Teaching Theory of Mind Skills to Individuals with Autism Spectrum Disorder: A Systematic Review and Meta-analysis

PURPOSE: In this study, we examined the effectiveness of Theory of Mind (ToM) intervention programs on the ToM skills of individuals with Autism Spectrum Disorder (ASD) through a systematic review and meta-analysis. METHODS: A comprehensive search was conducted in Web of Science, Scopus, EBSCO ERIC, Academic Search Complete, PubMed, ProQuest, and the Türkiye Council of Higher Education Thesis Center, completed on January 5, 2024. Studies were included if published in English or Turkish, involved participants with ASD, implemented interventions targeting ToM, used at least one ToM assessment tool, employed a randomized controlled trial (RCT) or quasi-experimental design, and provided sufficient data for meta-analysis. Methodological quality was evaluated using What Works Clearinghouse (WWC) standards. The meta-analysis used a fixed-effects model with Hedges' g in Comprehensive Meta-Analysis Software 4. RESULTS: We identified 20 studies (n = 924) meeting the inclusion criteria, of which 15 were included in the meta-analysis. Most interventions targeted understanding first- and second-order false beliefs and frequently used role-play and picture-based storytelling techniques. The results indicated a moderate positive effect (g = 0.492, 95% CI [0.322, 0.662]). Subgroup analyses showed no significant differences based on study characteristics. CONCLUSION: Findings should be interpreted cautiously due to publication bias, small sample sizes, and the lack of IQ, language, or prerequisite skill assessments. Crucially, insufficient reporting of social validity and generalization represents a major barrier to assessing real-world utility. Future research must prioritize rigorous RCTs and systematic functional reporting to strengthen the evidence base.