Mental Flexibility: What are some examples, and what exercises can be done to develop it?

The ability to understand that other people have thoughts, desires, beliefs and intentions that differ from one’s own is one of the most sophisticated cognitive skills in human beings. This capacity, known as Theory of Mind (ToM), forms the foundation of social life and interpersonal communication. 

Since the 1980s, research in this area has profoundly shaped the field of developmental neuropsychology and has opened up new avenues for understanding Autism Spectrum Disorder (ASD).

In this article, we explore what Theory of Mind is, how it develops, how it is assessed, its relationship to ASD, and activities that can support its development in both children and adults.

What is Theory of Mind, and how does it develop?

The term “Theory of Mind” was first introduced in 1978 by David Premack and Guy Woodruff in a study examining chimpanzees’ ability to attribute intentions and beliefs to others. In this experiment, chimpanzees observed scenarios in which a human faced a problem and were required to select, from several options, the one that correctly resolved it. This design made it possible to assess whether the chimpanzees understood the human’s intentions. However, the interpretation of these findings has been widely debated: Some researchers argue that the chimpanzees’ performance may be better explained by associative learning – that is, learning to link specific situations with correct responses based on prior experience, rather than by a genuine capacity to understand others’ mental states. From this perspective, such abilities may reflect more basic forms of ToM, comparable to the early precursors observed in the initial stages of human development.

This ability is not present at birth; rather, it develops progressively throughout childhood, particularly through interaction with others. Researchers have identified different levels or stages in its acquisition:

• At the most basic level (zero-order), the child does not yet understand their own desires or beliefs, and their experience is closely tied to the here and now. Nevertheless, from the outset, the child communicates with their environment through expressions, gestures, and emotions, eliciting responses from the adults around them. These early interactions lay the foundations for the later development of an understanding of mental states.
• From 18 to 24 months, early precursors of ToM begin to emerge, such as joint attention, symbolic play, and proto-declarative pointing. 
• Between the ages of 3 and 4, most children begin to understand that another person may hold an incorrect belief about reality. For example, if someone leaves an object in one place and, in their absence, it is moved elsewhere, the child understands that the person will continue to believe the object is where they originally left it. This ability is known as first-order false belief and is considered a central milestone in the development of ToM.
• Between the ages of 6 and 7, children consolidate second-order beliefs, meaning they can understand what one person believes about what a third person is thinking.
• More complex ToM abilities, such as understanding irony, sarcasm, white lies, or implicit communicative intentions, are acquired progressively throughout late childhood and adolescence. 

Thanks to ToM, we can adapt our behaviour to the social context, anticipate others’ reactions, detect deception, and build meaningful interpersonal relationships. 

From a neuropsychological perspective, the origins of Theory of Mind have traditionally been explained through two main approaches: the modular approach, which proposes a specific innate basis (as suggested by Alan Leslie), and the constructivist approach, which considers this ability to develop through social interaction. Current evidence supports an integrative view, whereby Theory of Mind arises from the interaction between both factors: the child is born with a potential that develops progressively in relation to their social environment.

Assessment of Theory of Mind in Neuropsychology

The neuropsychological assessment of ToM has been an area of intensive research since the 1980s, when Baron-Cohen, Leslie and Frith (1985) developed the well-known Sally–Anne test, based on the false belief paradigm originally proposed by Wimmer and Perner (1983). 

This task involves presenting the participant with a story in which one character, Sally, places a ball in a basket and then leaves. In her absence, another character, Anne, moves the ball to a box. When Sally returns, the participant is asked: Where will Sally look for her ball? Typically developing four-year-old children answer correctly by indicating the basket (where Sally originally left it), demonstrating their ability to attribute a false belief to the character. In contrast, the majority of autistic children studied by Baron-Cohen et al. (1985) failed this task, instead indicating the box where the ball was actually located.

However, classical first- and second-order false belief tasks present notable limitations: They rely heavily on language and broader cognitive abilities, which makes them less suitable for a significant proportion of autistic individuals. Furthermore, most six-year-old children with typical cognitive development complete these tasks without difficulty, and some autistic adults are also able to pass them when they have an average intellectual quotient. 

This led Baron-Cohen and his collaborators to develop assessment tools that are less dependent on language and intellectual level. Among these, the Reading the Mind in the Eyes Test, developed in 1997, is particularly notable. This task involves presenting photographs of the eye region of different individuals and asking the participant to identify the emotion or mental state conveyed by the gaze. 

Other instruments commonly used in the neuropsychological assessment of Theory of Mind include:

• Happé’s Strange Stories, which present scenarios in which a character makes ironic, sarcastic, or implicitly meaningful remarks that the participant must interpret. 
• The Faux Pas Test, developed by Baron-Cohen et al. (1999), which requires the participant to identify a socially inappropriate or tactless comment within a given situation, for example, accidentally revealing a surprise party. 
• The Theory of Mind Battery (ToM-TB), which comprises multiple tasks of increasing complexity, organised into subscales that assess different levels of mentalising ability. 
• The Hinting Task, which presents short stories containing implicit messages that must be inferred without relying on irony or sarcasm, but rather through inference.

In current clinical practice, these specific measures can also be complemented by broader Neuropsychological Test batteries, such as the NEPSY-II, which provide a more comprehensive view of cognitive functioning and allow Theory of Mind findings to be interpreted within the individual’s overall cognitive profile.

It is important to note that the assessment of ToM is not limited to individuals with autism or a suspected diagnosis of autism. Recent research indicates that other neurodevelopmental conditions, such as Tourette syndrome and childhood-onset obsessive–compulsive disorder, as well as conditions including schizophrenia, personality disorders, and neurodegenerative diseases, may also involve differences in ToM abilities. This highlights the importance of assessing ToM as part of a comprehensive neuropsychological evaluation, beyond its relevance to ASD alone.

Relationship between Theory of Mind and autism (ASD)

The link between ToM and Autism Spectrum Disorder has been a central focus of developmental neuropsychology over the past four decades. Baron-Cohen, Leslie and Frith (1985) were the first to systematically propose that the social and communicative difficulties characteristic of autism could be explained, at least in part, by a specific impairment in the ability to attribute mental states to oneself and to others. This hypothesis, known as the “mindblindness” hypothesis, had a transformative impact on both the clinical and research understanding of autism.

However, this view has been increasingly refined in recent years. Current evidence shows that not all individuals with Autism Spectrum Disorder (ASD) present ToM difficulties, and that individuals without ASD or with other clinical profiles may also demonstrate lower performance on these tasks. In other words, difficulties in Theory of Mind are neither exclusive to nor, in themselves, definitive of autism, and they do not fully account for the complexity of social difficulties.

As a result, recent research has emphasised the need to consider additional factors. In particular, the double empathy theory, proposed by Damian Milton, has gained prominence. This suggests that difficulties in mutual understanding are not unidirectional but bidirectional: not only may autistic individuals experience challenges in interpreting neurotypical individuals, but the reverse can also occur. From this perspective, difficulties in Theory of Mind do not reside solely within the individual but emerge through interaction between people who process and understand the world in different ways.

This shift in perspective does not imply that ToM is no longer clinically relevant or that it should not be assessed in depth. Its evaluation remains essential, but it must always be interpreted within context. It is not enough to just measure the ability to infer mental states in isolation; it is also necessary to consider the environments in which the individual develops, the support they receive, and the nature of their everyday interactions. 

From a neuropsychological standpoint, several complementary explanatory models have also been proposed to better understand ASD. ToM provides a cognitive account of social and communicative difficulties. Executive function theory, in turn, suggests that many characteristics of ASD, such as rigidity, repetitive behaviours, and difficulties with planning and adapting to change, may be explained by differences in executive functioning, including planning, cognitive flexibility, inhibition, and working memory. The weak central coherence theory, developed by Uta Frith, proposes that autistic individuals tend to process information in a detail-focused and fragmented manner, with difficulty integrating it into a coherent whole. These three models are not mutually exclusive; rather, they complement one another in providing a more comprehensive understanding of ASD.

Activities to support Theory of Mind in children and adults

Given that autistic individuals can develop mentalising abilities when provided with appropriate support, the systematic development of ToM should form a core component of any neuropsychological or educational intervention plan. Available empirical evidence suggests that, although generalization to everyday situations may be limited, targeted interventions lead to meaningful improvements in emotional recognition, understanding of intentions, and social skills. The following section outlines the main activities and strategies commonly used with both children and adults.

It is important to emphasize that this work should not focus solely on the individual with ASD, but also on their wider environment. The involvement of family, school, and peer groups is essential, as is the practice and generalization of these skills in real-life, everyday situations beyond the therapeutic context.

1. Working on sensory experience and visual perspective

One of the foundations of mentalizing work is understanding that people only know what they have seen or heard. Through exercises involving the five senses and everyday situations, the relationships between “seeing” and “knowing”, and between “hearing” and “knowing”, are explored. For example, the child or adult may be asked to close their eyes while a change is made in the environment, helping them recognise that they do not know what has happened because they did not see it.

2. Recognition of emotions

The recognition of simple emotional states, such as happiness, sadness, fear, and anger, as well as more complex emotions, including embarrassment, guilt, surprise, boredom, and apology, is a key step. This is typically supported through the use of facial expression images, videos of real-life situations, and activities that link emotions to everyday contexts. 

3. Adapted false belief tasks

False-belief tasks can be adapted for therapeutic use. One common activity involves presenting a closed box containing a hidden object, asking the child what they think is inside, then revealing the actual contents. The child is subsequently asked what another person, who has not seen inside the box, would think is inside when shown the closed box. This activity directly supports the understanding that others may hold mental representations that differ from one’s own.

4. Role play and social stories

Role play is one of the most effective tools for developing ToM. Through simulated social situations, the individual can practise interpreting others’ mental states within a structured and supportive environment. 

5. Use of digital resources and specialised materials

A range of resources has been specifically developed to support ToM in autistic individuals. These are particularly valuable for use at home and for promoting the generalisation of skills within the family environment.

In this context, the development of inclusive technologies has represented a significant advance, enabling the creation of digital tools tailored to different cognitive profiles and specific needs. These technologies support the personalisation of activities, the use of visual aids, and the development of more accessible and engaging environments, thereby enhancing both learning and the transfer of mentalising skills to everyday life.

References

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• Baron-Cohen, S. (1995). Mindblindness: An essay on autism and theory of mind. MIT Press.
• Baron-Cohen, S., O’Riordan, M., Jones, R., Stone, V., & Plaisted, K. (1999). Recognition of faux pas by normally developing children and children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders, 29(5), 407–418.
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