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Single Assessment to Capture Children's Cognitive and Social Flexibility Measures Flexible Thinking

"˜Flexibility Scale' assesses the link between cognitive skills and social function in children with autism and other disorders

WASHINGTON — Researchers from Children’s National Health System and Children’s Hospital of Philadelphia have developed a new measure of children’s flexible thinking, the Flexibility Scale. This tool is the first to provide a measurement that captures links between cognitive skills and social functioning in children and directly addresses social flexibility, which is fundamental to a child’s ability to make friends and be successful in school. The study to develop and validate the Flexibility Scale appears in the Journal of Autism and Developmental Disorders.

“A primary goal of this study was to better understand the different dimensions of children’s flexible thinking,” says John Strang, Psy.D, lead author and a neuropsychologist in the Center for Autism Spectrum Disorders at Children’s National. “The scale revealed several key characteristics of flexibility, including a child’s focus on routines, ability to manage change, strong interest in specific topics or activities, and capacity for social or interpersonal flexibility.

Tested in 177 youth with autism spectrum disorders and 57 without, the 27-item parent report questionnaire assesses a child’s flexible and inflexible everyday behaviors, highlighting problematic as well as adaptive and beneficial qualities of less flexible thinking across five categories captured through a range of questions based on daily activities:

  • Routines/rituals, including the need to perform activities in a particular order 
  • Transitions/changes, including the ability to manage a change of routine 
  • Special interests, such as routinely pretending to be the same character
  • Social flexibility, including ability to take turns 
  • Generativity, such as the ability to generate new ideas or brainstorm

“As scientists and clinicians, our primary goal is to provide the best assessments and treatments for children with autism,” says Benjamin Yerys, Ph.D., a clinical psychologist and researcher at the Children’s Hospital of Philadelphia’s Center for Autism Research, who contributed to the study. “ Until now, our ability to capture both the strengths and problems related to being inflexible has been limited. This study is the first step in creating a questionnaire that can help clinicians assess where children’s inflexibility is impairing their daily lives, and it could potentially be used to measure treatment progress.”

The link between cognitive flexibility and social function is particularly relevant for childhood social disorders such as autism, and contributes to the growing evidence base for critical connections between flexible thinking and social functioning.

“It is important to look at these skills specifically in children with autism because autistic youth are typically less flexible in their thinking, and we know that this inflexibility often occurs alongside a diminished ability to function socially,” says Lauren Kenworthy, Ph.D., Director of the Center for Autism Spectrum Disorders and the study’s senior author. “This new scale captures both, presenting a more comprehensive assessment of each child’s executive function abilities and allowing us to better map a therapy and intervention program that will truly improve a child’s daily living.” The Flexibility Scale was validated with existing childhood behavioral measures, including lab-based performance tasks of flexible thinking completed by the child. The measure is in the public domain and available upon request. 

The Center for Autism Spectrum Disorders at Children’s National
The Center for Autism Spectrum Disorders (CASD) at Children’s National is a multidisciplinary team comprised of pediatric autism specialists including clinical psychologists, neuropsychologists, child and adolescent psychiatrists, developmental pediatricians and speech/language pathologists. These experts not only provide the best possible care, but are also leading research to learn more about autism and potential treatments. 

About Children’s National Health System
Children’s National Health System, based in Washington, DC, has been serving the nation’s children since 1870. Children’s National is ranked in the top 20 in every specialty evaluated by U.S. News & World Report; one of only four children’s hospitals in the nation to earn this distinction. Designated a Leapfrog Group Top Hospital and a two-time recipient of Magnet® status, this pediatric academic health system offers expert care through a convenient, community-based primary care network and specialty outpatient centers. Home to the Children’s Research Institute and the Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National is one of the nation’s top NIH-funded pediatric institutions. Children’s National is recognized for its expertise and innovation in pediatric care and as a strong voice for children through advocacy at the local, regional and national levels. For more information, visit, or follow us on Facebook and Twitter.

About Children’s Hospital of Philadelphia
Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children’s Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 546-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit

Strang, J.F., Anthony, L.G., Hardy, K.K., Yerys, B.E., Wallace, G.L., Armour, A.C., Dudley, K., & Kenworthy, L. (2017). The Flexibility Scale: Development and preliminary validation of a cognitive flexibility measure in children with autism spectrum disorders. Journal of Autism and Developmental Disorders.

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