Second-generation antipsychotics (SGAs) may offer important benefits to children with mental health disorders. Recently, the use of SGAs in children has expanded to a number of mental health disorders including disruptive and aggressive behavior, irritability associated with autism spectrum disorders, mental retardation and mood disorders. Among atypical antipsychotics, clozapine is notorious for persistent hypersalivation that is distressing for the patients and interfering with treatment compliance. Hypersalivation is rarely reported with risperidone, olanzapine and quetiapine. It was reported that aripiprazole increased salivation in 2% of adult patients as compared to 1% of patients on placebo; whereas in children it varied from 4–6% with aripiprazole compared to 0–1% with placebo. In one retrospective chart review of 30 children and adolescents (mean age 13.3 years, range 5–19), akathisia was recorded in as many as 23% of patients taking aripiprazole. We report a case in which hypersalivation and akathisia emerged after the beginning of aripiprazole treatment. A11-year-old boy was diagnosed as having Autism and Attention Deficit Hyperactivity Disorder (ADHD) according to DSM-4 and was receiving Methylphenidate extended release (OROS MPH) 54 mg/day. Subsequently aripiprazole 5 mg/day was added because of his irritability. Sialorrhea, akathisia, restlessness, sedation and muscle weakness emerged after 4 days of adding aripiprazole treatment. Within a week after discontinuation of aripiprazole, particularly sialorrhea and sedation gradually decreased. Aripiprazole may rarely produce severe sialorrhea and akathisia; patients should be informed about, and assessed routinely for these adverse effects.