The aim of the study was to ascertain the effect of multiple special needs on the communication interactions between students and their carers in residential units of a special school. In particular, staff control, student engagement and type of communication were considered. It was predicated that staff control would increase over students with more impairments, that these students would communicate least and use less verbal language, and that more control would be exert during structured time periods. Naturalistic observations of communication took place on 20 young people, all of whom had learning disability and were further divided into groups based on their occurrence of hearing impairment (HI) and/or autism. Each participant was observed for one hour whilst relaxing and one hour eating dinner whilst interacting, as usual, with carers. It was found that students with autism were reduced in their overall communication, initiation and response but this was not differentially affected by HI. It was concluded that autism is more dehabilitating in production of communication than HI. HI autistic students were reduced in their verbal language compared with other groups suggesting that the increase in impairments is more detrimental in the use of language than in the production of communication. In addition it was found that staff communicated differentially to each group but there was no clear pattern in this. This was used to suggest staff are aware of the students differing abilities and are reacting to them in some way but it could not be concluded that staff controlling language accounted for reduced communication in autistic students or reduced verbal language in HI autistic students. Further analysis and research is needed to identify which staff approaches are facilitative to each group students. Implications and limitation are discussed.