Development of a Skills Training Educational Package for Children with Autism Spectrum Disorder Based on Theory of Mind and Iranian Cultural Characteristics

Abstract

This study aimed to develop a culturally adapted skills-training educational package for children with autism spectrum disorder (ASD) based on Theory of Mind (ToM) components and Iranian cultural characteristics. This qualitative exploratory study employed systematic literature review, document analysis, field investigation, and semi-structured interviews with autism specialists selected through purposive and snowball sampling until theoretical saturation was achieved. The participants included clinical psychologists, child psychiatrists, occupational therapists, speech therapists, and educational instructors with relevant professional experience. Interview data were transcribed and analyzed in MAXQDA using qualitative content analysis and a three-stage grounded-theory coding procedure comprising open, axial, and selective coding. The resulting categories were integrated into a paradigmatic model encompassing causal conditions, the central phenomenon, contextual and intervening conditions, strategies, and consequences. Content and face validity of the proposed package were evaluated by experts. The final intervention was organized as a structured 40-session program progressing from concrete to increasingly abstract ToM skills. The analysis indicated that deficits in understanding nonliteral language, intentions, deception, perspectives, and pragmatic communication constituted major causal mechanisms underlying impaired social skills and stereotyped behaviors. Child-related cognitive and behavioral characteristics, family support, parental cooperation, and environmental stability emerged as important contextual conditions, whereas sensory difficulties, behavioral problems, resistance to routine changes, limited generalization, and inadequate school–family coordination acted as intervening barriers. The principal educational strategies comprised training in basic emotions, joint attention, desires, first- and second-order false beliefs, behavioral prediction, empathy, humor, and irony. Experts further emphasized visual and concrete materials, role-play, video modeling, personalization, parental participation, school coordination, and practice across natural settings. The model indicated that these strategies could improve social interaction, empathy, communication, and ToM-related functioning while reducing stereotyped behaviors through greater environmental predictability and behavioral flexibility. The developed 40-session ToM-based package provides a culturally responsive and developmentally sequenced framework for strengthening socio-cognitive and interpersonal skills in children with ASD and may enhance the ecological applicability of autism interventions within Iranian family, educational, and clinical contexts.