Background: Children with complex communication needs (CCN) often experience problems achieving literacy. The aim of this project was to study phonological awareness, a central predictor for literacy achievement, in children with CCN, and to compare their performance to a group of children with natural speech. Method: One group of 15 Swedish children with CCN and cerebral palsy (CP), and one group of 15 children with natural speech, matched for gender, linguistic age and mental age, were administered nine phonological awareness tasks, testing onset/rime and phonemic awareness. Results: Overall, children with CCN showed good levels of phonological awareness. However, on the one task that did not include any verbal support from the experimenter, the children with CCN performed at a significantly lower level. Conclusion: Phonological awareness does not seem to depend on overt articulation, although the lack of speech might affect the children's ability to manipulate linguistic material that is not verbally presented. (Contains 5 tables and 2 figures.)