Extending Freeman and Alkin's review of the literature, this systematic literature review examines the social and academic outcomes of students with extensive support needs (ESN) taught in general education settings compared with those taught in segregated settings. Six comparison design studies were analyzed for contextual factors of educational environments, participants' characteristics, and outcomes related to social or academic attainment. Results indicate access to the general education classroom with same-age peers is associated with greater academic and social outcomes for students with ESN. There remains a need for improved reporting of participant support needs and demographic information (e.g., SES, nonbinary genders, and race and ethnicity), and a need for improved reporting of potential mediating factors (e.g., contextual factors and personnel) across settings. Detailed implications for future research are provided, particularly as they relate to providing high-quality instruction for students with ESN.