People with intellectual disabilities experience poorer health than the general population, largely due to preventable non-communicablediseases. Although randomized controlled trials (RCTs) are the gold standard for evaluating health promotioninterventions, they are rarely conducted with young people with intellectual disabilities because of inadequate research procedures.This methodological paper draws empirical insights from a research program and relevant literature involving co-designand an upcoming RCT of a digital health promotion intervention. Using the core RCT components, randomization, control, andtrial procedures as an analytical framework, the paper integrates empirical experience and literature to examine challenges inconducting inclusive RCTs. Participation and accessibility emerged as overarching methodological considerations influencingrecruitment, retention, engagement, statistical power, generalizability, and overall trial validity. Empirical experiences illustratedhow relational, organizational, and methodological adaptations can address these challenges in practice. By combiningevidence from the literature with empirically grounded strategies developed across the research program, this paper advancesmore inclusive and feasible RCT methodology for research involving young people with intellectual disabilities.