There is extensive discussion on the quality of education and support for individuals with profound intellectual and multiple disabilities (PIMD) in relation to inclusion and full citizenship. The discussions are complicated because of differences or lack of clarity in the description of the variations and types of PIMD. A description of the core group is offered, but it is also argued that there cannot be an absolute separation of this specific target group from other adjoining groups. The authors propose a multi-axial model-based taxonomy that distinguishes visual and/or auditory impairments, other physical impairments, and mental health problems, in addition to the two key defining characteristics (limited intellect and compromised physical functions). The authors also propose that assessment of people with PIMD be structured toward ascertainment of diagnostic objectives (e.g., confirming or disconfirming the person's level of intellectual disability) and the determination of a starting point and direction for support of the individual. They conclude that, to prevent misunderstanding in comparison of results of educational programs and interventions, it is recommended that workers describe individuals (or subgroups) with PIMD in publications in detail--using operational definitions. In addition, they propose that an international effort be undertaken to develop and use generally agreed assessment procedures.