Enhancing theory of mind in autism through humanoid robot interaction in a randomized controlled trial

Autism Spectrum Disorder presents significant challenges in social cognition, particularly in understanding others' thoughts, emotions, and intentions. Traditional interventions often rely on role-playing games with human therapists or inanimate objects, but these approaches may lack consistency and ecological validity. This study integrated Applied Behavior Analysis principles with robot-assisted training to improve social cognition in children with autism. A randomized, two-period crossover trial involving 32 children (mean age = 7.53 ± 1.32 years, 7 females) compared robot-assisted training using the humanoid robot iCub with standard therapy and an active human-assisted control condition. During robot-assisted sessions, children engaged in structured social role-play scenarios, practicing essential social skills such as perspective-taking, joint attention, and recognizing intentions. The robot's human-like appearance and adaptive behavior provided an engaging, predictable learning environment. Results indicated that robot-assisted training significantly improved social cognition, in contrast to traditional therapy and the human-assisted control group, where no improvements were found. Importantly, the active human control confirmed that these improvements were driven by the robot's presence rather than the protocol itself. These findings demonstrate the potential of humanoid robots as effective therapeutic tools for enhancing social skills in children with autism, offering a scalable and engaging complement to existing clinical practices. Clinical Trial Registration: ISRCTN15341724, registered on May 6, 2025. Available at: https://www.isrctn.com/ISRCTN15341724 .