when speech is unclear
Taking part in conversations, such as taking turns, staying on topic, or understanding facial expressions and other social cues
Reading and writing for daily tasks, such as reading a menu or work schedule or writing a text message
Communication challenges can become more noticeable in adult situations, such as at work, at medical appointments, or when talking with new people. When someone has difficulty communicating what they want or need, frustration can also occur.
What Does Speech Therapy for Adults with Disabilities Work On?
Speech therapy for adults with intellectual disabilities focuses on communication skills the person uses in everyday life. A speech-language pathologist evaluates the person's strengths and areas of difficulty and develops goals based on what will be most useful to that person.
Many goals focus on functional communication, such as asking for help, making choices, answering questions, expressing needs and ideas, and participating in conversations.
Speech therapy can be provided individually or in a group. Individual sessions provide one-on-one support based on the person's specific communication goals. Group sessions give adults opportunities to practice conversation and social communication skills with other people.
A 2018 study by Terband and colleagues followed 36 adults, ages 18 to 40, who had mild or moderate intellectual disabilities and were hard to understand. After two 3-month periods of speech and listening practice, the adults' speech intelligibility improved, meaning others understood them more easily. The group also understood more spoken words by the end of the study.
Receptive and Expressive Language Skills
Receptive language is the ability to understand what other people say. Expressive language is the ability to communicate thoughts, needs, and ideas. Speech therapy focuses on these skills by practicing following directions, learning words needed at work or at home, and using sentences to explain a problem.
Speech Clarity
When a person's speech is hard for others to understand, speech and language therapy can focus on what is affecting their speech clarity. Practice can include words and phrases the person uses in daily life, such as their name or phrases they use at work. It can also address speaking rate when it affects how easily others understand them.
When specific speech sounds are part of the problem, articulation therapy for adults uses focused practice on those sounds.
Social Communication Skills and Self-Advocacy
Social communication includes skills such as keeping a conversation going, noticing when a listener is confused, and asking for help. A person can practice social interaction skills by role-playing everyday situations, such as ordering at a coffee shop or asking a coworker a question.
Speech therapy can also work on self-advocacy, including expressing a preference, asking for clarification, or telling someone when something is wrong.
Reading and Writing for Daily Life
Some adults work on reading and writing skills they use each day, such as understanding signs, reading a bus schedule, following a recipe, or writing a short text message. Adults who can read or recognize written words but have trouble understanding their meaning can learn more in our guide to reading comprehension problems.
How Can AAC Help Adults with Intellectual Disabilities Communicate?
Augmentative and alternative communication (AAC) gives people ways to communicate in addition to or instead of spoken words. It can help adults who have difficulty speaking or whose speech is hard for others to understand. Before recommending alternative communication methods, a speech-language pathologist looks at how the person currently communicates, what they understand, their hearing and vision, their physical abilities, and what they need to communicate in everyday life.
| Type of AAC | Examples | Often a good fit when |
|---|---|---|
| Signs and gestures | Natural gestures, Makaton, or manual signing paired with spoken words | The person can move their hands well and talks mostly with family and staff who know the signs |
| Low-tech AAC | Picture boards, communication books, and picture schedules | The person understands pictures and needs a simple tool that works anywhere, with no charging |
| High-tech AAC | A speech-generating device or a tablet app that speaks out loud | The person needs to be understood by strangers or wants to say more than a board can hold |
| Connected Speech Pathology | connectedspeechpathology.com | ||
Some people use gestures or signs. Others use low-tech augmentative and alternative communication, such as picture boards or communication books, or high-tech AAC, such as a speech-generating device or tablet app that speaks a selected word or message aloud.
Many people use more than one way to communicate. For example, someone can use speech and gestures at home and a speech-generating device in other settings. AAC does not prevent someone from continuing to work on spoken communication when that is one of their goals. It gives the person another way to communicate when needed. Adults can also learn to use AAC even if they did not use it as children.
Down Syndrome Speech Therapy for Children and Adults
Learn more in our guide to Down syndrome speech therapy.
How Can Families and Support Staff Help Communication Every Day?
Family members and support staff can play an important role in helping an adult communicate throughout the day. A speech-language pathologist can show them communication strategies that can make everyday exchanges easier.
Use clear language the person understands, and break longer instructions into smaller steps when needed.
Use picture schedules or written lists to make daily routines easier to follow.
Use words, signs, or AAC messages yourself to show the person how they can use them during meals, chores, and other routines.
Give the person time to reply before you repeat the question or ask it in a different way.
When a question is hard to answer, offer two clear choices. For example, hold up two drinks and ask the person to choose.
Respond to the person's communication, including gestures and sounds.
Keep the AAC device or communication book available throughout the day, not only during speech therapy.
A speech-language pathologist can work with other people in an adult's life, such as family members, support staff, job coaches, behavior analysts, occupational therapists, and other professionals. Sharing communication strategies and goals can help everyone respond in similar ways and support the adult's communication across different parts of daily life.
What We See Working with Clients
We work with adults who have intellectual disabilities and with the families and staff who support them. The examples below are based on real clients we have worked with. Identifying details have been changed to protect privacy.
One young man in his late twenties stocks shelves at a grocery store. Customers and coworkers often asked him to repeat himself, and he had started nodding instead of answering some questions at work. He told his mother he felt embarrassed, and he had stopped calling his friends.
During online speech therapy sessions, we practiced saying the words he uses most at work. These included the names of store sections and the question "Can I help you find something?" We practiced speaking more slowly and role-played customer questions.
His mother joined some sessions to practice the same phrases with him at home. His supervisor told the family he was answering customer questions more often, although he still felt nervous with people he did not know.
Another client, a woman in her early forties, has a moderate intellectual disability and uses few spoken words. Staff at her group home often had to guess what she wanted. They reported that she sometimes became upset during outings and pushed away from the table at mealtimes.
We started with a communication book of photos of her favorite foods, drinks, and activities, and she later began using a tablet app to ask for things as well. Over video, we coached staff to give her time to respond, offer choices, and point to the pictures as they talked. Staff now report that she uses her book to ask for drinks and activities and that mealtimes go more smoothly on most days.
Frequently Asked Questions About Speech Therapy for Adults with Intellectual Disabilities
1. Is it too late to start speech therapy as an adult?
No, adults can keep building communication skills. In one study of 36 adults with mild or moderate intellectual disabilities, speech became easier to understand after two 3-month practice periods. How much progress someone makes varies from person to person.
2. Is “learning disability” another term for intellectual disability?
The terms have different meanings depending on where they are used. In the UK, “learning disability” is commonly used for what is called an intellectual disability in the United States. In the U.S., an intellectual disability affects intellectual abilities, such as learning, reasoning, and problem-solving, as well as skills needed for everyday life. A learning disability affects specific academic skills, such as reading, writing, or math. Dyslexia, for example, is a learning disability that affects reading.
3. Can families help with practice at home?
Yes, families can help with practice at home between speech therapy sessions. Training communication partners enhances the effectiveness of communication interventions.
4. Can adults who have an intellectual disability participate in speech therapy online?
Yes, online speech therapy services can work well for some adults with intellectual disabilities. A family member or support worker can help set up the video call and join when the adult wants them involved. Whether online speech therapy is a good fit depends on the person's needs and comfort with video, and a speech-language pathologist can help you decide after an evaluation.
How Connected Speech Pathology Can Help
At Connected Speech Pathology, our licensed speech-language pathologists work with adults on goals such as understanding spoken language, speaking clearly, and building social communication skills. In our online speech therapy for adults, goals are based on the communication situations that are important to each person.
Family members and support staff can join when the adult wants them there, and we show them ways to help with communication between sessions. Our speech therapy services take place over live video, so the person can use their own communication tools and practice in daily routines.
Summary
Speech therapy for adults with intellectual disabilities can help a person understand spoken language, express needs and ideas, and communicate more effectively in everyday life. Some adults focus on verbal speech, while others use AAC, such as signs, picture boards, or a speech-generating device, and some use both. Research suggests that adults with intellectual disabilities can keep building communication skills, and families and staff can support their communication at home and at work.
About the Author
Allison Geller, M.A., CCC-SLP, is a communication coach, speech-language pathologist, and founder of Connected Speech Pathology, an international online practice providing professional communication coaching and speech therapy for children, teens, and adults. With more than two decades of experience, she has worked in medical and educational settings and published research on aphasia. Today, she leads a team of specialists who help clients improve their skills in public speaking, vocal presence, accent clarity, articulation, language, fluency, and interpersonal communication.
