Summary: Toddlers who show strong pretend-play skills are far less likely to have emotional or behavioural problems once they reach primary school. A major longitudinal study of more than 1,400 Australian children identified this link, suggesting that imaginative play in early childhood supports long-term mental wellbeing.
The research indicates that pretend play is more than simple recreation: it appears to be a core developmental activity that helps shape children’s emotional and behavioural resilience. These associations persisted even after taking into account family socioeconomic status, the mother’s mental health, children’s language ability, and the security of parent–child attachment.
Key Findings
- Predictive value: Better pretend play performance at ages two and three predicted fewer mental health difficulties between ages four and seven.
- Not explained by emotion regulation: The expected role of emotional regulation did not explain the association, pointing to alternate developmental mechanisms.
- Brain–body interaction: The authors suggest pretend play may recruit motor and sensorimotor brain systems (an idea linked to embodied cognition), which could influence attention and anxiety pathways.
- Contextual concern: The study highlights a rise in screen time and highly structured schedules that may reduce opportunities for child-led imaginative play.
Source: University of Sydney
Overview of the research
An interdisciplinary team at the University of Sydney, led by Dr Fotini (Fontini) Vasilopoulos from the Matilda Centre for Research in Mental Health and Substance Use and the CREATE Centre, analysed data from the Longitudinal Study of Australian Children. The sample included 1,426 children born in 2004. Early childhood educators rated the children’s pretend play ability over a two‑year period, and mental health outcomes were later assessed by parents and educators when children were aged four to five and again at six to seven.
After controlling for key background factors, higher pretend‑play ability in toddlers was linked with fewer internalising (for example, anxiety and withdrawal) and externalising (for example, aggression or oppositional behaviour) problems in the early school years. These results point to pretend play as a potentially useful early target for prevention efforts aimed at reducing childhood mental health difficulties.
What is pretend play and why it matters
Pretend play involves children enacting imagined scenarios—using an object to stand in for something else, role-playing caregiving or professions, or inventing make‑believe situations. Although often dismissed as entertainment, this study supports the view that pretend play helps shape cognitive and emotional development in ways that matter for later mental health.
Dr Vasilopoulos commented that differences in pretend play ability very early in life were associated with measurable differences in mental health several years later. Given that about one in seven Australian children experience mental health difficulties, focusing on the preschool years offers an opportunity for earlier prevention, before many children start formal schooling.
Mechanisms: emotion regulation and beyond
Contrary to common assumptions, the analysis found that emotional regulation did not mediate the relationship between early pretend play and later mental health outcomes. That is, the protective effect of pretend play remained even when emotion regulation was taken into account. The researchers therefore propose other mechanisms—such as embodied cognition, where motor and sensorimotor brain systems engaged during play influence attention and anxiety processes—may help explain the association.
Practical tips for supporting child-led pretend play
The research team emphasises child-led, low-intervention approaches that preserve the imaginative flow. Recommended strategies include:
- Let play run its course: Avoid turning play into an instructional moment. If a child mislabels a colour or number, prioritise keeping the play going over correcting details.
- Follow the child’s lead: When adults join in, wait for the child to initiate and respond rather than taking control. Gentle prompts are helpful if a child seems unsure where to start.
- Offer observations, not instructions: Make simple comments about the play or ask open questions that invite imagination, rather than directing the activity.
- Enter the play as a participant: Ask the child what role the adult should play, or volunteer a minor, supportive character (for example, a confused visitor), instead of directing the scene.
“Pretend play doesn’t need to be complicated or instructional,” the lead author noted. Gentle, child-led involvement can help strengthen the imaginative skills linked in this study to better mental health outcomes in early childhood.
Key Questions Answered:
A: Pretend play is when a child enacts imaginary situations—using a block as a phone, “feeding” a stuffed toy, or pretending to be a doctor. The defining element is assigning new meanings to objects and roles.
A: No. The study reports a correlation, not a certainty. Pretend play appears to be a skill that can be nurtured. Supportive, child-led play with an adult can help children who initially struggle with imagination.
A: The researchers advise against correcting details during play. Allowing children to assign meanings freely preserves the developmental value of the imaginative moment.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- The journal paper was reviewed in full by the editorial team.
- Additional contextual information was added by staff.
About this research and authorship
Author: Emily Fraser
Source: University of Sydney
Contact: Emily Fraser – University of Sydney
Image: Image credit to Neuroscience News
Original research (open access): Longitudinal Evidence of the Relationship Between Pretend Play and Mental Health in the Early Years — Fotini Vasilopoulos, Lucinda Grummitt, Sasha Bailey, Louise Birrell, Iroise Dumontheil, Gill Francis, Eliza Oliver, Olivia Karaolis, Robyn Ewing, Michael Anderson, Maree Teesson & Emma L. Barrett. Published in Early Childhood Education Journal.
Abstract
Longitudinal Evidence of the Relationship Between Pretend Play and Mental Health in the Early Years
Previous work suggests pretend play can help children manage anxiety, but few large longitudinal studies have examined pretend play’s effects on population-level mental health outcomes. Using data from the Longitudinal Study of Australian Children (N = 1,426), this study investigated associations between pretend play at ages two to three and mental health at ages four to five and six to seven. Mental health was measured using the Strengths and Difficulties Questionnaire completed by primary caregivers and educators. Higher pretend play ability at age two to three was associated with fewer internalising and externalising problems later on, even after controlling for attachment to the main carer and other known predictors. Emotional regulation did not significantly mediate the relationship, indicating other mechanisms may be at work. The findings imply that pedagogical practices and high-quality preschool experiences that foster pretend play could help reduce mental health difficulties as children enter primary school.