Literacy is traditionally narrowly conceptualised as a set of skills related to accessing and generating written or printed text. For children designated as having severe learning difficulties (SLD), who are unlikely to develop these "conventional" literacy skills, such a conception implies their semi-literacy or nonliteracy. Although conceptions of multimodal literacy and multiliteracies have rarely been applied to this group, broader understandings of literacy that include a range of activities, modes and media provide greater opportunities for including these learners in literacy practices. Drawing upon our research with teachers of this group of children and young people, we illustrate these literacy practices. We note, however, that such practices are often haphazard, not coherently thought through, and that there is much confusion regarding any distinction between communication and literacy. We argue for literacy as a specific form of communication, but conclude that broader models of literacies should be utilised to guide and support practitioners in developing interactive practice and in making reasoned and principled approaches and decisions about literacy practices, routes and progression for children with SLD.