The aim was to investigate prescribing practices surrounding the use of medication for the management of behavioural problems in adults with intellectual disabilities with reference to a national guideline development project. A case note review methodology was employed to explore adherence to the audit criteria that were derived from the recommendations made in the guideline. A total of 154 cases were identified as meeting the inclusion criteria. There was some variation in adherence to the examined audit criteria with some areas achieving high compliance whereas others were deemed as lacking. Such areas achieving high compliance included assessment of the behaviour, assessment of surrounding behavioural, medical, psychological/psychiatric and social issues and communication of the treatment plan to other relevant professionals. However, the assessment of capacity issues and acquisition of consent or assent were rarely documented. The results highlighted certain areas of clinical practice that may need to be formally documented in patient case notes in order to provide evidence of the quality of healthcare an individual has received.