PURPOSE: Despite the importance of communication for educational participation, researchers have observed low frequencies of communication between teachers and students with multiple and severe disabilities (MSD). Little is known about reasons for these low frequencies. This article explores the literature to develop a new research agenda for approaching this issue. METHOD: Selected studies were reviewed, including qualitative studies involving teachers of students who use augmentative and alternative communication (AAC) in mainstream classrooms. RESULTS: Teachers identified a broad range of issues that influence their ability to educate students who use AAC or demonstrate other significant communication needs. These factors include teachers' attitudes, perceptions and beliefs and broader contextual factors, such as administrative support at the institutional level. However, to date, there has been little research with teachers of students with MSD about factors influencing communication with their students. CONCLUSIONS: A broad range of potential factors may impact upon teachers' ability to communicate with their students. Further research involving teachers of students with MSD is needed to explore the range of potential factors influencing low frequencies of communication. This research may contribute to an understanding of how best to support teachers to enhance communication access for students with MSD in the classroom.