The purpose of this study was to assess the efficacy and practicality of precision reading, a constructive reading intervention, with students with cognitive impairments, extreme academic deficits in reading, and severe social, emotional, and psychiatric problems. As precision reading had shown promise with students with low achievement, learning problems, and learning disabilities (Freeze, 2000; Freeze, 2002c; Updike & Freeze, 2001), it was hoped that it might enhance the literacy skills of students with more severe disabilities who had experienced little success with either traditional reading instruction or prior remedial reading interventions. The usefulness of precision reading for seven students in a self-contained special education learning assistance and behaviour support program, located at an inner city elementary school in a western Canadian city was explored. The students in the study made statistically and educationally significant gains of between 0.9 and 1.1 years, in grade equivalency scores, on a standardized reading test in the areas of oral reading fluency, word recognition, and passage comprehension after five minutes of precision reading per day over thirty weeks. In addition, they made observable gains in self-confidence, motivation, and attitude. Recommendations for the use of precision reading with students with severe academic deficits in reading and negative attitudes towards learning are discussed. Limitations in the efficacy of precision reading also are reported. Overall, precision reading appears to be a powerful new tool educators can use to help the most difficult to reach and teach students to read. This research was funded generously by the Sister Bertha Baumann Research Awards of St. Amant Centre.