This study explored the interactional aspects of text messaging on mobile phones for youth with complex communication needs. A qualitative case study design was used to investigate aspects such as reasons, place, timing of communication, content and communication partners. Data were gathered from seven youth with complex communication needs (primary participants) and one communication partner for each youth (secondary participants). In addition to using a questionnaire and tests to obtain participant background information, four data collection methods were used: (a) face-to-face interviews with the primary participants via text messaging, (b) researcher observations of these participants interacting via text messaging, (c) an asynchronous text-messaging focus group involving all seven primary participants, and (d) asynchronous interviews with the secondary participants via text messaging. The thematic data analysis highlighted numerous interactional benefits, most notably that text messaging offered the youth with complex communication needs a means of expressing themselves that was easier than face-to-face interactions. It also emphasizes interaction symmetry with a wide range of communication partners including groups, the privacy to interact with others beyond their often-restricted environments (absent presence), and a measure of anonymity and control over interactions. The study concluded that text messaging provides youth with complex communication needs with new communication possibilities.