Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that severely impairs children's health. Current data suggest that behavioral therapies are successful. Risperidone has been approved by the US Food and Drug Administration (FDA) to moderate impulsive behavior in people with ASD. This study aimed to evaluate the efficacy and safety of risperidone in children and adolescents with ASD. Methods: This study involved searching electronic databases for relevant articles, screening them based on inclusion and exclusion criteria, and performing a combined data analysis of the selected articles using Review Manager software. Results: This meta-analysis comprised 7 articles. The pooled analysis indicated that: (1) Risperidone intervention decreased scores on the Aberrant Behavior Checklist (ABC) scale in children and adolescents with ASD, as well as reduced scores related to stereotypy, social withdrawal, hyperactivity, inappropriate speech, and irritability on the ABC scale; (2) The use of risperidone raised the risk of weight gain, tremors, upper respiratory tract infection, and increased appetite. Other adverse responses, however, did not differ significantly from the placebo group. Conclusion: Risperidone demonstrated effectiveness and safety in managing behavioral issues and decreased ABC scores in children and adolescents with ASD. However, further research is needed, and the associated risks still need to be considered.