Children with severe and multiple disabilities constitute a heterogeneous population that typically experiences significant and lifelong difficulties in learning to read and write. These difficulties appear to be both intrinsic and environmental in nature. Children with severe and multiple disabilities struggle particularly with vocabulary acquisition and phonological awareness. Home, preschool, and school environments may limit literacy learning opportunities by making literacy a lower priority than the child's competing health, self-care, and therapeutic needs; by providing limited access to adapted print materials or tools; by providing limited access to communication supports; or by providing little time for literacy learning. Children with severe and multiple disabilities who have demonstrated literacy learning progress are often taught in technology-supported environments offering a wide range of word study, text-based reading and writing instruction, and opportunities for print exploration. Sufficient evidence exists for clinicians and educators to begin providing more successful literacy instruction to individual children and classrooms by comparing their children and intervention contexts with those reported in the limited body of research in this area.