Purpose -The purpose of this paper is to offer a general review of care for individuals on the autism spectrum, including Asperger's syndrome within a medium secure setting. Design/methodology/approach -The authors undertook a review of the current literature relating to pathways to care, offending characteristics and treatment interventions. They examined the available evidence and current practice. Findings -Available evidence suggests offending characteristics of individuals with autism are different to those of mental disorders such as schizophrenia. Limited evidence in treatment interventions and in risk management for those with autism presents a challenge to clinicians. The heterogeneity makes a strong case for an individualised case formulation approach to treatment and risk management. Originality/value -This paper offers an overview of the current evidence base relating to the treatment of individuals with autism spectrum disorders within medium secure settings.