Children who demonstrate pretend play ability as toddlers have significantly fewer emotional and behavioural difficulties at primary school, according to a new interdisciplinary University of Sydney study.
Published in Early Childhood Education Journal , the study found stronger pretend play ability among two and three-year olds was associated with fewer emotional and behavioural difficulties at later ages. The findings held after accounting for participants’ family’s socioeconomic position, mother’s mental health, language ability and the security of their relationship with their parents.
Led by Dr Fontini Vasilopoulos from the Matilda Centre for Research in Mental Health and Substance Use and the CREATE CENTRE , the researchers analysed data from more than 1400 Australian children taking part in the Longitudinal Study of Australian Children . Their pretend play ability was assessed by early childhood educators over a two-year period. Mental health outcomes were measured using parent and educator reports, submitted when participants were aged between four and five and again between the ages of six and seven.
Pretend play in early childhood linked to better mental health
In pretend play, children act out imaginary situations. Often viewed as purely recreational, the findings suggest it may play a more important role in children’s mental health development than previously recognised.
“We found that differences in pretend play ability very early in life were linked to differences in mental health outcomes several years later,” said Dr Vasilopoulos.
Mental health difficulties affect around one in seven Australian children, yet prevention efforts tend to focus on later childhood or adolescence. This study shifts attention to the earliest years of life, when foundational developmental skills emerge rapidly and before many children begin formal schooling.
Why early pretend play matters for families and schools
Unlike previous studies, the research was based on a large, population-based Australian sample, increasing its relevance for Australian families, educators and policymakers.
The findings come as opportunities for imaginative play are increasingly crowded out.
“These findings are especially relevant today, when many children spend more time on screens, take part in more structured activities, and have fewer opportunities for free, imaginative play,” said Dr Vasilopoulos.
“Pretend play can be easy to overlook, yet it plays an important role in supporting children’s mental health.”
Emotional regulation does not explain link
The researchers found emotional regulation did not explain the relationship between early pretend play ability and later mental health, challenging common assumptions about how play supports wellbeing.
“Emotional regulation – the ability to manage and respond to emotions – is often assumed to explain how early play influences later mental health, but that isn’t what we found,” said Dr Vasilopoulos. “When emotional regulation was taken into account, the association did not hold, suggesting other, less understood developmental processes may be involved.”
The researchers point to ‘embodied cognition’ as a possible explanation calling for further investigation. During pretend play, children possibly engage motor brain regions thought to play a role in attention and anxiety. This possible connection highlights how much remains unknown about how pretend play influences mental health.
Tips for encouraging child-led pretend play
The researchers emphasise the importance of child-led pretend play, and suggest adults can support it by:
“Pretend play doesn’t need to be complicated or instructional,” said Dr Vasilopoulos. “Using this kind of gentle, child‑led involvement may be one practical way to build the pretend play abilities our research links to better mental health outcomes later in childhood.”
-ENDS-
Early Childhood Education Journal
Meta-analysis
People
Longitudinal Evidence of the Relationship Between Pretend Play and Mental Health in the Early Years
27-Mar-2026
This study is funded by the Serpentine Foundation and the National Health and Medical Research Council (NHMRC). The authors declare no competing interests.