The extent and nature of need for mealtime support among adults with intellectual disabilities.
One in seven adults with ID needs mealtime support, so screen every client and use only validated swallow tools.
01Research in Context
What this study did
Goodwin et al. (2012) looked at adults with intellectual disability who were already on service lists. They wanted to know how many needed help at mealtimes and why.
Staff filled out a short checklist about each adult. The list asked about chewing, swallowing, food refusal, and risky eating like stuffing too much food in the mouth.
What they found
About one in every seven adults needed mealtime support. The main reasons were trouble moving food to the throat, unsafe eating habits, or saying no to food.
Problems were not the same for everyone. Some had physical issues, others had behavior issues, and some had both.
How this fits with other research
Sauna-Aho et al. (2025) later found that only four of thirty-one swallowing tests for adults with ID are truly reliable. Goodwin et al. (2012) showed the need is common; Minttu shows we should pick proven tools to measure that need.
O'Dwyer et al. (2018) saw that over half of older Irish adults with ID show problem behaviors. Goodwin et al. (2012) narrows the lens to behaviors that happen at the table, giving you a clearer target for intervention.
Ruud et al. (2016) asked caregivers what blocks healthy eating in group homes. Their answers line up with L et al.: staff time and know-how matter as much as the adult’s own difficulties.
Why it matters
If you serve adults with ID, plan for mealtime support in every seventh care plan. Start with a quick screen for swallow safety and food refusal. Then pick one of the four validated tools Sauna-Aho et al. (2025) list if you need deeper data. Train staff to spot both physical and behavioral signs, and give them scripts for safe mealtime routines.
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02At a glance
03Original abstract
BACKGROUND: For many adults with an intellectual disability (ID), mealtimes carry significant health risks. While research and allied clinical guidance has focused mainly on dysphagia, adults with a range of physical and behavioural difficulties require mealtime support to ensure safety and adequate nutrition. The extent of need for and nature of such support within the wider ID population has yet to be reported. METHODS: In this study, we have estimated the prevalence of need for mealtime support among people with ID in the UK, using a population of 2230 adults known to specialist ID services (in Cambridgeshire, UK, total population 586,900). In a sample (n = 69, aged 19 to 79 years, with mild to profound ID), we characterised the support provided, using a structured proforma to consult support workers and carers providing mealtime support, and health and social care records. RESULTS: Mealtime support was found to be required by a significant minority of people with ID for complex and varied reasons. Prevalence of need for such support was estimated at 15% of adults known to specialist ID services or 56 per 100,000 total population. Within a sample, support required was found to vary widely in nature (from texture modification or environmental adaptation to enteral feeding) and in overall level (from minimal to full support, dependent on functional skills). Needs had increased over time in almost half (n = 34, 49.3%). Reasons for support included difficulties getting food into the body (n = 56, 82.2%), risky eating and drinking behaviours (n = 31, 44.9%) and slow eating or food refusal (n = 30, 43.5%). These proportions translate into crude estimates of the prevalence of these difficulties within the known ID population of 11.9%, 6.6% and 6.4% respectively. Within the sample of those requiring mealtime support, need for support was reported to be contributed to by the presence of additional disability or illness (e.g. visual impairment, poor dentition and dementia; n = 45, 65.2%) and by psychological or behavioural issues (e.g. challenging behaviour, emotional disturbance; n = 36, 52.2%). CONCLUSIONS: These findings not only highlight the need for a multidisciplinary approach to mealtime interventions (paying particular attention to psychological and environmental as well as physical issues), but also signal the daily difficulties faced by carers and paid support workers providing such support and illustrate their potentially crucial role in managing the serious health risks associated with eating and drinking difficulties in this population.
Journal of intellectual disability research : JIDR, 2012 · doi:10.1111/j.1365-2788.2011.01488.x