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Communication is one of the challenges for children with severe and multiple disabilities due to their impairments (Turnbull et al, 2004). There is about forty percent of unknown causes of severe and multiple disabilities, but prenatal biomedical is the majority known cause of the disabilities.
While autism is highly heritable, researchers suspect both environmental and genetic factors as causes. In rare cases, autism is strongly associated with agents that cause birth defects. Controversies surround other proposed environmental causes; for example, the vaccine hypotheses, which have since been disproven.