Findings indicate that dysphagia is a significant issue for people with ID warranting further investigation. Practice implications detailed include increasing awareness of 'at risk' groups, changes in dysphagia with ageing, medication use and illness, and how findings can inform assessment and training.

Background There is scant research on the subject of dysphagia and people with intellectual disabilities. This study explores the barriers which caregivers believe make following Speech and Language Therapists' (SLTs) dysphagia management strategies more difficult. Method Semi-structured open-ended interviews were conducted with 46 caregivers who supported 40 intellectually disabled adults with dysphagia. Results Caregivers perceived particular difficulties in modifying food and drinks to safe consistencies, achieving the agreed positioning during mealtimes, and in using support and prompting strategies. Problematic support and prompting strategies included difficulties with pacing correctly; facilitating people to adequately relax and concentrate; observing and prompting people to pace suitably and take safe amounts of food and drink in each mouthful. Additional barriers identified included time pressures, staff turnover and insufficient reviewing of SLT management strategies by caregivers. Conclusions Findings suggest that additional training and monitoring is required to ensure caregivers are aware of their role and responsibility in promoting safe oral intake for adults with dysphagia and intellectual disabilities. Ongoing support is suggested for people with intellectual disabilities and dysphagia to help them understand the reasoning behind management strategies.

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Dysphagia can have many negative health consequences for people with learning disabilities, including dehydration, aspiration and asphyxiation. Few studies have investigated dysphagia management among adults with learning disabilities. This study aims to contribute to the existing knowledge by investigating carer knowledge of speech and language therapists' (SLTs) recommendations regarding dysphagia management, and by comparing carer knowledge with their behavioural adherence to SLT recommendations. An exploratory study was undertaken investigating carer knowledge of dysphagia management strategies, along with a within-participants' study comparing carer knowledge and adherence. Structured interviews were conducted with carers supporting adults with learning disabilities and dysphagia to explore and ascertain their knowledge of dysphagia management. These data were then compared with observational data gathered in naturalistic contexts, assessing the behavioural adherence of these same carers. Recommendations pertaining to altering consistency and using specialized equipment and utensils were recalled significantly more readily than those concerning support and prompting for the dysphagic persons. Moreover, carers adhered to management strategies to a significantly greater degree than they could recall the details of the written guidelines containing the dysphagia management strategies. The findings suggest that tangible and routinely used management strategies, e.g. food and drink consistency, and use of specialized utensils, are easier for carers to adhere to and remember than support-based strategies such as verbal prompting and pacing. The discrepancy between compliance and knowledge can be explained by calling upon cognitive theories of memory and skill acquisition. This has implications for the selection of relevant outcomes of dysphagia training of direct care staff. Knowledge does not necessarily predict actual behavioural adherence and, though desirable, does not appear to be an adequate outcome indicator if the goal is behavioural adherence. Practice implications for SLTs training carers in dysphagia management strategies include combating fossilization of incorrect knowledge; encouraging carers to refamiliarize themselves with management strategies and their rationales periodically following initial training; and providing more specific contingency information for support and prompting in the guideline documentation.

Accessible summary• We taught staff some useful signs to help them to communicate with people.• We asked staff if they liked the different ways of teaching we used.• We tested staff trained to see if they remembered the signs.We found out that:• Trained staff could do the signs better than untrained staff.• Staff who had been taught liked the different ways of teaching that we used.• Only a few staff used the signs a lot when they were communicating with people. SummaryTo contribute to increasing the quality and quantity of communication between staff and adults with intellectual disabilities, training was undertaken to enhance the awareness and knowledge of signing as a method of communication. Multidisciplinary team members, residential and day centre staff were trained to use 20 core signs. Training methods employed included: a training session; a training video; and a training card showing the 20 signs. Caregiver knowledge of the 20 signs was assessed between 6 and 12 months following implementation of the training. Information was also collected about the level of exposure to each of the training methods, and about staff perceptions of the usefulness and effectiveness of the different training types. Training was considered effective by staff, especially the formal training. Trained staff were significantly more accurate at signing, although this knowledge and capability did not often translate into everyday use of signs.