Many children with a vision impairment and complex needs have significant difficulties processing and interpreting auditory and visual information. Spoken words and manual signs are fleeting and usually bear no direct resemblance to the items they refer to. Some children with a vision impairment and complex needs frequently move in and out of alertness, and this may be especially true of those who also have poorly-controlled epilepsy. In addition, many children with a vision impairment and complex needs have difficulty focusing their attention. It is not surprising, then, that they often fail to attend to something as brief as a spoken word or manual sign. Their difficulties continue even if they do attend. This is because they also process information slowly. By the time they have interpreted and understood what they have heard or seen, events may well have moved on, leaving them confused. Some children with vision impairment and complex needs find it is easier to understand when they handle an object. If a child learns to attach a special meaning to an object, that object is regarded as an “object of reference”. An object of reference can enable the child to obtain information from several senses: touch, vision (if they have some useful sight), smell, taste, and sound (e.g. if they bang it against a surface). This is more reliable for them than relying only on hearing the spoken word, even if that is accompanied by a manual sign. For example Afzal, who had no functional vision, often became distressed in school when it was time to go home: she did not understand where she was being taken. Because Afzal always held on to her seatbelt in the car, it was decided to present her with a piece of seatbelt webbing immediately before going to the car. It was hoped that this would help her to understand she was going in the car. Each time the webbing was presented, the person giving it to her also said “Afzal; car.” After a few days, Afzal relaxed as soon as she was given the webbing. She had attached the special meaning of “car” to the webbing and thus it had become a true object of reference for her; it supported her understanding.