Clinical Question: Would a minimally verbal toddler with an autism spectrum disorder (ASD) benefit more from implementation of the Picture Exchange Communication System® (PECS®) or Pivotal Response Treatment® (PRT®) to increase communication initiations of his wants/needs? Method: Literature review of evidence-based practice (EBP) Intervention Comparisons. Sources: ASHA National Center for Evidence-Based Practice (N-CEP) in Communication Disorders, National Professional Development Center on Autism Spectrum Disorders, Google Scholar. Search Terms: early intervention, PECS AND early intervention AND ASD; Pivotal Response Treatment AND early intervention AND ASD. Number of Studies Included: 7. Primary Results: PECS was identified as an emerging evidence-based practice on the N-CEP website and as an evidence-based practice on the National Professional Development Center on Autism Spectrum Disorders website. Implementation of PECS yielded significant increases in requests and/or initiations in two of the four studies. PRT was identified as an evidence-based practice on the N-CEP and the National Professional Development Center on Autism Spectrum Disorders websites. Implementation of PRT resulted in significant increases in verbal initiations and/or functional verbal utterances in all three studies. Conclusion: PECS and PRT are appropriate for increasing communication initiations in toddlers with ASD. Because PRT has been consistently categorized as an evidence-based practice and large effect sizes have been noted across research studies, it appears to be a more effective intervention than PECS for increasing initiations, requests, and/or functional verbal utterances in toddlers with ASD.