Brain injury - Flexible thinking skills

  • Flexible thinking skills help us to adjust to changes in routine, expectations and to shift our thinking from one topic to another. These skills can be affected following a brain injury.

    What do flexible thinking problems look like?

    The following list outlines some of the things that could indicate problems in this area if they happen on a daily basis:

    • sticking too strictly to a routine and/or getting upset when that routine is changed
    • not being able to see the point of view of others or accept when somebody wants to do something differently
    • getting 'stuck' on particular activities, ideas or topics of conversation, repeating themselves - this is sometimes called 'perseveration'

    What strategies might help?

    • Avoid sudden changes in routine as much as possible. Provide lots of forewarning and explanation.
    • Provide forewarning in a number of ways to reinforce the message. For example, tell the child verbally and also post a sign next to their timetable or write it in their diary in the days leading up to the change.
    • Move the child on by distracting them from the topic or activity they are stuck on.
    • If the child does not shift, ask relevant questions or remind them they are being repetitive.
    • Provide clear, calm feedback that they have 'said or done that before'. Then ignore further repetitions so as not to reinforce the behaviour.
    • Try not to become angry. The child/young person is not being difficult on purpose.
    • Provide opportunities for them to improve their judgment and understanding of others by role playing and having detailed discussions about certain situations.
    • Encourage the child to imagine how they would feel in other situations.

    When to see a doctor

    Difficulties with flexible thinking skills, as well as other cognitive difficulties, are formally identified by a neuropsychological assessment. A neuropsychologist can help devise strategies that are suitable for each individual child and their particular issues.

    Key points to remember

    • Flexible thinking skills help people to adjust to changes in routine and expectations and to shift their thinking from one topic to another.
    • Flexible thinking skills can be affected following a brain injury.

    For more information


    Developed by The Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

    Reviewed September 2020.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit


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