Nearly 63% of students with disabilities are included in general education classrooms for some part of their day, and at the high school level, 79% participate in state reading and math assessments (U.S. Department of Education, 2016). Middle and high school classes pose particular challenges because, unlike elementary classrooms, they are usually content specific, are taught by content specialists, and have some form of high-stakes assessment linked to them (e.g., final exams, standardized assessments). Curriculum and pacing guides dictate teacher planning, and students must accumulate course credits by successfully completing course requirements to graduate with a diploma (Kennedy & Ihle, 2012). These characteristics are particularly relevant to mathematics in that each grade or course builds on the next, pacing guides require teachers to move quickly, and in many states, successful completion of three or more courses is required for graduation from high school. Mathematics courses also require abstract thinking and knowledge of increasingly difficult vocabulary. Mathematics poses unique challenges for many students with disabilities. Low achievement of students with math disabilities in mathematics courses is not related to intelligence or opportunities to learn. Research shows these students have unique cognitive profiles that set them apart, even from other students who struggle in mathematics. There is some evidence students with disabilities in mathematics have difficulty building representational understandings of numbers, which affects their ability to understand magnitude and develop automaticity with numerical operations (Geary, 2011). It is important for special educators to understand these common characteristics so they can purposefully design or modify lessons and activities in ways that will enhance students' ability to be successful.