Aims <p>Based on the observed correlation between core symptoms and fine motor function in children with ASD, this study aimed to evaluate the therapeutic effect of a novel, fine motor task-oriented sports game intervention, compared to traditional SI.</p> Methods <p>Forty-five children with ASD were randomly allocated to two groups. The experimental group received the fine motor-oriented sports game intervention, while the control group received traditional SI. Core symptoms and fine motor function were assessed using the ABC, CABS, CARS, and PDMS-FM scales at both baseline and post-intervention, with the ABC scale serving as the primary outcome measure.</p> Results <p>In the randomized comparison, the experimental group showed superior outcomes to the control group post-intervention, with significantly greater reductions in ABC, CARS, and CABS scores and a greater increase in PDMS-FM score (all <i>P</i> &lt; 0.05).</p> Conclusions <p>The fine motor-oriented sports game intervention proved more effective than SI in ameliorating the core symptoms and improving fine motor function in children with ASD.</p> Trial registration <p>The study has been registered at ChiCTR.org (ChiCTR2400086052) on 2024-06-24.</p>