Objective To investigate the effects of the pivotal response training combined with role-play training on mood state and severity of autism in children. Methods A total of 120 children with autism admitted to Xinyang Central Hospital from June 2023 to December 2024 were selected. They were divided into group Ⅰ (n=60) and group Ⅱ (n=60) by computer numbering method. Group Ⅱ received routine rehabilitation intervention, group Ⅰwas supplemented with pivotal response training combined with role-play training. Both groups continued the intervention for 3 months. Mood states, severity of illness, autism behavior, and sensory integration were compared between the two groups. Results After 3 months of intervention, the scores of Screen for Child Anxiety Related Emotional Disorders (SCARED) and Depression Self-rating Scale for Children (DSRSC) in both groups were lower than before intervention. The scores of SCARED and DSRSC in group Ⅰ were (17.50±2.14) and (13.25±2.03) respectively, lower than those in group Ⅱ , which were (20.06±2.82) and (17.44±2.46) (t=5.602, 10.176; both P < 0.001). After 3 months of intervention, the scores of the Autism Treatment Evaluation Checklist (ATEC) in both groups were lower than before intervention. The scores of social ability, expression/verbal communication, perception/cognitive ability, health/physiology/behavior in group Ⅰ were (9.43±1.73), (7.45±1.33), (16.18±2.03) and (14.13±1.79), lower than those in group Ⅱ, which were (12.50±2.50), (10.60±2.15), (19.47±3.09) and (16.82±2.25) (t=7.822, 9.651, 6.893, 7.247; all P< 0.001). The scores of all dimensions of Autism Behavior Checklist (ABC) were lower in both groups after intervention than before intervention, and the scores in group Ⅰ were lower than those in group Ⅱ (all P < 0.05). The scores of sensory integration ability in both groups were higher after intervention than before intervention, and scores of group Ⅰwas higher than those of group Ⅱ (all P < 0.05). Conclusion The pivotal response training combined with role-play training can significantly improve the mood state and severity autism behavior of autism in children, and can improve the sensory integration ability.