Upper secondary vocational education and training (VET) in Sweden has been subject to frequent educational policy reforms which have resulted in reduced numbers of students and student groups comprising many students with special education needs (SEN). These changes can be assumed to have resulted in increasing demands on VET teachers’ work with special needs education (SNE). The purpose of this study is to contribute knowledge about VET teachers’ conditions for, and work with, SNE in Swedish VET programmes. An analysis of interviews with 15 teachers from eight VET programmes revealed the following themes: 1) Framework factors in the learning environments affecting teaching and learning, 2) The schools’ organisation of special educational competence and the VET teachers’ application of special needs education, 3) Communicative teaching for increased knowledge of students’ strengths and needs, 4) Adaptations at individual and group level, 5) Integration of theory and practice, and 6) Reconsidering teaching approaches through follow-ups. The analysis, based on Skrtic’s theory, reveals a dichotomy in the VET teachers’ conditions for, and work with, SNE. In the schools, a bureaucratic approach is applied where overriding goals are attributed high value, while the VET teachers strive for an adhocratic approach where the teaching is based on their students’ needs. Based on Ainscow’s theory, the analysis shows that the VET teachers take an interactive learning environment-related approach, which means that, based on their understanding of the students’ difficulties, they develop adaptations to stimulate their students’ learning and development.