Following a review of the literature, the paper describes a total communication approach to the language development of a 4-year-old autistic child. It is explained that the child was videotaped while being trained to simultaneously use elements of American sign language together with the correct spoken word or words. Training procedures are described for nouns, verbs and noun-verb pairs. Among results analyzed are a drastic reduction of verbal echolalia, a marked increase in simultaneous vocal and signed labeling, an increase in umprompted vocal labeling, and increases in simultaneous vocal and signed telegraphic phrasing. Followup evaluation is noted to have shown a continued low level of echolalic production and continued high percentage of both prompted and unprompted vocal labeling. (CL)