Behavioral researchers have investigated procedures for identifying preferred items for individuals with varying levels of developmental disabilities. Some researchers in this area have reported difficulties in identifying preferred items for individuals with severe to profound multiple disabilities (SPMD), in part because the individuals may not possess the motor skills needed to select and manipulate the items included within the assessment. The purpose of the current study was to address three research questions: Would differences in preference patterns be observed if individuals with SPMD could activate toys with a motor response that is within their repertoire (i.e., press a large microswitch to activate the toy) versus when they are required to perform a motor response that may not be within their repertoire (e.g., sliding knobs, twisting dials to activate a toy)? Would teaching specific skills to activate a toy result in increased toy engagement and a shift in preference toward directly operating the toy? Would teaching the participant a motor response to activate the toy directly affect the levels of microswitch engagement observed? Data were collected within a combination multiple baseline (across 2 participants) and multielement (across conditions) design. The results of this study showed that (a) differences in preference were observed when different measures of assessing preferences were conducted, (b) acquisition of specific motor skills resulted in an increase in preference toward directly manipulating items, and (c) acquisition of motor skills also resulted in a decrease in activating items via microswitches. These results extend the preference assessment literature by showing that the motor skills present within an individual's current repertoire may affect the results of preference assessments for individuals with SPMD.