Individuals with profound intellectual and multiple disabilities (PIMD) rely on direct support professionals (DSPs) to communicate with them and plan meaningful activities of daily living (ADL) for them. This qualitative descriptive study explored how DSPs providing ongoing care who work directly with individuals with PIMD describe the use of reciprocal communication to develop meaningful ADL for those individuals to improve or maintain their QOL. The study focused on the cyclical nature of this phenomenon. Examining first communication, second planning and completing activities, and third, the impact of communication and planning on QOL. The study employed 15 participants who worked with individuals with PIMD for a minimum of one year. Ten were DSPs from various agencies who participated in virtual one-on-one semi-structured interviews and five were direct support managers who participated in an hour-long focus group. The data were analyzed using Braun and Clarke's thematic analysis. Research findings suggest that DSPs use connections to build relationships and understand sources of information and the emotional responses of those with PIMD. Additionally, the strength of the connection can encourage or discourage communication attempts between the caregiver and the recipient. An individual with PIMD's zone of proximal development (ZPD) may be restricted by plans, environment, or resources; DSPs use observation and understanding to involve the individual and expand upon the zone through interests or goals. Finally, attitude and mood can affect both the DSP and the individual with PIMD in their care. Keywords: Profound intellectual and multiple disabilities, communication, developmental disabilities, Zone of Proximal development. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]