Seventy-five literacy activities of eight middle and high school students with severe disabilities were analyzed in terms of the literacy content, materials used, student engagement, and contexts, including location and instructional arrangement. Coded observations, review of teaching materials, and follow-up teacher interviews and questionnaires revealed that students spent a disproportionate amount of time passively engaged in reading activities (i.e., listening without the opportunity to respond) in one-to-one instructional arrangements located in self-contained classes. Active engagement in written and spoken expressive communication was underemphasized. Worksheets and picture symbols were the most often-used materials. Activities rarely occurred in the natural setting for use of the literacy skill, or with the materials that would be used under natural circumstances. Findings are discussed in relationship to research-based practices.