Research has demonstrated that multilingual exposure does not inherently impede language development or academic achievement in autistic children. Nevertheless, autistic students who are multilingual learners may experience unique challenges in the United States, where systemic barriers constrain both the diagnosis and the delivery of education. This review synthesizes 46 US-based studies to assess how educational and, to a lesser extent, medical systems are (or are not) prepared to offer adequate support to autistic individuals from multilingual families. Results reveal varied patterns of systemic inequity faced by multilingual children on the autism spectrum, elucidating the issues of disproportionality as well as unequal access to educational and medical resources. While the majority of studies emphasize the benefits of multilingual environments for autistic students, a persistent trend in favor of monolingual instructional strategies remains. Despite this, emerging publications present experimental evidence that drawing on students' first languages can bolster academic and behavioral performance and strengthen executive functioning.