Objectives To evaluate the effects of parent-delivered traditional Thai massage (TTM) on children with autism and its potential influence on parenting stress. Methods Forty-eight children with autism (aged 10.32 ± 1.35 years) were enrolled from Haikou Special Education School (Haikou Province, China) and randomly assigned to either the TTM group or control group in a 1:1 ratio. Alongside their regular school routines, the TTM group underwent 16 sessions of 50-min TTM, twice weekly for 8 weeks. The control group continued their usual daily school routines. Intervention effects and parenting stress were measured using the Autism Treatment Evaluation Checklist and Parenting Stress Index, Fourth Edition Short Form. Results The TTM intervention had a significant positive impact on sociability (p = 0.001, partial ŋ2=0.168) and total scores (p = 0.009, partial ŋ2=0.103). Additionally, the TTM group had significantly reduced parental distress (p = 0.016, partial ŋ2=0.179), parent − child dysfunctional interaction scores (p = 0.008, partial ŋ2=0.206), and total scores (p = 0.001, partial ŋ2=0.179) post-intervention, with a significant rebound observed during the follow-up period. Conclusions Our findings indicate that parent-delivered TTM can effectively improve certain autism symptoms and reduce parenting stress in the short-term. Incorporating parent-delivered massage into family-based interventions offers a convenient, effective, and personalized treatment option for families with limited access to alternative treatment resources. Trial registration Clinical Trials Registry Identifier: ChiCTR2100051355, 2021-09-21