Autism spectrum disorders (ASD) are defined by significant and persistent deficits in two main domains: a) social communication and interaction and b) restrictive, repetitive behaviors. They represent a worldwide epidemiological challenge, given their increasing prevalence and because they correspond to a condition that permanently compromises the patient and their families, with a significant impact on quality of life and economics. The clinical presentation in childhood, the interindividual variability determined by the heterogeneity of its clinical, genetic and pathogenic presentation, have hindered the development of clinical trials and subsequent validation of specific drugs for the central symptoms of the condition, due to a series of methodological difficulties. The demands for care and treatment change dynamically with development, presence of co-morbidities and environmental adaptive demands (school, relational and occupational), this demands specific treatment strategies, with a low risk profile in long-term use and good tolerance at all ages. On review of the current literature, the drugs authorized by the FDA are still only two (risperidone and aripiprazole) for irritability and behavioral symptoms. We will reviewsome commonly used drugs in ASD patients, some common comorbidities, available emerging approaches to therapy and obstacles to the development of pharmacological treatments.