The aim of the current pilot study is to depict the pattern of management of autism spectrum disorder (ASD) in Saudi Arabia, focusing on the efficacy of risperidone in reducing the target symptoms of ASD compared to only behavioral therapy. A cross-sectional study was conducted at two main centers for 10 months. On a convenience basis, prospective visits were scheduled for children, who had received regular behavioral therapy and/or antipsychotics? (mainly risperidone), and their parents to assess the efficacy and side-effects of the treatment. The improvement of symptoms of ASD was assessed using the Aberrant Behavior Checklist-Community Version (ABC-CV) including five subdomains: Irritability, Lethargy, Stereotypic behavior, Hyperactivity, and Inappropriate speech. Twenty-nine children (26 boys and 3 girls) with a mean age of 8.96 years (range: 5-15 years) were included in this study. The distribution of management strategy was: risperidone (11, 37.9%), behavioral therapy only (9, 31.0%), risperidone and behavioral therapy (9, 31.0%). The use of a combination of antipsychotics and psychostimulants (17.24%) was less common than in a previous American study (38%). Surprisingly, scores for all ABC subdomains were higher than those of previous studies, indicating less efficacy of risperidone in this group. Additionally, for the Lethargy subdomain, the score was 74.3±24.3. Interestingly, children who received behavioral therapy only, had lower scores compared to their counterparts who received risperidone only in all ABC subdomains and the total score. Consistent with other reports, this study highlighted the efficacy of risperidone alongside behavioral therapy on reducing hyperactivity symptoms and total ABC score. Despite the published data regarding the efficacy and safety of risperidone, supporting that it may have an important role in the management of ASD in children, further prospective design studies in Saudi Arabia are warranted to confirm the findings or encourage its continuous employment as long-term maintenance therapy. [ABSTRACT FROM AUTHOR]