Social Inclusion and Belonging for Adults with Developmental Disabilities in Ontario

If you’re supporting an adult with a developmental disability in Ontario, you already know that getting them “out into the community” is only half the story — being somewhere is not the same as belonging there. This guide gathers what the research actually says about isolation, loneliness, and friendship for adults with intellectual and developmental disabilities: how small their social networks tend to be, why loneliness is a genuine health risk and not just a sad feeling, and what has been shown to help build real, freely chosen relationships. Every figure and finding here is sourced and dated so you can see where it comes from. It’s neutral reference information for families, the public, and providers — current as of July 2026.

The short version

• Adults with intellectual and developmental disabilities (IDD) are among the most socially isolated groups in society. Their social networks are small and dominated by paid staff, family, and other service users; almost half report having no friends outside their home, and roughly 42–45% experience loneliness — about double the rate of the general population (Alexandra et al., 2018, JARID; Llorens-Roman et al., 2026, JARID; McCausland et al., cited in Stancliffe & Hall, 2023).
• Loneliness is not just a bad feeling — it is a health risk. The U.S. Surgeon General’s May 2023 advisory concluded that “the mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day, and even greater than that associated with obesity and physical inactivity,” and the WHO’s 2025 Commission on Social Connection estimated that “loneliness accounts for approximately 871 000 deaths each year – or around 100 deaths an hour” (Holt-Lunstad et al., 2015; U.S. Surgeon General, 2023; WHO, 30 June 2025).
• Being in the community is not the same as belonging in it. Decades of disability scholarship (John O’Brien; Wolf Wolfensberger’s Social Role Valorization) distinguish “community presence” — physically being there — from “community participation”: having relationships, being known, and mattering. Access without relationship falls short.
• The goal is unpaid, reciprocal relationships. A network made up of people paid or obligated to be there is fragile; it collapses when staff turn over or parents die. What protects wellbeing is freely given, two-way friendship — the kind of connection explored further in Relationships, Sexuality, and Intimacy: A Rights-Based Guide for Adults with Developmental Disabilities in Ontario.
• A good day program is measured partly by the relationships it grows, not just the outings it runs. Connection is fragile at life transitions (leaving school, losing parents), hard to build, and chronically under-resourced — which is precisely why intentional relationship-building belongs at the centre of a program’s purpose.

What every family should know

1. The isolation is measurable and severe. Where a non-disabled adult may have a network of over 100 people (Hill & Dunbar, 2003, cited in Harrison et al., 2021), adults with intellectual disability commonly have networks of roughly 20–22 people or fewer, disproportionately composed of paid staff, family, and other people with disabilities rather than freely chosen friends (Forrester-Jones et al., 2006; Robertson et al., 2001; Harrison et al., 2021).

2. Loneliness prevalence is roughly double the general population. A first systematic review found an average loneliness prevalence of 44.74% across studies of people with IDD (Alexandra et al., 2018); a 2026 systematic review found a sample-size-weighted mean of 41.70% (Llorens-Roman et al., 2026, JARID). In the UK, about 24% of adults with disabilities experienced substantial loneliness versus 7% of non-disabled adults, and loneliness was more likely to persist over time (Emerson et al., 2023, BMC Public Health).

3. Relationships are dominated by people paid or related to be there. In the Irish IDS-TILDA study, best friends were most often peers with intellectual disability (63.2%), followed by carers/service providers (15.9%) and family (8.4%); friendships with staff were rated important by 62.5% of participants (McCausland et al., 2021, JARID). Over 40% had not had contact with a non-paid friend in over a year (McCausland et al., cited in Stancliffe & Hall, 2023).

4. Presence is not participation. As one adult with a disability put it, “Just because a place has access doesn’t mean it includes everybody” (Strnadová et al., 2018, quoted in Stancliffe & Hall, 2023). Simply attending a day program or a club does not, on its own, generate new reciprocal friendships (Stancliffe & Hall, 2023).

5. The network shrinks at exactly the wrong moments. Leaving school (the “transition cliff”), the death or decline of parents, and moves between homes all sever the few relationships a person has — often with no mechanism to rebuild them (Hole, cited in CBC News, 2025; Stancliffe & Hall, 2023).

6. Connection can be built, but interventions are modest and fragile. Person-centred planning, community connecting/social prescribing, and befriending schemes can enlarge networks and reduce loneliness, but the evidence base is thin and effects are often small (Brand et al., 2024, JARID; Frontiers umbrella review, 2022). The single biggest structural threat is the direct-support workforce shortage, which undermines the very staff who broker connections (Hall & Rossetti, 2023, ICI Impact; Community Living Ontario, December 2024).

How isolated? The social-network evidence

The most striking and consistent finding in this field is the size and make-up of people’s social networks. Non-disabled adults typically maintain networks of well over 100 people spread across different corners of life (Hill & Dunbar, 2003, as cited in Harrison et al., 2021, JARID). By contrast, studies that actually map the networks of adults with intellectual disability find them dramatically smaller and tighter. Forrester-Jones and colleagues (2006), following 213 people 12 years after they moved out of long-stay UK hospitals, found an average network size of just 22 contacts, with membership “restricted to mainly other adults using intellectual disability services” (Journal of Applied Research in Intellectual Disabilities, 19(4):285–295). Other studies report even smaller networks — a median of six members (Robertson et al., 2001) up to averages of about 12–14 (Lippold & Burns, 2009; van Asselt-Goverts et al., 2013), as summarized by Harrison et al. (2021).

What matters just as much as the size is who is in the network. Reviews consistently find that the networks of adults with IDD are “dominated by family, paid disability staff, and other service users with IDD, especially for those living in staffed congregate settings” (Stancliffe & Hall, 2023, International Review of Research in Developmental Disabilities; PMC12955816). One comparison study found that adults with intellectual disability had smaller networks made up mostly of family, paid staff, and other service users, whereas adults with physical disability had larger networks with more friends, neighbours, and co-workers — and that simply attending day programs or clubs did not generate new, freely chosen friendships for the group with intellectual disability.

The Irish IDS-TILDA study (a nationally representative sample of adults aged 40+ with intellectual disability) gives some of the most precise numbers we have. In its 2021 friendship analysis (McCausland et al., JARID 34(3):763–776), a large majority (92.4%) said they had friends, but just over half (52%) had a “best friend.” Co-resident friends (71.8%) were more common than non-resident friends (62%), and staff friendships were rated important by 62.5%. Most best friends were peers with intellectual disability (63.2%), carers/service providers (15.9%), or family (8.4%) — leaving strikingly few whose closest friend was an unpaid, non-disabled community member. Reviews of the same body of work report that almost half of adults with IDD have no friends outside their home, and that over 40% had not had contact with a non-paid friend in over a year (McCausland et al., 2016/2018, as cited in Stancliffe & Hall, 2023).

Loneliness, and why it lasts

Loneliness — the subjective, distressing sense that your relationships fall short of what you want — is different from social isolation, which is the objective state of having few contacts. A person can be surrounded by people at a day program and still feel profoundly lonely (Hall & Rossetti, 2023, ICI Impact 38(1)).

The prevalence data are consistent. A first systematic review found an average loneliness prevalence of 44.74% across five studies of people with IDD (Alexandra et al., 2018, JARID 31(5):643–658). A 2026 systematic review updated this, finding a sample-size-weighted mean loneliness prevalence of 41.70% among people with intellectual disability (Llorens-Roman et al., 2026, JARID). A US study found that 50% of adults with ID reported being lonely sometimes or often (Stancliffe et al., 2007, cited in ICI). One large study found 73.1% of adults with intellectual disability reported feeling lonely (Macdonald et al., 2018).

Comparisons with the general population show roughly a doubling of the risk. Emerson and colleagues (2023, BMC Public Health 23:2537), analyzing the UK’s Understanding Society panel, found about 24% of adults with disabilities experienced substantial loneliness versus 7% of non-disabled adults — and, critically, that loneliness was more likely to persist: about 46% of disabled adults experienced long-lasting loneliness compared with 22% of non-disabled adults. Persistent loneliness is associated with worse health outcomes than the passing kind.

Why it matters: the health and wellbeing toll

The case for treating connection as a core outcome, not a nice-to-have, rests on a large public-health evidence base.

• Mortality. Holt-Lunstad and colleagues’ foundational meta-analyses established that social relationships influence mortality risk as much as well-established risk factors like smoking. Their 2010 review (PLOS Medicine) found stronger social relationships associated with roughly a 50% increased likelihood of survival. Their 2015 review (Perspectives on Psychological Science 10:227–237) found social isolation, loneliness, and living alone associated with 29%, 26%, and 32% increased likelihood of mortality respectively.
• The Surgeon General’s advisory (May 2, 2023). The U.S. Surgeon General’s 81-page advisory, Our Epidemic of Loneliness and Isolation, concluded that “the mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day, and even greater than that associated with obesity and physical inactivity.” It reported that poor social connection is associated with a 29% increased risk of heart disease and a 32% increased risk of stroke, with chronic isolation raising dementia risk in older adults by approximately 50%.
• The WHO Commission on Social Connection (30 June 2025). The WHO’s flagship report, From loneliness to social connection: charting a path to healthier societies, found that roughly 1 in 6 people worldwide experience loneliness, and estimated that “loneliness accounts for approximately 871 000 deaths each year – or around 100 deaths an hour.” The report explicitly names people with disabilities among the groups more likely to experience loneliness and isolation.

Applied to adults with IDD — who start out with smaller networks, higher loneliness, and more persistent loneliness — this evidence implies a compounded health burden. The link between loneliness and mental-health difficulty is also stronger for adults with disabilities; in adults with autism, loneliness predicted depression, and greater loneliness was linked to suicidal thoughts (Hedley et al., 2018, Depression and Anxiety).

The flip side is that connection protects. Having friends is associated with reduced loneliness among community-dwelling adults with IDD (Stokes et al., 2025, The Gerontologist 65(4)); participation in mainstream community groups and religious services is associated with better friendship outcomes (Stancliffe et al., cited in Stancliffe & Hall, 2023).

Presence versus participation, integration versus belonging

The central idea running through this whole field is that physically placing a person in the community does not, by itself, include them. This critique is most associated with John O’Brien and Connie Lyle O’Brien, whose “Five Valued Experiences” / Five Accomplishments framework (developed from 1987 onward) distinguishes:

• Community Presence — sharing the ordinary places of community life; and
• Community Participation — “expand[ing] and deepen[ing] people’s relationships,” being part of a growing network of personal relationships.

Alongside these sit Making Choices, Developing/Contributing Competencies, and Being Respected / having a valued social role (O’Brien & Lyle O’Brien; Inclusion Press; Abilities Manitoba). O’Brien’s point is that services can achieve presence — a person is physically “out” in restaurants, malls, and programs — while leaving the relational gulf (what he calls “the critical boundary” between “Service Land” and community life) entirely uncrossed.

Erik Carter’s ten dimensions of belonging put into words what genuine inclusion actually feels like: a person truly belongs when they are present, invited, welcomed, known, accepted, involved/supported, heard, befriended, needed, and loved (Carter, 2016, Journal of Psychology and Theology; TIES Center). Carter’s central argument is that “integration” and “inclusion” both fall short of belonging: “People want to be more than merely integrated or included. They want to experience true belonging” (Carter, Vanderbilt Kennedy Center). The dimensions of being befriended, needed, and loved are precisely the ones that presence alone never delivers.

This is echoed by people with lived experience. As one concert-goer with a disability observed, being seated in the disability section is not the same as being included: “Just because a place has access doesn’t mean it includes everybody” (Strnadová et al., 2018).

Paid versus freely given relationships

A network dominated by people who are paid or related to be present is structurally fragile. Paid staff leave when they change jobs; parents age and die. The debate over whether staff “count” as friends is a real one — many people with IDD experience staff relationships as genuine and valued (62.5% rated staff friendships important; McCausland et al., 2021), and one young man said, “I consider him staff and a friend at the same time” (Hall, 2009, cited in Stancliffe & Hall, 2023). But the risk is asymmetry and impermanence: the relationship exists because of a shift schedule, not mutual choice, and it ends when the funding or the roster changes.

This is why the literature consistently frames unpaid, reciprocal relationships as the real goal. Reciprocity — being able to give as well as receive — is central to how people with IDD themselves describe friendship (“Being friends means helping each other, making coffee for each other”; Callus, 2017, Disability & Society). Yet reciprocity is exactly what tends to be missing: fewer than one in six adults with IDD had the opportunity to help a neighbour or family member (McCausland et al., cited in Stancliffe & Hall, 2023). Being cast permanently as the receiver of care, never the giver, is itself a form of exclusion — a theme picked up again in Relationships, Sexuality, and Intimacy: A Rights-Based Guide for Adults with Developmental Disabilities in Ontario.

What builds belonging

Several approaches, drawn from research and practice, are used to move a person from presence to genuine participation:

• Social Role Valorization (SRV). Formulated by Wolf Wolfensberger in 1983 (succeeding the principle of normalization), SRV is “the application of empirical knowledge to the shaping of the current or potential social roles of a party … primarily by means of enhancement of the party’s competencies and image — so that these are, as much as possible, positively valued in the eyes of the perceivers” (Wolfensberger & Thomas, 2005). The core insight: people who hold valued social roles (neighbour, volunteer, teammate, member, contributor) gain access to “the good things in life” — including “a sense of belonging” — because others treat role-holders well. The two main levers are enhancing personal competencies and enhancing social image. For a day program, this means helping people take on real, recognized roles rather than being perpetually positioned as clients.
• Friendship-building and community connecting. Person-centred planning (developing individualized goals with the person’s “circle of support”) has been shown to reduce loneliness and improve contact with friends and sense of connection. Community-linkage / social-prescribing interventions can increase network size — including non-paid contacts — and reduce loneliness (Frontiers umbrella review, 2022).
• Shared-interest groups and inclusive activities. Structured social groups and inclusive leisure and sports programs — for example, Special Olympics Unified Sports, which places athletes with and without ID on the same team — can create equal, teamwork-based bonds (McConkey et al., 2013). Young adults join such groups explicitly “to meet people” and make friends (Van Asselt et al., 2015). The everyday building blocks of this are covered further in Recreation, Leisure, Sport & the Arts for Adults with a Developmental Disability in Ontario.
• Befriending schemes. One-to-one matched befriending is popular but has a limited evidence base; meta-analyses find small positive effects on combined outcomes and inconsistent effects on single outcomes like loneliness or depression (Brand et al., 2024, JARID; Siette et al., 2017). Befriending can increase social contacts but should be seen as a supplement, not a substitute for organic relationships.
• The day program / community hub as a place where relationships form. The reframe here is that a community-based program’s most important product may be the relationships it grows — among members, between members and the wider community, and through the valued roles it helps people take on — rather than the calendar of outings it completes.

Where families get stuck

• Transportation. A lack of transportation is repeatedly identified as one of the primary barriers to community integration, “resulting in social exclusion, isolation” (Friedman, 2024, Disability and Health Journal). Qualitative studies of public-transit use by people with IDD identify transportation as a factor shaping participation in work, school, and social and leisure life (Bezyak et al.; IDD transit studies).
• Attitudes and stigma. Exclusion and discrimination drive loneliness directly. Adults with ID reported feeling lonely because they were “laughed at, bullied, ignored, overlooked, put down, and treated as less valued than others” (Robinson & Idle, 2023, Journal of Intellectual & Developmental Disability). Stigma is a major barrier to acceptance regardless of culture — a reminder that support has to fit each family’s background and community, a theme taken up in Culturally Responsive Support for Adults with Developmental Disabilities in Ontario.
• Segregated settings. Congregate and institutional living is associated with greater loneliness than community or family living; larger settings (seven or more housemates) are associated with more loneliness, and institutional residents fare worse than community-dwellers (Stancliffe et al., 2007; Stokes et al., 2025, The Gerontologist).
• Communication and thin infrastructure. Lack of communication supports, absence of cognitively accessible information, and thin community infrastructure (few welcoming, accessible groups) all raise loneliness (Azzopardi-Lane et al.; WHO 2025). The WHO names “inadequate community infrastructure and public policies” among loneliness’s structural causes.

Isolation across the lifespan

Networks that are already small are most vulnerable at life transitions:

• Leaving school. School is often where a young person’s densest friendships live. Leaving it — the “transition cliff” families describe at ages 18–22 — commonly severs those ties. Transition “often results in the loss of friendships, relationships and social networks,” and young people with intellectual disability experience “a progressive reduction in their circles of friendships” (transition-review literature; Personal Support Networks study, 2021). In Canada, UBC Okanagan social-work professor and Canadian Institute for Inclusion and Citizenship co-director Rachelle Hole says many families face a “transition cliff” when school-based supports end (CBC News, “How some students with disabilities avoid the ‘transition cliff’ after high school,” 2025).
• Losing parents. Many adults with IDD live with and depend on parents into middle age; the death or decline of parents removes both a primary caregiver and the person’s main social broker (Stancliffe, ICI Impact 38(1)).
• Moving home. Relocations — into or between residential settings — repeatedly reset a person’s network, often replacing the one friend or neighbour with a paid worker (Grant, 1993, cited in Harrison et al., 2021).

Because these losses land on an already-thin network, they can tip a person from “few relationships” to “none but paid ones” at exactly the moment they most need continuity.

The Ontario and Canadian context

Ontario’s developmental-services system is formally organized around inclusion: the governing statute is the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA), and Individual Support Plans are meant to be built on “self-determination, social inclusion, citizenship and choice” (Ontario MCCSS). The province’s policy vision, Journey to Belonging: Choice and Inclusion, states the goal that “people with developmental disabilities are supported by their communities, support networks and government to belong and live inclusive lives.” Community Living Ontario — a confederation of 128 local agencies advocating with people who have intellectual disabilities and their families — and its national body Inclusion Canada carry the community-living movement’s emphasis on inclusion and belonging.

Canadian population data confirm the general backdrop: in the Canadian Social Survey (August–September 2021), 13% of Canadians aged 15 and older reported they “often or always” felt lonely, rising to 23% among youth aged 15–24 (Statistics Canada, 2021). People with disabilities are consistently over-represented among the most isolated — the Angus Reid Institute’s national study (with Cardus) found that “nearly four-in-ten (38%) of those who have a physical disability are among the Desolate,” against an overall Desolate rate of 23%.

A pressing Ontario-specific friction point is the developmental service worker (DSW) shortage. In December 2024, Community Living Ontario and OASIS warned that federal changes excluding DSW graduates from post-graduate work permits had “already led to the cancellation of programme intakes at many Ontario colleges,” worsening workforce shortages for “some of Ontario’s most vulnerable residents.” Because it is often paid staff who broker community connections, workforce instability directly threatens relationship-building — the very thing this document argues is central.

Grey areas and points of confusion

• How do you measure “belonging”? Social inclusion has been assessed objectively (number of friends, frequency of contact, group memberships) and subjectively (a person’s own sense of satisfaction, acceptance, and belonging). Scholars increasingly argue the subjective appraisal is decisive — “if they feel rejected or ignored, then they are not genuinely included” (Stancliffe & Hall, 2023) — but there is no single agreed metric, and the WHO’s proposed global “Social Connection Index” (2025) is still under development.
• Do paid staff and other people with IDD “count” as friends? Genuinely contested. Some argue paid relationships cannot be true friendship because they end when the job does; others insist the person’s own definition should govern, and that dismissing these relationships denies people the friends they actually have (Bogenschutz & Amado, 2016, cited in Stancliffe & Hall, 2023). This document takes the position that such relationships are real and valuable but structurally fragile, so unpaid reciprocal relationships remain the goal.
• Thin longitudinal data. Most evidence is cross-sectional. We know networks are small and loneliness is high at a point in time, but there is limited long-term data tracking how individuals’ networks change and how durable any intervention gains are. Systematic reviews repeatedly flag weak study quality and few controlled trials (Alexandra et al., 2018; Brand et al., 2024).
• Intervention evidence is modest. Befriending, social prescribing, and person-centred planning show promise, but effect sizes are small and inconsistent, and low uptake in several studies suggests acceptability problems (Frontiers, 2022; Brand et al., 2024). No intervention has been shown to reliably manufacture durable, reciprocal friendship at scale.
• Prevalence figures vary widely (from ~42% to ~73% for loneliness) depending on definition, measure, population, and setting. The ~42–50% range is the most defensible central estimate.

How current is this, and what to double-check

• Recency. The core public-health anchors are current: the WHO Commission report (30 June 2025) and the U.S. Surgeon General’s advisory (May 2023) are the most authoritative recent syntheses. The disability-specific network data lean older (Forrester-Jones 2006; Robertson 2001) but are corroborated by recent reviews (Harrison et al., 2021; Stancliffe & Hall, 2023; Llorens-Roman et al., 2026), and no recent evidence suggests networks have substantially widened.
• Geography. Most quantitative network and loneliness data come from the UK, Ireland (IDS-TILDA), Australia, and the US. Direct Canadian/Ontario-specific quantitative data on IDD social networks are sparse; the international evidence is the strongest available and there is no reason to expect Ontario differs materially, but this should be stated rather than assumed.
• Attribution notes. Several widely cited IDS-TILDA figures (“almost half have no friends outside the home”; “fewer than one in six” have reciprocal opportunities; “over 40% no non-paid-friend contact in a year”) are drawn from McCausland et al. (2016 and 2018) as paraphrased in the peer-reviewed Stancliffe & Hall (2023) review; the exact original percentages sit behind paywalls and the phrasings are the reviewers’. The 62.5% staff-friendship figure and the best-friend composition figures (63.2% peers with ID, 15.9% carers/providers, 8.4% family) are confirmed directly from the McCausland et al. (2021) abstract and are high-confidence.
• Secondary sources. A few claims (for example, the Geurts et al. network comparison) are drawn from research digests rather than the primary article; they are treated as illustrative and are corroborated by the broader review literature.
• Scope. This document owns the social and relational dimension — loneliness, friendship, belonging, and social inclusion. Physical health and active living, community integration as a program-quality criterion, community-based versus facility-based models, and valued work and employment roles are treated in sibling documents and are only touched on here where they bear directly on relationships. This is general reference information, not clinical, legal, or financial advice.

Related: Recreation, Leisure, Sport & the Arts for Adults with a Developmental Disability in Ontario · Relationships, Sexuality, and Intimacy: A Rights-Based Guide for Adults with Developmental Disabilities in Ontario · Culturally Responsive Support for Adults with Developmental Disabilities in Ontario