Clinical Question: Do children with complex communication needs show greater improvement in requesting behaviors with the Picture Exchange Communication System® (PECS®) versus a speech-generating device (SGD)? Method: Systematic Review. Sources: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Linguistics and Language Behavior Abstracts (LLBA), PsycINFO Search Terms: AAC OR augmentative and alternative communication OR complex communication needs OR communication aids OR assistive technology devices OR communication aids (for disabled) OR total communication OR augmentative communication systems; AND PECS OR picture exchange communication OR low-tech AAC OR aided symbol systems OR nonverbal communication; AND SGD OR speech generating device OR VOCA OR voice output communication aid OR high-tech. Number of Studies Included: 4. Primary Results: Overall, PECS and SGD were equally effective methods to teach children with complex communication needs to make requests. Conclusion: Children with complex communication needs can learn to make requests using either PECS or an SGD. Some children preferred one method over another. It is important to take client and family preferences into account when deciding whether to pursue a high-tech (i.e., SGD) or low-tech (e.g, PECS) intervention. Because preferences may change after exposure to both interventions, it may be helpful to introduce both methods before deciding which method to pursue long-term.