Transition from pediatric to adult health care is a complicated process that goes far beyond transfer of care. The young person who is intellectually impaired or who must struggle to master daily living skills faces more challenges in this process than other adolescents. Physicians, nurses, social workers, occupational therapists, and other health care providers must work with adolescents, their parents, and teachers to assess abilities and transition needs. Communication skills, capacity for decision making, adherence, vocational and educational issues, sexuality, and relationships should be addressed. Interventions may include the creation of an individualized transition plan, skills training, family counseling, a lengthened transition process, involvement in a support group, health promotion, and teaching of self-care skills. The summary for the adult provider should include information about how best to communicate with the young person and an assessment of capacity to make decisions and self-management skills.