The Picture Exchange Communication System (PECS) and a speech-generating device (SGD) were compared in a study with a multiple baseline, alternating treatment design. The effectiveness of these methods in increasing social-communicative behavior and natural speech production were assessed with three elementary school-aged children with severe autism who demonstrated extremely limited functional communication skills. Results for social-communicative behavior were mixed for all participants in both treatment conditions. Relatively little difference was observed between PECS and SGD conditions. Although findings were inconclusive, data patterns suggest that Phase II of the PECS training protocol is conducive to encouraging social-communicative behavior. Data for speech outcomes did not reveal any increases across participants, and no differences between treatment conditions were observed.