Well-ordered empirical information on ‘what works’ in art therapy with children diagnosed with Autism Spectrum Disorders (ASD) hardly exists. For that reason a systematic review was undertaken covering the period 1985–2012. Our study explored academic and practice-based sources with the aim to identify core elements of art therapy for normal/high intelligent target group children up to 18 years. Eighteen descriptive case-studies were found and analyzed according to the Context Outcomes Art Therapy (COAT) model. The results indicate that art therapy may add to a more flexible and relaxed attitude, a better selfimage, and improved communicative and learning skills in children with ASD. Art therapy might be able to contribute in mitigating two main problem areas: social communicative problems, and restricted and repetitive behavior patterns. Typical art therapeutic elements such as sensory experiences with sight and touch may improve social behavior, flexibility and attention-abilities of autistic children. Considering the limited evidence that was found, primarily existing of elaborated clinical case descriptions, further empirical research into the process and outcomes of art therapy with ASD children is strongly recommended