Counting is an important functional skill that is embedded throughout people's daily lives, which can result in numerous meaningful opportunities through which students can learn. Counting, especially early counting, provides a foundation for the development of later mathematics understanding and is highly predictive of later mathematics achievement. Ensuring that students with significant cognitive disabilities have access to instruction that supports the development of conceptual and procedural knowledge of counting requires the use of an instructional routine. Routines provide students with significant cognitive disabilities with the kind of predictable, extensive, and repeated instruction they need while allowing teachers to develop adapted materials and means of accessing information that can be used each day. The multi step routine described here in this article is just one component of math instruction each day and generally takes about 15 minutes to complete (see Table 1). The routine provides a structure that offers teachers an opportunity to provide instruction that is focused and systematic, as is typically recommended for students with significant cognitive disabilities, while applying research-based understandings of the importance of distributed practice.