<p>Autism spectrum disorder (ASD) is a neurodevelopmental disorder with inconclusive and controversial etiology. Both genetic and environmental factors play essential roles in the development of ASD. This was a cross-sectional, case–control study to investigate the heavy metal and trace element status through inductively coupled plasma mass spectrometry (ICP-MS) in children with ASD. This was correlated with the severity of ASD based on the Childhood Autism Rating Scale (CARS). Consecutive children (n = 72) diagnosed with ASD (DSM-V criteria) at 3–10&#xa0;years of age were enrolled as cases along with age and sex-matched healthy children from the same environment as controls. Children with ASD had a significant history of pica, exposure to batteries, and scented body products as compared with controls (<i>p</i> = 0.001). Significantly higher levels of lead, mercury, and arsenic (in serum, hair, and whole blood), Nickel (in serum), manganese, and cobalt (in whole blood and serum) and, on the contrary, significantly lower levels of copper and selenium (in hair) were observed in children with ASD in comparison to controls. ASD severity was found to have a significant positive correlation with levels of arsenic (whole blood) (<i>p</i> = 0.04) and lead (hair) (<i>p</i> = 0.003) and, in contrast, negative correlation with levels of copper (hair) (<i>p</i> = 0.03), zinc (hair) (<i>p</i> = 0.001) and magnesium (hair) (<i>p</i> = 0.03). The index study suggests a possible association between elevated blood/hair heavy metals and ASD. Exposure to batteries, scented home/body products, and history of pica were found to be the major sources of heavy metals in North Indian children with ASD.</p>