This article examines the issue of who are the most severely disabled students and clients and how they have or have not benefited from educational and postschool professional services to date. A loosely structured working definition of this subpopulation is offered. The existing base of literature is analyzed based on a tripartite body of work encompassing intervention studies (primarily independent variable focused); mediating considerations, standing between, but affecting both treatments and outcomes (intervening variables); and outcome-focused studies (dependent variable studies). Because the existing literature base is, for the most part, ambiguous as to the exact parameters of the population studied, a brief review of both published work that clearly applies to the most severely disabled subpopulation and a selection of very recent unpublished studies which seem to fit the same criterion is presented. This article concludes with a set of recommendations, including the need for a “zero exclusion” policy, the need for increased focus on social and behavioral development, the need for further analysis of quality educational outcomes, and the need for continued integration and inclusion of these individuals in supported work and community living.
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