This brief clinical exchange article supports the use of milieu training (MT) as a communication treatment option for adults with severe intellectual disabilities (SID). It examines aspects of MT that appear well matched to the communication and other abilities of adults with SID. It also provides an argument that MT is not unlike functional communication training (FCT), an intervention frequently and successfully used with adults with SID. In addition, Developing Communicative Interactions (DCI), one little-known framework that advocates for MT use with this population, is briefly introduced. Finally, a clinical example is provided that illustrates the application of MT with one adult with SID. The article concludes with comments for clinicians charged with communication treatment for this special population.