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Levels of serotonin (5-HT), dopamine (DA), norepinephrine (NE) and epinephrine (E) were determined in the whole blood and urine of 23 children with autism and compared to those of normal children. Very significant group effects (low whole blood 5-HT, high urinary 5-HT and high NE+E in autism) and age effects (urinary 5-HT and DA decrease with age) were found. Moreover, the urinary DA and the whole blood E levels were correlated with clinical findings. The results suggest a maturation defect of noradrenergic systems, possibly disturbed dopaminergic and serotoninergic metabolism, and a functional imbalance among these neurotransmitters in autism.

Clinical studies of early symptoms are among the most significant advances achieved during recent years in the field of autism. The first descriptions of early symptoms were retrospective and lacked precision. Autistic children are now being seen increasingly early and new insight is being gained into the initial manifestations and differences in clinical patterns. Similarly, differential diagnosis problems (borderline forms) are changing as clinicians evaluate children at younger ages. Although a definitive diagnosis is neither possible nor even desirable before the age of 18 to 24 months, detailed clinical data should be collected early. This data forms the basis for differential diagnosis and will be needed later for differentiating various clinical patterns of developmental disorders, establishing a prognosis, and monitoring therapeutic effects. In prospective longitudinal studies of autistic children, comparison of recent observations with detailed early data is essential. Early initial evaluation includes videotape recordings, assessment of cognitive functions and communication skills, and use of a scale for autistic symptoms. Using the results of evaluations of very young children, a specific semiology (communication disorders) can be developed. Several symptoms probably denote neurophysiologic and/or perceptive disorders. Primary symptoms are now being better distinguished from secondary anomalies (behavior disorders) that may be avoidable or treatable.