A population-based neurobiological study of 35 children with autistic disorder (AD) and 17 with autistic-like conditions (ALC) is reported from the Department of Child and Adolescent Psychiatry, University of Goteborg, Sweden. Major indications of brain damage or dysfunction were found in 90%. Etiological groups included Moebius syndrome (9%), fragile X syndrome (6%), chromosomal anomalies (6%), neurocutaneous disorders (6%), congenital hydrocephalus (3%), Rett syndrome (3%), Laurence-Moon-Biedl syndrome (3%), severe perinatal distress (9%), and epilepsy or severe EEG pathology (20%). Genetic factors were implicated in 9% with fathers and a brother with Asperger’s syndrome. The EEG was abnormal in 50% and 18 (40%) had epileptiform discharges, maximal in the temporal lobes. CAT scan abnormalities in 25% included dilated ventricles, porencephaly, and general atrophy. BAERs were abnormal in 33%. 
COMMENT. Multiple biological etiologies for autism and autistic-like disorders are suggested by this comprehensive study. Despite the extra effort and patience involved, the pediatric neurologist should not dismiss the child with autistic symptoms to the care of the psychiatrist without first attempting a full neurologic evaluation including EEG and CT or MRI.