The aim of this study was to compare the efficacy with which the use of a speech generating device (Apple iPad TM with GoTalk Now TM application) versus a communication board promoted the production of two-symbols combinations (agent-action and attribute-entity combinations) by children limited speech within a shared story reading context. Four children between the ages of 6;8 (years;months) and 11;4 with severe motor speech disorders and a variety of developmental 1 disabilities participated in the study. An adapted alternating treatment design was used. All four participants showed increased production of two-symbol combinations in both intervention conditions. The Wilcoxon ranked pairs test did not show differences between the conditions for any participant. The results suggest that symbol combination skills can effectively be taught using either AAC system. A preference assessment indicated that all participants preferred to use the speech generating device during shared story reading. all studies focussed on basic requesting skills requiring the use of only one symbol per response in all or at least one of the intervention conditions; and (b) most studies did not support consistent differences between electronic and non-electronic systems. One explanation for the lack of clear differences between the conditions may be that the acquisition of the requesting skills targeted in these interventions is strongly motivated by the reinforcer. Participants might be so motivated to obtain the reinforcer, that the method to obtain it loses particular relevance. The acquisition of communication functions that are not as tangibly motivated but that proceed for social and interactive reasons might be more prone to influence by the system used, as internal rather than external motivation may play a larger role (Light, Parsons and Drager 2002). Of the 31 participants that took part in the studies comparing SGDs to non-electronic AAC systems reviewed by Gevarter et al (2013), 17 had a diagnosis of autism spectrum disorder (ASD), autism or pervasive developmental disorder (PDD). Young children with these diagnoses typically are more likely to communicate in order to regulate the behavior of others (i.e., requesting or protesting), rather than for the purpose of social interaction (Wetherby, Watt, Morgan and Shumway 2007), which may explain the focus on requesting in these studies.The use of electronic versus non-electronic systems may differentially influence the production of multi-symbol combinations (Binger, Kent-Walsh, Berens, Del Campo and Rivera, 2008). An SGD provides auditory feedback to the person using it on his/her own productions, which may facilitate language learning (Romski and Sevcik 1988;1996;Romski, Sevcik and Adamson 1997). The digital or synthetic speech generated by the SGD may reinforce the learning of symbol sequences. This may be a benefit that is particularly relevant to children who have an understanding of spoken language, whereas the receptive (spoken) language skills of the 3 participants...