Shared reading is a powerful literacy intervention for the development of early communication and literacy skills. For students with extensive support needs who are beginning communicators, shared reading has the potential to support the development of initiation and expressive symbolic communication skills. This descriptive, multicase, mixed methods study investigated changes in teacher shared reading practices and perspectives, as well as the communication skills of students with extensive support needs associated with completing professional development focused on a responsive and interactive approach to shared reading. The sample included four classroom teachers and 13 students with extensive support needs in one rural U.S. public elementary school. Teachers increased their use of targeted interactive shared reading practices from 50% to 90%. Students increased the number of expressive communication skills they exhibited (p = 0.031, r = 0.60), as well as the highest level of their symbolic communication (z = 2.16, p = 0.031, r = 0.60). Thematic analysis of teacher interviews identified shifts in their perceptions of their role, expectations, and ability to support student communication development during shared reading, which converged with the changes noted from fall to spring during observations of teacher practice and students' communication skills during shared reading.