This research investigates whether children with autism learn picture, word and object relations as associative pairs or whether they understand such relations as referential. In Experiment 1, children were taught a new word (e.g. "whisk") repeatedly paired with a novel picture. When given the picture and a previously unseen real whisk and asked to indicate a whisk, children with autism, unlike typically developing peers matched on receptive language, associated the word with the picture rather than the object. Subsequent experiments respectively confirmed that neither a bias for selecting pictures nor perseverative responding accounted for these results. Taken together, these results suggest that children with autism with cognitive difficulties are learning picture-word and picture-object relations via an associative mechanism and have difficulty understanding the symbolic nature of pictures. (Contains 1 tables and 5 figures.)