Training Transfer Between False-belief, Card Sorting and Counterfactual Reasoning in Children with ASD.

Dublin Core


Training Transfer Between False-belief, Card Sorting and Counterfactual Reasoning in Children with ASD.


Amna Ahmed




Previous training studies for typically developed (TD) children and children with Autism Spectrum Disorder (ASD) show that theory of mind and executive functions are two interrelated domains, and that training in one task could lead to improvement on the other. This training study aimed to examine the developmental relationship between three domains (Theory of Mind (ToM), Executive Functions (EF) and Counterfactual Reasoning (CR)) in children with ASD. A group of 30 children diagnosed with ASD were randomly allocated to one of three training groups, each group received training in one of the three domains stated. After training, the entire sample was tested to measure for improvements. Results indicate that ToM training leads to improvement on the EF and CR tasks, while EF training did not lead to ToM improvement and CR training did not lead to EF improvement. Findings are discussed and a novel cognitive model is proposed to account for the observed outcomes.


ASD, Training study
Domain general
Theory of Mind
Counterfactual reasoning
Executive Functions


Following the design of Kloo and Perner (2003), first children were pretested. The pretest involved measures of verbal and nonverbal ability, two false-belief tasks followed by a card sorting task and two counter-factual reasoning tasks. The pretest was scored to create a baseline for the participants' abilities in each of the areas assigned to the training groups. Children were then randomly assigned to one of three experimental training groups. Each group was given two sessions of training (approximately 1 week apart) on one of the three areas; false belief, counterfactual reasoning or DCCS. A posttest was given a week after the second training session, it was similar to the pretest in design but different materials were used. The posttest was given to the children to measure any improvements in performance after training and examine any crossover effects between the different training groups. Finally, the children were given a follow-up test (approximately 6 weeks after the posttest) to investigate if the effects of training are lasting. All of the sessions took place in a quiet room in the child's school.

Procedure and Materials
Pretest and posttest. Both sessions that preceded and followed the training sessions involved tasks measuring performance in false belief, counter-factual reasoning and card sorting.
False-belief. One of two traditional unexpected transfer tasks was administered on the pretest based on Wimmer and Perner (1983), modeled after Baron-Cohen et al.’s Sally-Anne task (1985). A scene was enacted to the child using wooden toy figures and a kitchen model in which an item is unexpectedly transferred during the protagonist's absence. The stories where altered slightly to be more fitting to the knowledge of a Bahraini child by changing character names and making other alternations where appropriate. However, the main consciences of the stories remained very similar to the original stories. After the story is told, the character returns to the scene and the child is then asked a false-belief test question such as 'where do you think Ahmed will look for his teddy bear now?' followed by two control questions (memory and reality). One of the two stories was administered in the pre-test and the other in the post-test.
The false-belief pretest and posttest also included an unexpected content task, another task modeled by Wimmer and Perner (1983) as a measure of false-belief. In this task the child was presented with a closed familiar container (such as a Band-Aid box) and then the child was asked to guess the content of the box. The item in the box was then revealed to the child (a coin, for example). Next the item was placed in the closed box again and the child was asked 'what did you think was in the box before I opened it?' The correct answer should be Band-Aids, but most children with ASD find difficulty in suppressing the reality of what they know to be in the box so the answer they give is ‘a coin’. The child was then asked about another person’s state of mind 'what will (name another child) think is inside the box?’ Finally, the child was asked a memory control question 'what is really in the box?'

Card Sorting. Following the false-belief task, the child was presented with a dimensional change card sorting task (DCCS; Frye et al., 1995). One set of cards (5cm x 10cm) was used as well as two target cards (a blue house and an orange car) to be placed on two sorting boxes (12cm x 16cm). The card set had 12 testing cards (6 orange houses and 6 blue cars). The task involved two phases, in the pre-switch phase the participant was asked to sort the cards according to shape. After completing six trails successfully, the examiner explained to the child that now the rules of the game will change and the child was asked to sort the cards according to colour rather than shape in the post-switch phase.
Counterfactual Reasoning. Lastly, the pretest and posttest sessions included two counterfactual thinking tasks based on Beck et al. (2011). One of the tasks in each session was enacted using wooden figures and materials such as doll sized bed, cabin, teddy bears or pets. The second task was presented using a picture story consisting of three panels illustrating the events of the story. In these stories, both enacted and illustrated, a series of events lead to a specific end state. For example, the character picks flowers from the garden and places them in a vase on the table. Then the child is asked 'if Zainab had not picked the flowers where would they be’? Two control questions (memory and reality) followed. Similarly to the false-belief task, some alterations where made to the stories where appropriate to accommodate the child's environment and imagination. The use of two different methods of delivery for the counter-factuality task was introduced to create more variation in the understanding of counterfactual reasoning and to distinguish this task from the false-belief task.
Following the pretest, the participants were assigned to three experimental groups each receiving two training sessions in one of the three areas; false-belief, counterfactual reasoning and DCCS. The aim of the training is to provide the children with explanations and feedback based on performance.
False-belief training group. In each of the training sessions, the false belief group received two of four Ernie-says-something-wrong tasks (renamed to Ali-says-something-wrong) (Hale & Tager-Flusberg, 2003), one unexpected transfer task different from the tasks administered during the pre and post-test sessions, and finally one unexpected content task.
Ali-says-something-wrong. As in the original Kloo and Perner (2003), the task was presented with the aid of three puppets. In each of the stories Ali carried an action towards one of the puppets but then stated that he did it to another puppet. In each training session the child received two of the four original stories followed by a question about the content of Ali's statement and about the conflicting reality. The other two stories where then administered in the following session.
Unexpected transfer. The training sessions also included one story about an item being unexpectedly transferred in the protagonist's absence following Baron-cohen et al. (1985). The stories was enacted using wooden dolls and doll house furniture. This training task aimed to teach children about the main aspects of an unexpected transfer and to gradually guide them towards considering the character's false belief (Kloo and Perner, 2003).
Unexpected content. This task is presented using a different box and content for each test and training session. Examples of the materials used are a smarties tube, a pringles box, a crayons card box. The training of this task aimed to help the child understand his own false-belief as well as others’ state of mind.

DCCS training group. The card sorting group was given training in two DCCS tasks in each of the training sessions. Both tasks involved sorting according to colour and number, and the switch was always from colour to number. The two tasks administered were the three dimension switch and the transfer sorting task.
Three dimension switch. In this card sorting task, the participant was presented with two target cards (one yellow house and two green houses) placed on a sorting box. The test cards were similar to the target cards on one dimension; either colour or number (two yellow houses, one green house). The child had to sort by colour, then number, then by colour again and finally by number one last time. Two sets of cards were used, one for each training session. The experimenter helped the child identify each dimension after each switch was made and the rules of the game were covered again. Each switch involved six trials.
Transfer sorting task. Here, the target cards remained the same as the previous task (one yellow house and two green houses) but a new test card that is only similar to the target cards on one dimension (two yellow cars) was introduced. The test cards was supposed to be sorted according to the dimension stated by the experimenter, starting with colour then switching to number.

Counterfactual reasoning training group. Counter-factual reasoning tasks and false-belief tasks are interchangeable in some studies by asking questions testing both skills following a single story. However, in this study, the training groups had to receive different stories, followed by questions that only tap on counterfactual thinking in order to distinguish it from false-belief training. The purpose of this divide in training is to ensure that each experimental group receives training that does not overlap with the other groups' as the study aims to ultimately measure the crossover effects. The CR group received two tasks in each training session. Like the pretest and posttest, one of the tasks was enacted using figures and the other was presented as a picture story. The stories are based on Beck et al. (2011) and Guajardo and Turley-Ames (2004).
Figure stories. Following Guajardo and Turley-Ames' (2004) counterfactual thinking tasks, the children were shown a story, presented using wooden dolls, in which an event occurs (usually as a consequence of an action taken by the protagonist) and the child was asked to generate alternative scenarios that would have prevented the occurrence of that event. For example, the character is drawing a picture using pencil colours when the colour breaks and a result he cannot finish his drawing. The question following this story is 'what could the character have done so that he would have drawn the rest of the picture?' and the child is to give as many responses as he/she can generate. Other scenarios include avoiding breaking a glass, keeping their clothes clean, taking a nap leading them to miss their favorite show, and someone eating the character's last chocolate bar. In the training sessions, the examiner walks the child through the logic of having different actions leading to alternative endings.
Picture stories. The second task in the counter-factual training involved a single picture story based on Beck et al (2011). The images were digitally drawen using Adobe Illustrator and the stories showed a sequence of three square panels. However, the question format following the stories differed from the task given using figures. In the picture stories task, the child is presented with a simple story of consequential events followed by a question about where someone or something would have been if a certain event had not occurred. For example, one of the stories showed a cat napping on top of a car, the cat then spies a bird flying by and chases the bird all the way to the traffic light. The question associated with this story is 'if the cat had not spied the bird, where would the cat be?' Similar illustrations include a man receiving a call to meet a friend, a girl picking flowers, a drawing flying out of an open window and a man who gets sand on his shoes. The training aims to allow the child some insight on how an occurrence could alter the course of events resulting in certain outcomes, and thus if the occurrence had not taken place we would be presented with a counterfactual state.

Follow-up test. The follow up test was added to the experiment to measure whether children with ASD maintained any effects gained from the training past the posttest. Therefore, this test was similar to the pretest and posttest in design; it included a false belief task, a card sorting task and two counter-factuality tasks. However, the materials and stories used were all different from those used previously in the tests and training. The follow-up test took place 6 weeks after the post-test session.


Lancaster University






John Towse













Charlie Lewis

Project Level



Developmental Psychology

Sample Size

Participants were 30 children with ASD (2 girls, 28 boys; M age = 6,5 years, SD = 24 months). Children, recruited from special education schools in Bahrain, received a diagnosis of ASD by a team of qualified educational psychologists either based on DSM-IV or CARS II and OWL

Statistical Analysis Type

mixed effects analysis




Amna Ahmed, “Training Transfer Between False-belief, Card Sorting and Counterfactual Reasoning in Children with ASD.,” LUSTRE, accessed April 19, 2024,