Pictures and related types of communication symbols (e.g., line drawings, photographs) represent forms of aided augmentative and alternative communication that are widely used with individuals with severe disabilities and limited or no speech. This chapter will describe how pictures have been used to enhance the communicative functioning of nonverbal and minimally verbal individuals with severe disabilities. Key aspects of the extensive research on the use of picture exchange as a form of communication for people with severe disabilities are reviewed. Strengths and limitations of using pictures as a mode of communication will also be addressed. What research can affirm about picture communication and where further research may be needed are also discussed.