Many children with severe or multiple disabilities, including those with visual impairment, are limited in their ability to communicate. "Communication" is defined as how a person exchanges information about his or her desires, needs, knowledge, and perceptions with another person. Communication can be verbal, written, or nonverbal, such as gestures or symbols. Young children typically communicate through gestures and vocalizations and then learn to speak words within the first year of life. Children who have severe and multiple disabilities have difficulties in all aspects of communication. The term "tangible symbol," also known as "tangible cues," refers to three-dimensional tactile objects that can be manipulated easily and possess tangible qualities such as shape, texture, and consistency. Tangible symbols are typically used with children who have visual or dual sensory impairments and cognitive delays. They are real objects, miniature objects, and partial objects affixed to cards. Symbols should be selected for the similarities of their tactile properties in relation to their referents, not for their visual similarities. The response required when using a tangible symbol is pointing, touching, picking up, or, if possible, gazing in the direction of the symbol. The study presented in this article introduces a communication system that uses tangible cues to all 48 of the preschool and lower school children at the Lavelle School for the Blind in the Bronx, New York, who met the criteria for the intervention. These children had multiple disabilities, including visual impairment, and limited to no verbal skills. (Contains 1 table and 3 figures.)