This study addressed two aims: First, to examine the quality of adult shared book-reading behaviors for teachers and caregivers of children with communication impairments (CI) and, second, to compare the level of child literacy engagement during the teacher-led (group) and caregiver-led (one-on-one) shared book-reading sessions. Sixteen children with communication impairments were observed in both teacher-led and caregiver-led book-reading sessions using four matched manipulative storybooks. Children were observed during the fall and the spring of their preschool year. The quality of book-reading was evaluated using the ‘systematic assessment of book reading’ (SABR). Children’s level of literacy engagement was documented using the Children’s Orientation to Book Reading Rating Scale. Results indicated that teachers’ shared book-reading quality was significantly higher than caregivers’. Children’s level of engagement was high across both adult-led contexts.