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This systematic review and meta-analysis evaluates Theory of Mind (ToM) training effectiveness for children and adolescents with autism spectrum disorder (ASD) and identifies potential moderators. After comprehensively searching EBSCO, ERIC, Web of Science, and PubMed up to March 31, 2025, we included 15 peer-reviewed randomized controlled trials (RCTs) assessed with the Cochrane risk-of-bias tool, with 11 studies suitable for meta-analysis. The results demonstrate that ToM training produces a statistically significant improvement in ToM ability (Hedges’ g = 0.41, 95% CI: 0.02, 0.79). Additionally, a significant beneficial effect was observed on the secondary outcome measure (Hedges’ g = 0.26, 95% CI: 0.09, 0.44), providing evidence for the intervention’s efficacy in this population.