This article focuses on teachers' pedagogical decision-making and influences on this decision-making when teaching students with severe intellectual disabilities. The research reported and discussed forms part of an international collaborative research project in the south west of England and Florida, US. The study is set within the broader socio-political context of inclusion, contributing a pedagogical dimension to other aspects of inclusion, such as placement, curriculum and accountability. Houssaye's (2000) pedagogical interaction model is examined and adapted to situate and analyse teachers' pedagogical decision-making, and influences on this, when teaching students with severe intellectual disabilities. The study shows a prominence and privileging of pedagogical decisions and influences around teacher-student pedagogical interactions over curriculum-teacher or curriculum-student pedagogical interactions. The implications of this emphasis are considered in the historical context of teaching and learning models and approaches for this group of learners.