Background <p>The number of autistic patients globally has been increasing year by year, imposing a severe burden on society and families. It is urgent to find effective treatment methods. Acupuncture treatment for autism is safe and effective, yet there has been no systematic review to clarify the curative effect and the rules of acupoint selection.</p> Methods <p>Computer searches were conducted in PubMed, Web of Science, Cochrane library, CNKI, Wan fang Database, and VIP Database for all RCTs from the establishment of the databases to January 1, 2025. The EndNote X9 software was used for literature screening.</p> Results <p>A total of 19 literatures were finally included. The results of the curative effect evaluation showed that acupuncture therapy had an improving effect on the social communication disorder, repetitive and stereotyped behaviors, and restricted interests in ASD (ABC scale, CARS scale). Acupuncture therapy could change the content of serum factors (increase the contents of folic acid, GSH, GSH/GSSG, and t-PA, and reduce the contents of Hcy, GSSG, PAI-1, 5-HT, and Glu/GABA), excite brain waves, so as to promote the repair of nerve function and improve the core symptoms of autistic patients. In terms of acupoint selection, the acupoints on the head and those of the Governor Vessel were mainly selected, mainly including DU24, EX-HN1, GB13, DU17, GB19, DU20, and She San Zhen.</p> Conclusion <p>Acupuncture therapy has an overall curative effect on ASD, and there are regularities in acupoint selection. However, its mechanism and long-term effects need to be verified by more high-quality studies.</p> Graphical abstract <p></p>