Early pretend play is linked to better mental health years later

A recent study suggests that toddlers who show stronger abilities in pretend play tend to experience fewer emotional and behavioral difficulties as they enter primary school. Published in the Early Childhood Education Journal, the research provides evidence that encouraging imaginative play early in life could support better long-term mental health. The findings highlight the potential benefits of simple childhood activities on psychological well-being.

The authors of the new study sought to explore the long-term mental health benefits of pretend play for children in the general population. Identifying mental health concerns in young children often relies on observing their behaviors during play, as their cognitive and social skills are still developing rapidly. Past research suggests that pretend play helps children express feelings and manage anxiety.

To build on these earlier findings, the authors wanted to see if the ability to engage in pretend play during toddlerhood predicts better mental health outcomes in later childhood. “The team wanted to focus on whether creative processes are important for mental health and wellbeing for young children,” said Fotini Vasilopoulos, a researcher at the Matilda Centre for Research in Mental Health and Substance Use and the CREATE Centre at the University of Sydney.

“Pretend play is the precursor to the performing arts and is also like ‘the secret language of a child’ so looking at pretend play was a natural fit,” Vasilopoulos said.

Longitudinal studies tracking these benefits over several years are uncommon. Most previous studies have either focused on small groups of children in laboratory settings or looked at short-term interventions. The researchers aimed to test whether emotional regulation explains the connection between play and mental health over time.

Emotional regulation refers to a child’s ability to manage and respond to their feelings in different situations. It is a foundational skill for good mental health that develops quickly during the preschool years. The scientists hypothesized that children who engage in complex pretend play might develop better emotional regulation, which would then lead to fewer behavioral problems.

To answer these questions, the authors analyzed data from a large ongoing project called the Longitudinal Study of Australian Children. They focused on a specific sample of 1,426 children who regularly attended daycare or a childminder. The researchers tracked these children across three different developmental stages at ages two to three, four to five, and six to seven.

At ages two to three, early childhood educators rated the children’s pretend play abilities. The educators answered three specific questions about how well each child engaged in imaginative activities. These activities included simple pretend play, like pretending to feed a stuffed animal or a doll.

The assessment also included substituting objects, such as using a towel as a blanket or turning a cardboard box into a house. Finally, the educators rated the children on peer pretend play. This involved using materials to role-play in costumes or playing house with other children.

The scientists accounted for several outside factors that might influence a child’s development. These factors included the family’s socioeconomic status, which combines income, education, and occupational standing. They also controlled for the mother’s mental health, the child’s vocabulary and grammar abilities, and the security of the child’s attachment to their parents.

To measure emotional regulation at ages four to five, parents completed a temperament survey. This survey assessed how easily their child became upset and how difficult they were to comfort. Higher scores on this scale indicated lower levels of emotional regulation, meaning the child was highly reactive to stress.

At ages four to five and six to seven, both educators and primary caregivers evaluated the children’s mental health. They used a widely recognized behavioral screening tool called the Strengths and Difficulties Questionnaire. Because children often act differently at home than they do at school, collecting data from both parents and teachers provided a more complete picture.

This questionnaire measures internalizing problems, which refer to inward-facing struggles such as anxiety, depression, and social withdrawal. It also measures externalizing problems, which are outward-facing issues like aggressive behavior, hyperactivity, and rule-breaking. Higher scores on these sections indicate greater mental health difficulties, while lower scores point to better psychological adjustment.

The researchers found that higher pretend play ability at ages two to three predicted fewer internalizing and externalizing problems at later ages. This positive association was observed primarily in the mental health evaluations provided by the early educators. The connection was noticeable when the children were aged four to five and persisted when they reached ages six to seven.

Primary caregivers also reported a small but significant link between early pretend play and fewer behavioral issues when the children reached ages six to seven. The fact that this relationship held true even after controlling for family background and language skills suggests that play has a unique role in development.

Vasilopoulos emphasized the primary takeaway for the public. “Pretend play is important for the wellbeing of young children,” Vasilopoulos told PsyPost. “Play for play sake (not with a learning goal in mind) is also important.”

Interestingly, the researchers found that emotional regulation did not act as a bridge between early pretend play and later mental health. The data provided no evidence that emotional regulation at ages four to five explained the positive outcomes seen at ages six to seven.

This specific finding was unexpected for the research team. Vasilopoulos noted that the team was surprised “[t]hat emotional regulation did not mediate the relationship between pretend play ability and mental health outcomes.”

Because emotional regulation was not the connecting factor, the authors suggest that other unknown developmental processes might be at work. They point to a concept called embodied cognition as a possible explanation. This theory suggests that thinking is deeply tied to the body’s physical movements and interactions with objects.

During pretend play, children use their motor skills to simulate actions, even if the objects are imaginary. These physical simulations support higher-level thinking goals like improvising, finding solutions, and solving problems. Previous brain imaging research suggests that these physical simulations activate specific motor regions in the brain. The scientists note that these same brain regions are thought to play a role in attention and anxiety disorders.

Readers should note that this study is observational, which means it cannot prove that pretend play directly causes better mental health. It only suggests a statistical association between the two factors.

“This study shows that there is a relationship between pretend play ability and mental health,” Vasilopoulos said. “The next step is to show this through a randomized control trial.”

One limitation of the research is that pretend play was measured using just three questions answered by educators. This brief method may not capture the full complexity of a child’s imaginative abilities.

The study also focused exclusively on children who were already enrolled in formal childcare programs. This requirement might exclude children from highly disadvantaged backgrounds whose families cannot afford regular daycare. As a result, the findings might not perfectly apply to every segment of the population.

Additionally, the researchers did not test whether the relationship works in the opposite direction. It remains possible that children with inherently better mental health and fewer behavioral problems simply choose to engage in more pretend play. Because the data relies on surveys and questionnaires, there is always room for different interpretations of a child’s behavior.

Future studies should use a wider variety of methods to measure pretend play. The authors suggest incorporating direct observations by researchers or using structured play tasks rather than relying solely on educator surveys. Scientists also recommend looking into contextual factors that might influence play, such as daily screen time limits and different types of educational settings.

The research team is already taking steps to build on these findings. “We have completed a pilot program supporting quality of pretend play in early childhood settings and understanding its effects on self-regulated agency and emotional and behavioral difficulties,” Vasilopoulos said. “We will be publishing the paper soon and we have identified preliminary signs of promise.”

The study, “Longitudinal Evidence of the Relationship Between Pretend Play and Mental Health in the Early Years,” was authored by 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.