This research provides detailed summaries of the diverse communication skills of two children with Pitt-Hopkins Syndrome. One participant had level III Communication Matrix skills (unconventional communication), and was pre-symbolic, pre-intentional, non-imitative, and reliant upon others to interpret her proximal actions. The other participant had level IV (conventional communication) and V (concrete symbols) Communication Matrix skills, with emerging symbolic forms, some imitation, and directedness to his proximal and distal actions. Results are discussed in comparison to other children with severe disabilities.