The Edinburgh Children's Hospital speech clinic is a joint paediatric and speech therapy clinic which was first established in 1950 and accepts referrals of children for whom speech and language difficulties are the principal concern. An audit was conducted for children presenting consecutively over January 1993 to January 1994 to identify what proportion of these children had autism and related disorders. The mean age of presentation of all children seen was in their final pre-school year, with 80 percent of children already being managed in the community by other professionals such as speech and language therapists and educational psychologists. Of 103 children, 22 had autism or a related disorder. A retrospective analysis of parental report and clinical assessment at the first clinic consultation confirmed that a complaint of no communication with peers coupled with temper tantrums was highly predictive for membership of this group of disorders. The audit confirmed that the contribution of autism to the children's communication difficulties had not been fully recognized and addressed prior to the speech clinic consultation. The audit has informed our practice and we intend attracting clinical psychology and child psychiatry services into the speech clinic to enhance the service we deliver and also to employ our findings to highlight consideration of autism in the young child with speech and language difficulties.