Clinicians are faced with the challenge of making informed decisions amidst heated debates over the most effective treatment approaches for young children with autism. This article provides a more specific focus to this debate by considering the practice of enhancing spontaneous language and related social-communicative abilities of young children with autism/pervasive developmental disorder (PPD). First, a historical perspective of the evolution of different approaches for enhancing communication and related abilities is presented, followed by a description of characteristics of the approaches. The approaches are described along a continuum from massed discrete trial, traditional behavioral to social-pragmatic, developmental. The current state of knowledge regarding the effectiveness of early services for children with autism/PDD is examined and conclusions are presented with consideration of the need for more meaningful outcome measures than are currently used for the next generation of outcome research.