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Understudied and 
Underserved: Advancing 
Inclusive Mental Health 
Care for Individuals 
with Intellectual 
and Developmental 
Disabilities
SHAYNA DELVECCHIO, LMSW



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UNDERSTUDIED AND UNDERSERVED

ABSTRACT
Individuals with intellectual and developmental disabilities (IDD) face 
profound inequities in accessing and receiving quality mental health 
care despite being at increased risk for psychological distress. This 
paper examines the historical and systemic barriers that perpetuate 
these disparities—including financial limitations, imbalances within the 
healthcare system, provider shortages, inadequate research funding, and 
persistent misconceptions about the therapeutic potential of individuals 
with IDD. The exclusion of individuals with IDD from research and 
psychotherapy further exacerbates these challenges, creating significant 
gaps in clinical knowledge and guidance. In addition, individuals with 
IDD face disproportionately severe mental health challenges, including 
heightened exposure to trauma, diagnostic overshadowing, and the 
impact of social stigma. 

In response, inclusive strategies are proposed to improve care by 
addressing the unique cognitive, communicative, and emotional needs 
of this population. Central to these recommendations is a shift toward 
person-centered, dignity-affirming care that recognizes individuals with 
IDD as autonomous participants in their own treatment. To advance 
equity in mental health care, it is imperative to pursue transformative 
change through inclusive research, targeted provider training, and 
evidence-based therapeutic adaptations. By amplifying the voices of 
individuals with IDD and addressing the systemic factors that have long 
excluded them, it will be possible to move toward a more equitable and 
responsive mental health care system for this underserved community.

Keywords: intellectual and developmental disabilities (IDD), mental 
health disparities, diagnostic overshadowing, person-centered therapy, 
trauma-informed care, inclusive psychotherapy, disability advocacy

SHAYNA DELVECCHIO, LMSW

UNDERSTUDIED AND UNDERSERVED: 
ADVANCING INCLUSIVE MENTAL  
HEALTH CARE FOR INDIVIDUALS  
WITH INTELLECTUAL AND 
DEVELOPMENTAL DISABILITIES
Individuals with intellectual and developmental disabilities (IDD) are 
multidimensional human beings with rich emotional lives and significant 
capabilities, yet they are often inadequately recognized as such. Despite 
growing awareness and advocacy efforts, outdated perceptions continue 
to shape societal attitudes, policies, and clinical practices. As a result, 
individuals with IDD frequently encounter barriers that limit their 
autonomy, access to care, and overall well-being. 

IDD encompasses a broad range of conditions characterized by 
impairments in intellectual functioning and adaptive behavior that 
emerge during development and persist throughout a person’s lifetime 
(Eunice Kennedy Shriver National Institute of Child Health and Human 
Development [NICHD], n.d.). Per the NICHD (n.d.), these differences 
can impact multiple domains, including:
• Cognitive and learning abilities—reasoning, problem-solving, 

communication.
• Behavioral and social functioning—social skills, emotional 

regulation, self-care.
• Physical ability and motor skills—mobility, coordination.

IDD includes chromosomal conditions such as Down syndrome and 
fragile X syndrome, as well as neurodevelopmental conditions including 
autism spectrum disorder and fetal alcohol syndrome (NICHD, n.d.). 
Compared to the general population, individuals with IDD are more 
vulnerable to experiencing mental health challenges, including anxiety, 
depression, and PTSD—yet they remain far less likely to access 
appropriate resources and support (Lineberry et al., 2023).

Multiple factors contribute to the inequitable access to mental health 
care for individuals with IDD, including systemic barriers, research 



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gaps, and long-standing misconceptions. Systemic challenges such 
as financial inequities, a shortage of trained providers, and a lack of 
accessible services create considerable obstacles to receiving appropriate 
care. Individuals with IDD also face a heightened risk of trauma and 
psychological distress, yet their mental health concerns are frequently 
overlooked due to diagnostic overshadowing and the impact of stigma. 

These interconnected forces continue to perpetuate the disparities 
individuals with IDD experience in mental health care. Despite increased 
need, this population remains vastly underrepresented in psychological 
research, limiting the development of effective, evidence-based 
interventions. As a result, care often fails to reflect the diverse needs of 
the IDD community, leading to inadequate support and reinforcing an 
ongoing pattern of excluding them from active participation in their own 
care. This paper examines the systemic disadvantages that individuals 
with IDD experience in mental health care, highlights the intersecting 
barriers to equitable treatment, and proposes recommendations to foster 
greater inclusion and accessibility in therapeutic settings and beyond.
 
SYSTEMIC BARRIERS TO EQUITABLE 
MENTAL HEALTH CARE
Individuals with disabilities face systemic marginalization across various 
facets of their lives, limiting their access, opportunities, and inclusion. 
Deeply rooted historical discrimination and ongoing barriers have led to 
profound inequities—particularly in financial stability, access to mental 
and physical health care, and funding for research. These challenges 
significantly contribute to negative mental health outcomes. 
 
HISTORICAL CONTEXT

Beginning in the 19th century and continuing well into the 20th century, 
the widespread institutionalization of people with disabilities led to 
their forced removal from society. Within these institutions, individuals 
were often subjected to dehumanizing conditions (Davis, 2015). This 

systemic othering contributed to the exclusionary view of individuals 
with disabilities as burdensome or even dangerous (Davis, 2015). These 
perceptions worsened as the eugenics movement gained traction between 
the 1900s and 1940s, when policymakers and medical professionals 
advocated for the forced sterilization of individuals with disabilities, 
further entrenching the belief that they were inherently flawed (O’Brien, 
2023, chapter 3). 

This deprivation of fundamental human rights had a detrimental impact 
on the mental health of individuals with IDD, though their psychological 
well-being was largely disregarded by institutions at the time (Burns, 
2009). While the latter half of the 20th century saw monumental shifts 
away from this harrowing past with the rise of the Disability Rights 
Movement and landmark legal reforms, substantial barriers remain in 
addressing the injustices and ongoing challenges faced by individuals 
with IDD (Burns, 2009; Davis, 2015).

FINANCIAL INEQUITIES THAT LIMIT 
OPPORTUNITY

The consequences of this long history of discrimination manifest in 
various forms, including stark economic disparities that limit access 
to essential resources and opportunities. According to the National 
Disability Institute (2020), 26% of individuals with a disability live 
below the poverty line, compared to 11% of individuals without a 
disability. Structural barriers—including limited educational resources, 
discrimination in hiring, physically inaccessible workplaces, and 
inadequate social support—hinder financial stability (World Bank, 2023). 
This is further compounded by higher rates of unemployment, limited 
employment opportunities, and wage inequalities: Under Section 14(c) 
of the Fair Labor Standards Act, individuals with IDD can legally be 
paid subminimum wages, with median earnings as low as $3.50 per 
hour (Wage and Hour Division, 2024). These inequities make financial 
independence exceptionally difficult to attain. Additionally, individuals 
receiving Supplemental Security Income (SSI) face asset limits in 
which they risk losing crucial benefits, including Medicaid, if they save 

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more than $2,000 (Musumeci & Orgera, 2021). This cycle of financial 
precarity impacts mental health, as financial instability contributes to 
chronic stress and limits access to resources—further deepening systemic 
disadvantages for individuals with disabilities (Houtrow et al., 2023).

LIMITATIONS IN HEALTHCARE

Healthcare access remains a major barrier for individuals with IDD, 
who often receive lower-quality medical and mental health care and face 
obstacles that impede comprehensive treatment (Krahn et al., 2015). 
An estimated 50% to 70% of individuals with IDD who require mental 
health services do not receive them, in part due to the lack of appropriate 
services covered by funded programs (Harris et al., 2018). 

Medicaid, the primary funding source for IDD care, covers 
approximately 77% of essential services for individuals with IDD, 
including home- and community-based supports and general healthcare. 
However, it often provides only limited coverage for mental health 
services. These limitations include restrictions on specialized therapy, 
session frequency, and provider availability (Barth, 2021). Medicaid-
funded programs tend to prioritize behavioral interventions over 
psychotherapy, reflecting outdated assumptions about the psychological 
needs of this population (Barth, 2021). While strictly behavioral 
interventions can be effective for managing specific concerns, neglecting 
emotional well-being leaves many individuals with IDD struggling with 
undiagnosed or untreated psychological issues (McNally et al., 2021).

Healthcare disparities extend beyond mental health to physical health. 
Individuals with IDD are more than twice as likely to experience 
chronic, preventable conditions—such as obesity, diabetes, heart disease, 
stroke, and other cardiovascular diseases—compared to those without 
disabilities (Dixon-Ibarra & Horner-Johnson, 2014). This elevated 
risk is often linked to systemic barriers, including inadequate access to 
routine and preventive care such as screenings, early interventions, and 
health education (Escudé, 2022; Gréaux et al., 2023). These structural 
shortcomings not only affect physical health but can also intensify mental 

health difficulties, creating a cycle in which one condition exacerbates 
the other (Division of Population Health, 2012).

LIMITED RESEARCH FUNDING

Beyond service access and coverage, another major challenge lies in 
the limited research infrastructure supporting IDD mental health care. 
Research on the mental health needs of individuals with IDD remains 
severely underfunded (Hassiotis et al., 2022). Government investment in 
this area is limited, partly due to systemic oversight and the minimization 
of IDD-related concerns within broader mental health policy agendas 
(Hassiotis et al., 2022). As a result, many initiatives depend on short-term 
grants from nonprofit organizations and private foundations (Hassiotis et 
al., 2022). Despite the substantial, well-documented needs of individuals 
with IDD, research specific to this population has historically received 
a disproportionately small fraction of overall mental health funding 
(National Institutes of Health, n.d.). 

While nonprofit organizations play a vital role in supporting these 
efforts, their financial resources are far more limited than those of 
public institutions (Frumkin & Kim, 2001). This has made it difficult 
to initiate and sustain large-scale, long-term studies—limiting both the 
generalizability of findings and the ability to produce insights that are 
responsive to the varied needs within the IDD community (Frumkin 
& Kim, 2001). The scarcity of dedicated funding hinders scientific 
progress and restricts the development of effective, evidence-based 
interventions. These funding gaps contribute to the continued exclusion 
of individuals with IDD from both research and clinical care—reflecting 
and reinforcing broader patterns of systemic neglect.

LACK OF TRAINED PROVIDERS

Even when care is otherwise accessible, another major limitation is the 
shortage of trained professionals equipped to provide mental health 
treatment to individuals with IDD. Effective therapy for this population 
requires clinicians with specialized expertise in the psychological, 
biological, and sociocultural dimensions of IDD (American 

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Psychological Association [APA], 2022). However, many clinicians 
lack the necessary training and confidence to diagnose and treat mental 
health conditions in this community (Hinde & Mason, 2020). Although 
training opportunities are increasing, they remain insufficient to meet 
the growing demand (Lamar, 2020). Many states report a shortage of 
specialized providers, which causes long wait times: Some individuals 
face wait periods of three to six months before receiving mental health 
care (Lamar, 2020). These delays are particularly harmful to individuals 
with IDD who require timely support. 

Existing clinicians often become overextended due to the shortage of 
trained professionals, the backlog of cases, and high caseloads. This 
overextension often dilutes the time and attention spent on each client. 
This, in turn, increases the likelihood of burnout and reduces the capacity 
to provide individualized care (Hinde & Mason, 2020). As a result, the 
quality of care suffers as clinicians struggle to meet the diverse needs of 
each client, which can contribute to worsening symptoms and diminished 
outcomes (Hinde & Mason, 2020). This issue highlights the critical need 
for both more specialized training and a greater number of qualified 
professionals to effectively address the unmet mental health needs of 
individuals with IDD.

The consequences of these systemic barriers are grave. Limited access 
to routine healthcare, higher prevalence of preventable physical 
conditions, elevated rates of mental health difficulties, and broader 
social determinants of health—such as economic instability and social 
exclusion—all culminate in an average 15- to 20-year reduction in life 
expectancy for individuals with IDD (White et al., 2023). A staggering 
42% of deaths among individuals with IDD result from potentially 
preventable causes—nearly double the rate in the general population, 
22% (Cooper et al., 2020). These disparities necessitate a multifaceted 
and systemic approach—one that addresses not only individual mental 
health needs but also the broader social, economic, and structural factors 
contributing to poorer health outcomes.
 

EXCLUSION FROM RESEARCH AND 
EVIDENCE-BASED PRACTICE
BARRIERS TO PARTICIPATION IN 
PSYCHOLOGICAL RESEARCH

Equitable care is not possible without a strong research foundation, 
yet the persistent exclusion of individuals with IDD from the research 
landscape has severely limited the understanding of their mental health 
needs and hindered the development of effective, evidence-based 
interventions (DeCormier Plosky et al., 2022). Individuals with IDD 
remain critically underrepresented in mental health research and clinical 
trials, resulting in a limited evidence base to guide psychological 
care (DeCormier Plosky et al., 2022; Friedman & Spassiani, 2024). 
Researchers have historically deemed controlled studies involving this 
population too difficult due to lingering misconceptions and various 
methodological challenges (Friedman & Spassiani, 2024). These 
challenges include participant recruitment, ethical concerns around 
ensuring informed consent, and the need for accessible accommodations, 
which can be costly (Friedman & Spassiani, 2024). Without appropriate 
infrastructure, researchers have often viewed such studies as too 
logistically challenging to pursue—inadvertently excluding this 
population even further. 

However, recent efforts to rectify this historical exclusion have focused 
on increasing awareness of ethical research practices and actively 
addressing logistical barriers to participation. These efforts have led 
to the adoption of more inclusive methodologies, such as participatory 
research approaches (Sadler, 2023). These methods involve integrating 
individuals with IDD as active participants in the design and execution of 
studies, taking on collaborative roles such as co-researchers and advisors 
(Sadler, 2023). By showcasing the lived experiences of individuals 
with IDD, these approaches produce more accurate and contextually 
relevant findings, while helping counteract the historical exclusion of this 
community from research (Sadler, 2023).

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DISPARITIES IN GLOBAL RESEARCH 
REPRESENTATION

While this progress is promising, there is a significant gap in research on 
how disability intersects with different racial, ethnic, and socioeconomic 
backgrounds, particularly in low- and middle-income countries 
(Magaña et al, 2022; Susanty et al., 2020). Cultural adaptations of 
psychosocial interventions are necessary to deliver effective support 
across diverse populations; however, such adaptations remain limited 
and underdeveloped (Susanty et al., 2020). Approximately 80% of 
people with disabilities globally live in developing countries, yet 
the vast majority of psychosocial interventions and research on IDD 
have been concentrated in high-income, Western countries, where 
the resources and frameworks for conducting such studies are more 
readily available (Susanty et al., 2020). This inequity places the vast 
majority of individuals with IDD at an even greater disadvantage, as 
most interventions designed in high-income countries fail to account 
for the cultural, socioeconomic, and contextual factors that shape their 
psychological needs. 

Interventions must be designed to be both effective and accessible for 
individuals in resource-constrained settings, ultimately contributing to 
the reduction of global inequalities in disability care. True inclusivity 
cannot be achieved while much of the global IDD population remains 
especially overlooked. Only when these disparities—both between high- 
and low-income countries and across cultural groups—are addressed will 
meaningful equity in disability mental health care be within reach.

The exclusion of individuals with IDD from research is both a symptom 
and a driver of broader systemic inequities—rooted in inadequate 
funding, limited infrastructure, and ingrained biases within the research 
field. As a result, individuals with IDD continue to be left out of the very 
systems intended to support their well-being, perpetuating exclusion in 
both knowledge and care.
 

BARRIERS TO PSYCHOTHERAPY: 
MISCONCEPTIONS AND EMERGING 
PROGRESS
LEGACY OF EXCLUSION IN MENTAL  
HEALTH TREATMENT

Although participatory research approaches and more inclusive research 
have improved representation in mental health studies, misconceptions 
about the emotional experiences and therapeutic potential of individuals 
with IDD continue to limit their access to appropriate mental health 
care. Historically, disabilities were treated as illnesses requiring a cure 
rather than inherent parts of a person’s experience (Linton, 1998). As 
psychology and Western psychotherapy emerged as formal disciplines in 
the late 19th and early 20th centuries, individuals with disabilities were 
systematically excluded due to prevailing discriminatory beliefs that 
viewed them as intellectually inferior (Linton, 1998). This “therapeutic 
disdain” (Bender, 1993) was rooted in assumptions that individuals with 
IDD lacked awareness of their mental health and were incapable of 
participating in their own psychological treatment. 

These beliefs persisted into the 1990s and early 2000s, reinforcing the 
notion that psychotherapy was not a viable option for individuals with 
IDD. For decades prior, many professionals believed that individuals 
with IDD lacked the cognitive capacity to benefit from self-reflection 
or insight-based therapies (Bender, 1993). As a result, mental health 
treatment primarily followed the medical model, which focused on 
symptom management and modifying external factors, often without 
addressing deeper psychological needs (Olkin, 2022; Willner & Lindsay, 
2016). Within this framework, concerns were predominantly addressed 
through pharmacological treatments, hospitalization, and strictly 
behavioral interventions (Olkin, 2022; Willner & Lindsay, 2016). These 
interventions were frequently administered by third parties—such as 
healthcare providers without mental health training or caregivers—often 
without the individual’s consent (Willner & Lindsay, 2016). 

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Misconceptions about the cognitive capacity and self-efficacy of 
individuals with IDD led many professionals to assume they were 
incapable of making informed decisions about their own care (Bender, 
1993). Consequently, treatment plans were often imposed rather 
than developed with their collaboration or consent, further stripping 
individuals of agency in their mental health treatment (Dunkley et al., 
2018). Such methods distanced the individual from their own emotions 
and volition, reducing them to passive recipients of care and leaving 
mental health concerns inadequately addressed. When individuals 
with IDD are excluded from decisions about their care, it can lead to 
feelings of disempowerment and a reluctance to seek help in the future 
(Dunkley et al., 2018). This can contribute to medical trauma, worsen 
psychological distress, and deepen disparities in mental health support 
(Bradbury-Jones et al., 2020).

PROGRESS TOWARD INCLUSIVE AND 
EMPOWERING CARE

The long-standing belief that individuals with IDD cannot benefit from 
psychotherapy has begun to dissolve as research and advocacy efforts 
expand (Shepherd & Beail, 2017). In the late 1990s and early 2000s, 
emerging research began to demonstrate the effectiveness of adapted 
psychotherapeutic approaches, such as modified cognitive behavioral 
therapy—prompting a gradual shift in professional attitudes (Willner, 
2005). Psychotherapy is now more widely recognized as an effective 
treatment for individuals with IDD (Porcelan et al., 2019; Shepherd 
& Beail, 2017). Informed mental health and disability professionals 
acknowledge that, with appropriate resources and support, individuals 
with IDD are wholly capable of growth, change, and recovery from 
mental illness through psychotherapy (Porcelan et al., 2019). This 
understanding has catalyzed positive change, prompting the integration 
of cognitive principles into behavioral therapy, creating a more 
comprehensive model that addresses potential behavioral challenges and 
the emotional experiences of individuals with IDD. 

While many past misconceptions have been dispelled, remnants of these 

beliefs remain, and considerable progress is still needed to achieve 
truly equitable mental health care. Since psychotherapy for individuals 
with IDD is still a relatively new and evolving field, continued research 
is essential to refine and enhance treatment methods. Addressing 
research gaps and promoting integrated treatment approaches are key to 
strengthening the knowledge base needed to better support individuals 
with IDD. A crucial part of this effort involves amplifying the voices of 
individuals with IDD in both psychological research and clinical care, as 
inclusive mental health care cannot exist without their representation and 
participation. 

MENTAL HEALTH EXPERIENCES AND 
TREATMENT
INCREASED RISK OF TRAUMA AND ADVERSE 
CHILDHOOD EXPERIENCES

The systemic inequities that limit access to inclusive care also contribute 
to the significantly higher rates of trauma, abuse, and mental health 
challenges experienced by individuals with IDD compared to the 
general population (Didden & Mevissen, 2022; Lunsky & Lake, 2019). 
Individuals with IDD are also more likely to experience multiple 
disabilities and comorbidities: Between 39% and 52% of people with 
IDD have a co-occurring psychiatric condition, such as anxiety or mood 
disorders (Healthy Minds Policy Initiative, 2024). Individuals with 
IDD are disproportionately exposed to adverse childhood experiences 
(ACES)—stressful or traumatic events experienced in childhood that can 
have lasting effects on an individual’s physical, emotional, and mental 
health. This further compounds their risk of psychological distress 
(Division of Violence Prevention, 2019; McNally et al., 2021).

Approximately 44% of people with IDD have experienced at least four 
ACEs, compared to just 13% of the general population (National Core 
Indicators, 2023). Some of the traumas individuals with IDD are more 
likely to experience include physical and emotional abuse and neglect 
at the hands of caregivers, as well as social challenges such as bullying, 

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isolation, and exclusion (Didden & Mevissen, 2022; National Council on 
Disability, 2022). Individuals with IDD also experience higher rates of 
sexual abuse, coercion, and exploitation, as others may wrongly assume 
they lack decision-making capacity and exploit their trust, reliance on 
support, or limited access to resources (Beadle-Brown et al., 2010; Nixon 
et al., 2017). The cumulative impact of these experiences during crucial 
developmental years increases vulnerability to long-term mental health 
challenges, chronic health conditions, and persistent social isolation 
(National Core Indicators, 2023). 

DIAGNOSTIC OVERSHADOWING

An additional barrier to effective mental health care for individuals 
with IDD is the tendency for providers to minimize or disregard their 
mental health challenges, or attribute them entirely to their disability. 
A pervasive issue known as diagnostic overshadowing occurs when 
symptoms are misattributed solely to a person’s disability. This involves 
overemphasizing or focusing excessively on the disability while 
overlooking other important aspects of the individual’s life, including 
life events, strengths and capabilities, and additional factors related to 
the client’s presenting concerns (APA Task Force, 2022; Hallyburton, 
2022). This bias results in individuals being perceived almost exclusively 
through the lens of their disability, often overshadowing their broader 
identity (APA Task Force, 2022).

While challenges associated with disabilities can contribute to mental 
distress, they are not the sole explanation for these individuals’ 
difficulties. Disability may be an important and meaningful aspect 
of their identity, but it does not encompass the entirety of it. Unlike 
individuals without disabilities, who are typically viewed holistically by 
mental health professionals, individuals with IDD are frequently viewed 
through the restrictive framework of their condition (APA Task Force, 
2022). Without proper training, many clinicians struggle to recognize 
how mental health conditions may present differently in individuals with 
IDD (Fletcher et al., 2016). Although clinicians generally mean well and 
are often motivated by a desire to help, the lack of sufficient training 

and awareness can unintentionally result in diagnostic overshadowing. 
The implications of this phenomenon are profound: Professionals often 
overlook or dismiss symptoms of anxiety, depression, PTSD, and other 
mental health disorders, leaving diagnosable and treatable mental health 
conditions unaddressed (Lunsky & Lake, 2019). 

To effectively combat diagnostic overshadowing, treatment should 
aim to bridge the gap between the internal experiences and outward 
expressions of individuals with IDD. It is important for clinicians to 
have a foundational understanding that disabilities can profoundly affect 
mental health, while also recognizing that individuals often present 
with concerns unrelated to their disability. This awareness should 
inform the therapeutic process, wherein clinicians actively explore both 
disability-related and independent mental health challenges. This more 
nuanced perspective enhances diagnostic accuracy and fosters more 
compassionate, individualized care that addresses the full spectrum of 
challenges experienced by individuals with IDD.

IMPACT OF SOCIAL STIGMA

Social stigma and isolation may also harm the mental health of 
individuals with IDD. Although stigmatization has decreased in recent 
years due to growing awareness and advocacy efforts, residual stigma 
remains deeply ingrained in societal perceptions. Many individuals 
with disabilities unconsciously internalize these negative views, 
increasing their risk of psychological distress—particularly anxiety 
and depression—and contributing to social withdrawal and a decreased 
likelihood of seeking support (Dagnan & Waring, 2004).

In addition to stigma, factors such as low self-esteem, negative self-
concept, unfavorable social comparisons, feelings of hopelessness, and 
limited social support have all been linked to heightened mental health 
difficulties among this population (Evans & Randle-Phillips, 2018). 
These psychosocial stressors, coupled with the ongoing lack of accessible 
mental health care, have been associated with increased suicide risk. 
Individuals with IDD are three times more likely to face suicide risks 

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than the general population, and those on the autism spectrum are 
particularly vulnerable (Santomauro et al., 2024). 

These disparities underscore the urgent need for accessible, trauma-
informed mental health care that not only addresses the varied needs of 
individuals with IDD but also actively combats stigma and promotes 
psychological well-being. Without a nuanced understanding of how 
mental health conditions uniquely impact this population, clinical 
approaches risk overlooking the complex interplay between disability, 
trauma, stigma, and emotional well-being. To meaningfully improve 
care, it is vital to center the voices and lived experiences of individuals 
with IDD. Their perspectives offer invaluable insight into how mental 
health services can become more accessible, affirming, and responsive—
ultimately contributing to a more inclusive and equitable mental health 
system. 

RECOMMENDATIONS: THERAPEUTIC 
MODIFICATIONS FOR INCLUSIVE CARE
ADAPTING THERAPY FOR INDIVIDUALS  
WITH IDD

Traditional psychotherapeutic models often fail to address the unique 
cognitive, communicative, and social needs of individuals with IDD. 
Meaningful adaptations are integral to promoting engagement, enhancing 
comprehension, and creating a more empowering, supportive therapeutic 
experience. Therapy is most effective when tailored to the individual’s 
developmental level, support needs, and cognitive and verbal abilities 
(Porcelan et al., 2019). 

Clinicians should account for differences in how individuals with IDD 
communicate, express their emotions, process information, and use 
cognitive functions, such as emotional literacy, memory, and executive 
functioning (Porcelan et al., 2019). To support these differences, 
therapy can be modified in terms of time frame, session pace, and 
complexity of content. For example, therapists can adjust their speech, 

use visual aids to convey emotions or experiences, and alter the number 
of themes addressed in a single session to suit the individual’s needs 
(Kneuer, 2024). Additionally, therapists should encourage multimodal 
communication as needed—using a variety of methods to accommodate 
different communication preferences and abilities—by incorporating 
assistive technology, gestures, or alternative methods (Communication 
Community, n.d.). 
 
LANGUAGE CONSIDERATIONS

In addition to adapting therapeutic techniques, clinicians should also 
be intentional with their language and use terms that respect individual 
preferences to ensure inclusive therapy (Bui et al., 2018). Preferences 
for person-first language (PFL) and identity-first language (IFL) vary 
within the disability community (APA Task Force, 2022). Person-first 
language (e.g., “a person with IDD”) prioritizes the individual and their 
personhood first, framing disability as one aspect of identity rather than 
a defining feature. Identity-first language (e.g., “an autistic person”) 
places disability at the forefront, recognizing it as a core and inseparable 
aspect of identity. Many individuals with Down syndrome prefer PFL, 
whereas many autistic individuals advocate for IFL, though preferences 
are personal and not universal (National Down Syndrome Society, 2022; 
Taboas et al., 2022). Clinicians should ask clients about their language 
preferences to ensure that therapeutic conversations align with their 
sense of self. Sensitivity to language use fosters stronger relationships, 
validates identity, and challenges stigma (Bui et al., 2018). 

While honoring personal preferences, clinicians should also be mindful 
of how broader language choices can unintentionally reinforce ableist 
assumptions. Using disability-friendly, inclusive language that is free 
from stereotypes and bias is necessary to promote equitable care. 
Language plays a powerful role in shaping public attitudes toward 
people with disabilities. Recognizing and working to counter implicit 
ableism is crucial to prevent harm to clients and avoid perpetuating 
societal stigma (Friedman, 2019). Terms like “heroic,” “suffering from,” 

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or “wheelchair bound” reflect and reinforce limiting perceptions, while 
euphemisms such as “special needs” can diminish the reality of disability 
and contribute to discomfort and stigma (APA Task Force, 2022). It is 
imperative to focus on the whole person, and using respectful language—
avoiding both overly idealized and stigmatizing terms—is an essential 
part of that commitment. 

PROMOTING AUTONOMY AND DIGNITY IN 
THERAPEUTIC PRACTICE

Clinicians must also consider how their tone and behavior may affect 
a client’s therapeutic experience. One common concern in therapeutic 
settings is the risk of infantilizing clients with IDD. Infantilization occurs 
when adults with IDD are treated and spoken to as if they are younger 
than their actual age, often with an unintentionally patronizing tone 
(Robey et al., 2006). Assuming individuals with IDD lack agency and 
competency can undermine their autonomy and diminish their self-
esteem (Schuengel et al., 2020). 

Such assumptions can lead to learned helplessness—where an individual 
feels powerless to enact change, resulting in passivity and dependence 
(van der Molen et al., 2017). Infantilization may also contribute to 
internalized feelings of inferiority among clients with IDD (Robey et 
al., 2006). Clinicians should encourage independence, bolster self-
confidence, and treat individuals as equals to eliminate harmful power 
dynamics and ensure dignity in therapeutic relationships. Clients have 
noted that the aspects of psychotherapy they most appreciate include 
feeling valued, validated, and treated like adults by their therapists (Pert 
et al., 2012). Feeling empowered and autonomous, along with engaging 
in meaningful conversations and observing changes taking place, 
significantly enhances their experience and outcomes (Pert et al., 2012). 

IMPLEMENTING STRENGTHS-BASED CARE

Beyond avoiding infantilization and promoting autonomy, clinicians 

can support clients with IDD by employing a compassionate, strengths-
based approach to therapy. Interventions that center personal strengths 
have been shown to promote positive mental health outcomes and help 
individuals with IDD experience a deeper sense of fulfillment and well-
being (Flückiger et al., 2023). By recognizing and emphasizing clients’ 
strengths, clinicians can help bring about increased empowerment, 
resilience, and a sense of self-worth (Dunn & Dougherty, 2005). This 
approach encourages individuals with IDD to build on their existing 
capabilities, reinforcing their agency and capacity to navigate life’s 
complexities (APA Task Force, 2022).

Clinicians can strike a thoughtful balance—giving ample space to share 
and process difficult emotions while also highlighting clients’ inherent 
strengths. By remaining perceptive, offering validation, and allowing the 
client to guide the therapeutic process, clinicians can better attune to each 
person’s needs and provide life-enhancing care. 

CENTERING THE CLIENT WHILE 
COLLABORATING WITH CAREGIVERS AND 
FAMILY

Effective therapy for individuals with IDD begins by centering the client 
as the primary participant, while involving caregivers as supportive 
partners when appropriate. Collaborating with family members and 
caregivers from residential or day programs can greatly enhance the 
therapeutic process, as their involvement helps individuals practice 
skills in natural, familiar settings (Rogers et al., 2024). In addition to 
reinforcing skills, family members often play a critical role in supporting 
emotional regulation and facilitating effective communication outside 
of sessions (Rogers et al., 2024). Strong, trusting relationships with 
caregivers and support systems promote emotional well-being and foster 
a greater sense of safety, consistency, and belonging (Hughes et al., 2023; 
Mestre et al., 2024).

While caregivers can be valuable supports, they should not become 

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the primary focus of treatment. Less informed clinicians may engage 
almost exclusively with caregivers, unintentionally excluding the client 
(APA Task Force, 2022). However, therapy sessions should not just be 
about the client—they must actively involve and prioritize the client in 
their own treatment. For all clients, including nonspeaking individuals 
and those who use alternative communication methods, it is crucial that 
therapists directly address them and engage them in the conversation. 
Support members can assist as needed, but excluding clients from their 
treatment can be invalidating and disempowering (Pert et al., 2012). An 
especially vital adaptation in therapeutic practice with individuals with 
IDD is a deliberate shift toward actively involving them throughout the 
process—recognizing that they are the experts in their own experiences. 

Collectively, these modifications help establish a therapeutic environment 
that honors dignity, promotes engagement, and empowers individuals 
with IDD as active participants in their care. When thoughtfully adapted 
to meet individual needs, psychotherapy can be a powerful and healing 
process (Porcelan et al., 2019). Although such practices are not yet 
standard in many therapeutic settings, implementing them consistently 
can help shift the field toward more responsive and person-centered 
models of care.

 
LOOKING AHEAD: FUTURE 
CONSIDERATIONS
To address the long-standing injustices faced by the IDD community, 
inclusion must be promoted at every level—with a strong focus on the 
mental health field. Individuals with IDD have experienced acute and 
enduring societal and institutional barriers that impact both access to 
and quality of care. Substantive progress requires increased research, 
education, advocacy, and awareness to promote a deeper understanding 
of their needs. Mental health professionals, social workers, and advocates 
must commit to ongoing learning and inclusive practices. At the heart 
of this work, advocacy efforts must center and elevate the voices of 
individuals with IDD—ensuring their needs and perspectives are heard 

and actively shape the future of care.

At the macro level, systemic change is fundamental. Policy reform 
must directly address the pervasive inequities in mental health care for 
individuals with IDD. This includes advocating for Medicaid coverage 
that prioritizes inclusive mental health services and expanding funding 
for clinician training programs. Advocacy efforts should highlight both 
the critical importance and the rewarding nature of IDD mental health 
care. Raising awareness of the urgent need—and the profound impact—
of this work can inspire more providers to enter the field and help build a 
more prepared and responsive workforce.

Progress also requires increased investment in research to better 
understand the needs of individuals with IDD, close gaps in care, and 
enhance the quality of evidence-based interventions available to this 
population. Policies must mandate inclusive practices across healthcare 
settings, from ensuring equitable access to enforcing antidiscrimination 
standards. Additionally, addressing global disparities in mental health 
care for individuals with IDD should remain a key priority to advance 
equitable treatment for those who have been historically underserved. 

At the micro level, meaningful change begins in clinical practice. 
Clinicians must adapt care to the individual and adopt a person-centered 
approach that honors agency and autonomy. Therapists and social 
workers should cultivate therapeutic environments characterized by 
empathy, dignity, and mutual respect, where individuals with IDD remain 
central to their own treatment. When professionals see and support the 
whole person, they contribute to better mental health outcomes and 
improved quality of life. These efforts help lay the groundwork for a 
society in which individuals with IDD are truly valued, included, and 
equipped with the resources they need to thrive.

Looking ahead, the goal is for individuals with IDD to be able to readily 
access therapy when needed and to be recognized as people with a wide 
breadth of life experiences—not reduced to individuals defined solely 
by their disabilities. Achieving this vision requires moving away from 

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