Background: The Sally-Anne test has been extensively used to examine children’s theory of mind understanding. Many task-related factors have been suggested to impact children’s performance on this test. Yet little is known about the interactional aspects of such dyadic assessment situations that might contribute to the ways in which children respond to the test questions. Aims: To examine the interactional factors contributing to the performance of two children in the Sally-Anne test. To identify the interactional practices used by the tester administering the task and to describe how interactional features can pose challenges in the critical belief and reality questions for both the tester and the testee. Methods & Procedures: The Sally-Anne test was carried out as part of a project examining children’s interactions in a technology-enhanced environment. The present study uses video recordings of two children with communication disorders (one with a current diagnosis of autism spectrum disorder [ASD]) and an adult tester. We draw on a multimodal approach to conversation analysis (CA) to examine the sequential organization of the test questions and answers. Outcomes & Results: The children drew on diverse resources when producing responses to the test questions: responding verbally, pointing or manually handling objects. The tester treated these responses differently depending on how they were produced. When the child pointed at an object and verbally indicated their response, the tester moved on to the next question apparently accepting the child’s answer. When the child manually handled an object or produced a quiet verbal response, the tester repeated the question indicating that the child’s actions did not constitute an adequate response to a test question. In response to this, both children modified or changed their previous responses. Through monitoring each other, the tester and the child produced actions highly responsive to the features of each other’s conduct, which underpinned the conduct of the test itself. Conclusions & Implications: Children’s responses in the test might not be solely indicative of socio-cognitive capacities but also show orientation to interactional nuances. The study proposes that children can demonstrate diverse ways of responding to questions, yet testers may treat these as test-irrelevant behaviours if they do not correspond to the scoring criteria. A video-based CA study can broaden our understanding of children’s pragmatic competencies in responsiveness that may not always embody an expected form. This can have implications for the development of future assessment tasks and revision of existing scoring practices.