Effectiveness of a Combined Theory of Mind and Floortime Program on Social-Communication Skills, Emotion Regulation, and Behavioral Flexibility in Children with Autism Spectrum Disorder

The objective of this study was to evaluate the effectiveness of a combined Theory of Mind and Floortime-based intervention on social-communication skills, emotion regulation, and behavioral flexibility in children with autism spectrum disorder (ASD). This semi-experimental study used a single-subject design. The participants were four children aged 5 to 10 years diagnosed with ASD, recruited purposively from the Avaye Autism Center in Mashhad. Data collection instruments included the Gilliam Autism Rating Scale (GARS-2), the Autism Social Skills Profile, and the Emotion Regulation Checklist. The 12-session intervention combined ToM training with Floortime techniques delivered individually. Data were analyzed using descriptive statistics, visual analysis, effect size (Cohen’s d), and percentage of non-overlapping data (PND). The results showed significant improvements across all three variables. Social-communication skills improved by 14.30% to 20.43%, emotion regulation by 17.95% to 23.80%, and behavioral flexibility by 15.85% to 21.05%. Effect size and PND indices supported the effectiveness of the intervention, indicating moderate to good outcomes. Improvements remained stable during the follow-up phase, confirming the sustained impact of the combined program. The combined Theory of Mind and Floortime program proved effective in enhancing social-communication skills, improving emotion regulation, and increasing behavioral flexibility among children with ASD. By integrating cognitive, emotional, and interactive dimensions, this multimodal intervention offers a practical and promising framework for rehabilitation programs targeting children with autism.