A case of tuberous sclerosis presenting with autistic behaviour is described. Although tuberous sclerosis is a rare cause of the autistic syndrome, it should be more strongly suspected when autistic behaviour is associated with seizures in a young child.

An 18-year-old male, originally diagnosed as suffering from infantile autism but with a developmental history and clinical picture in keeping with Asperger's syndrome, and showing current signs of impairment of higher cerebral functioning, is presented. The subject and several males of his family present behavioural disturbances of an enduring type. An aminoaciduria was discovered in the subject and his father. A possible relationship between the metabolic disturbance and the neurological and behavioural disturbance is raised. Mechanisms for this relationship are discussed, including sporadic hyperlysinaemia.

The birth of a mentally handicapped child to a couple is a traumatic event. It has even been compared with a bereavement. In the crisis of family handicap, however, there is also anxiety, fright, guilt and shame. Some of these reactions have been denied by families but it has to be borne in mind that mothers of abnormal babies, although they are not aware of it consciously, may be protective and dominant (Prechtl, 1963). The reactions of parents of mentally handicapped may swing from extremes of over-protection to complete rejection. On the other hand, there is stress both emotional and physical in looking after the handicapped day in, day out. The amount of the emotional stress has not been quantified, but of the many forms of interactions between parent and offspring, over-involvement, criticism, hostility, and warmth can be evaluated using the Expressed Emotional scales.

The case of an 82-year-old woman with delusional infestation and senile dementia of the Alzheimer type is reported. Her symptoms of infestation ceased dramatically with pimozide given for 5 weeks, and did not recur during follow-up over 9 months. The importance of organic factors in patients with this disorder is emphasised.