Appendicitis is the most common surgical emergency in children and can lead to significant complications. The aim of our study was to determine whether children with autism spectrum disorders (ASD) are at increased risk for appendicitis and its complications compared to neurotypical (NT) peers. From 2000 to 2013, 292,572 children were included (n=48,762 ASD). ASD children exhibited an incidence of 8.66 appendicitis cases per 10,000 person-years, P>0.05. There was an increased risk of perforation in ASD children age 15-17 years-old (OR 2.25; 95% CI 1.15-4.42) as well as an increased odds of sepsis (OR 3.44, 95% CI 1.43-8.27). Providers should display heightened awareness for the risk of complicated appendicitis in children with ASD.