The hydrological cycle is anticipated to become increasing variable due to intensified global climate extremes and frequent floods. Understanding the evolution and driving mechanisms of floods in the context of climatic extremes is essential, particularly on the Loess Plateau (LP) where anthropogenic activities are significant. Here, we examined the spatiotemporal variability of climate extremes and their impacts on flood processes on the LP during 1956–2015. We employed a paired year approach to quantitatively assess the driving role of anthropogenic activities on flood changes in 11 major basins. Our findings indicated a general decline in extreme precipitation indices, while temperature has increased across most of the LP. Both annual runoff (Q) and high flow (Q5) magnitude significantly decreased in all basins. We identified that the major climatic indices driving Q5 included erosive precipitation amount, flood season precipitation, heavy precipitation amount, and maximum 7-day precipitation amount. Importantly, anthropogenic activities have mitigated the impact of climate extremes on Q5 regimes. Compared the post-2000 with reference period (1956–1979), under similar climatic conditions, we observed a reduction in the average Q5 magnitude by 30.19–78.14%, and a decrease in the average Q5 duration by 46.48–100.00% across the basins. The contributions of climate variability and anthropogenic activities to Q5 magnitude changes among 11 basins ranged from –37.58% to 22.02% and –56.84% to –15.08%, respectively, highlighting the crucial role of ecological restoration in reducing Q5 magnitude. These results underscore the importance of ecological restoration in flood regulation and offer valuable insights for basin management in the Yellow River Basin.