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Royal commission on the NHS.

assay techniques or disparate diagnostic criteria remains to be determined. The serotonin findings may well be important, but their meaning remains obscure. So far attempts to relate serotonin concentrations to clinical differences within autistic or retarded groups have proved rather disappointing.13 Moreover, the mental retardation syndromes particularly associated with autism include some with high 5HT concentrations (such as infantile spasms) and some with low (phenylketonuria).2 On the other hand, in Down's syndrome, which is the variety of mental retardation least likely to coexist with autism, the serotonin concentrations are consistently low. Behaviouralbiochemical links warrant further exploration even if, on present evidence, autism seems unlikely to be due to a defined inborn error in a general metabolic pathway,3 like that in phenylketonuria.