This review examines research studies that utilize the behavior chain interruption strategy (BCIS) to teach communication skills to individuals with severe disabilities. The BCIS is a naturalistic teaching procedure that uses an interruption to a behavior chain (i.e., a routine) as the point of instruction. The BCIS has been successfully applied to the teaching of communication skills to individuals across a wide range of ages and of levels of disability, including learners with multiple disabilities. It has been employed to teach a range of communication forms, including pictorial communication systems, natural gestures, signing, and a switch activated communication device. However, a number of questions remain regarding the BCIS. In particular, it is questioned whether the type of interruptions employed in the procedure are likely to occur outside a training context and whether communication taught with the procedure generalizes to out-of-routine contexts. Implications for practice are considered and suggestions are offered for future research.