This paper reports the findings from a project focused on teaching secondary aged pupils with moderate learning difficulties (MLD) using Lesson Study methodology--a collaborative approach for teachers to assess, evaluate and plan a sequence of lessons that focuses on the learning of one to two focus pupils identified as having MLD. The research aimed to examine the beliefs and attitudes of participating teachers about inclusion, teaching efficacy and the concept of MLD. It also aimed to examine what pedagogic approaches were developed through Lesson Study and whether these approaches represented a distinctive pedagogic approach for pupils with MLD. The study found that the views of teachers about inclusion reflected a conditional concept of inclusion and that their attitudes to inclusion were stronger in principle than in practice. Their concepts of MLD meanwhile reflected the uncertain place of intellectual abilities in defining the category and doubts about differentiating MLD from low attainment. Analysis of pedagogic approaches used by participating teachers at the end of the programme indicated a holistic model of approaches that go beyond cognitive adaptations to include input modes, grouping and learning relationships, while also indicating a continuum model of pedagogy for pupils with MLD in which pedagogy is not distinct but an extension and intensification of general approaches. (Contains 4 tables and 5 figures.)