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.