Means-end behavior occurs when the child can carry out a sequence of steps, including the removal of a physical obstacle, to achieve a goal. The development of means-end knowledge occurs in three stages: transitional, intentional, and comprehensive. Comprehensive means-end is achieved when the child can generate solutions without demonstration of the solution by another and without trial and error. The achievement of means-end is considered a pivotal developmental milestone because of its strong positive correlation to intentional communication and its relationship to understanding the intent of other's actions. It is important to create accessible opportunities for children with disabilities to observe others solving means-end problems. High interest and personalized materials that are age appropriate will motivate children to solve means-end problems. This article presents a review of research on means-end development in children with severe disabilities, information on how to assess and teach means-end, and two case studies (with lessons and video) to illustrate key concepts. (Contains 5 figures.)