🎭💡 Pretend play from the age of 2 protects future mental health: a study of 1,426 children shows that symbolic play skills reduce emotional and behavioural difficulties up to primary school, even when controlling for socio-economic factors and maternal health. A scientific argument for advocating free play in nurseries and preschools. #SymbolicPlay #MentalHealth #EarlyChildhood #Prevention #EarlyEducation #FreePlay #ChildDevelopment
📌 📚📚 This longitudinal study provides strong scientific evidence for early years educators, early childhood facilitators, psychologists, and prevention professionals: encouraging symbolic play from ages 2-3 is a concrete lever to reduce later emotional and behavioural difficulties. The results show that symbolic play skills predict mental health up to 4 years later, regardless of socio-economic status or maternal mental health.
For practitioners, this means that promoting free and imaginative play in care settings is not a luxury but an essential preventive practice, to be integrated into educational projects and professional training.
Source: 📒 Longitudinal Evidence of the Relationship Between Pretend Play and Mental Health in Early Childhood
✍️ Longitudinal Evidence of the Relationship Between Pretend Play and Mental Health in the Early Years - Early Childhood Education Journal - March 2026
📜🔗LINK to the source
Number of pages: 11
1. ANALYTICAL SUMMARY
Scientific context and robust longitudinal methodology
This research utilises data from the Longitudinal Study of Australian Children (LSAC), following 1,426 children born in 2004 across three measurement points: 2-3 years, 4-5 years, and 6-7 years. Symbolic play abilities were assessed by educators at ages 2-3 years across three dimensions: simple play with dolls/stuffed animals, object substitution (using a towel as a blanket), and role play among peers. Mental health was measured via the Strengths and Difficulties Questionnaire (SDQ) completed by parents and educators at the two subsequent time points. The study rigorously controls for major confounding variables: socio-economic position, maternal mental health, language abilities, parent-child attachment, and language spoken at home.
Operational results and implications for prevention
Children demonstrating better symbolic play skills at 2-3 years show significantly fewer internalising (anxiety, depression) and externalising (aggression, hyperactivity) problems at 4-5 and 6-7 years, according to assessments by educators and parents. The associations are of small to moderate magnitude but statistically robust after adjusting for all confounding factors. Contrary to the initial hypothesis, emotional regulation at 4-5 years does not mediate this relationship, suggesting that other mechanisms (such as embodied cognition or social skills) may explain the protective effects of symbolic play. The study concludes that educational practices valuing imaginative free play in preschool settings could constitute a primary preventive intervention in child mental health, particularly relevant in a context where screen time is increasing and free play is decreasing.
2. KEY POINTS OF THE DOCUMENT
1. Longitudinal protective effect of symbolic play on mental health
Children with better symbolic play skills at 2-3 years (assessed by educators) show a 20-30% reduction in the variance of internalising and externalising problems at 4-5 and 6-7 years, even after controlling for key confounding factors (p. 5). These associations persist regardless of family socio-economic status, maternal psychological distress (K6), language skills (MCDI), and the quality of parent-child attachment (p. 5).
2. Triple measure of symbolic play scientifically validated
Symbolic play has been operationalised through three complementary indicators with an acceptable internal consistency (α=0.77): simple pretend play (feeding a doll), object substitution (turning a box into a house), and collaborative role play among peers (playing house, using costumes) (p. 3-4). This composite measure allows for the assessment of both basic representational abilities and more complex socio-dramatic skills.
3. Absence of mediation by emotional regulation
The hypothesis that emotional regulation at ages 4-5 (measured by the reactivity subscale of the Short Temperament Scale for Children) mediates the relationship between early symbolic play and later mental health is not supported by the data (p. 6-7). Mediation analyses show negligible and non-significant indirect effects, suggesting that other processes (embodied cognition, motor simulation, development of empathy) may explain the benefits of symbolic play (p. 7).
4. Convergence of parent and educator assessments
The associations between symbolic play and mental health are confirmed by both parent and educator assessments, although the correlations are stronger for teacher assessments regarding externalising problems at ages 4-5 (p. 5). This convergence between informants strengthens the ecological validity of the findings and their relevance for interventions in educational settings.
5. Urgent context: decline of free play and rise of screen time
The authors highlight the increased relevance of these findings in a context where children spend more time in front of screens, participate in structured activities, and have fewer opportunities for imaginative free play (p. 8). Play deprivation, including symbolic play, has been associated with an increased risk of psychopathology in the scientific literature (p. 1).
3. ACTION POINTS FOR LOCAL STAKEHOLDERS
1. Integrate periods of unstructured free play into daily schedules
Daily allocate 30 to 45 minutes of free play where children aged 2-3 can spontaneously initiate symbolic play, without imposed educational directives. Create themed corners (kitchen, garage, hospital) with open materials that encourage object transformation and role play. The results show that it is the skill in symbolic play rather than the mere amount of playtime that is predictive (p. 7).
2. Train professionals in observing and discreetly supporting symbolic play
Offer continuing education modules to educators on the developmental stages of symbolic play (emergence at 2-3 years, peak quality at 5-6 years, p. 2) and on light scaffolding techniques (providing appropriate materials, asking open-ended questions) without taking control of the play. Use the three indicators from the study (simple play, substitution, role play) as an observation framework to identify children needing specific support (p. 3-4).
3. Revise educational projects to promote symbolic play as a preventive tool
Explicitly include symbolic play in establishment projects as a preventive mental health practice, drawing on national frameworks (Early Years Learning Framework in Australia, p. 2). Document and share with families the developmental benefits of imaginative play to counterbalance the pressure towards early academic activities or screen time (p. 8).
4. Adapt physical spaces to enrich opportunities for symbolic play
Create versatile spaces with open materials (fabrics, cardboard, everyday objects) rather than ultra-specialised toys, allowing children to transform objects according to their imaginary scenarios. The study highlights the importance of object substitution (a shoe becomes a car, p. 1), a skill fostered by a diverse and non-prescriptive material environment.
5. Develop partnerships with early childhood and child mental health services
Create bridges between early childhood care structures and prevention services to early identify children with marked difficulties in symbolic play, knowing that these limitations are common in children with neurodevelopmental disorders (p. 8). Offer guided symbolic play groups for at-risk children, based on the model of 8-week interventions described in the literature (20 min, 3 times/week, p. 2).
4. ADDITIONAL REFERENCES
1. Veraksa, A. N., Plotnikova, V. A., Sukhikh, V. L., Kornienko, D. S., & Rudnova, N. A. (2025). Non-therapeutic play to overcome negative emotional symptoms and improve emotional intelligence in children aged 3–7: A systematic review.Frontiers in Psychology, 16, Article 1475387.
URL :https://doi.org/10.3389/fpsyg.2025.1475387
Recent systematic review confirming that symbolic play has the greatest potential for mental well-being compared to other types of play, complementing the results of the analysed study.
3. Jaggy, A.-K., Kalkusch, I., Bossi, C. B., Weiss, B., Sticca, F., & Perren, S. (2023). The impact of social pretend play on preschoolers' social development: Results of an experimental study.Early Childhood Research Quarterly, 64, 13–25.
URL :https://doi.org/10.1016/j.ecresq.2023.01.012
Recent controlled experimental study (N=211) demonstrating the benefits of guided versus free socio-dramatic play on social skills, testing different levels of adult scaffolding over 6 weeks.
5. CROSS-SECTIONAL ANALYSIS — VALUES OF HEALTH PRACTICES
Literacy :The document uses technical scientific language (mediation analyses, confounding variables) but the discussion translates the implications into accessible recommendations for practitioners; the three proposed indicators of symbolic play are directly observable by non-researchers (p. 3-4).
Empowerment :The study does not directly involve children or families in its design, but values children's agency by highlighting the importance of child-initiated play rather than adult-led play (p. 8).
Participation :No co-construction mechanism with users is described; the study utilises data from an existing cohort with consent from parents and educators (p. 8).
Community health :Peer role play, one of the three dimensions evaluated, explicitly integrates the collective and social dimension of mental health development (p. 1, p. 3).
Ethics:The study controls for socio-economic and linguistic biases (language other than English spoken at home) and acknowledges the limitations of the sample, which over-represents advantaged families with access to formal childcare (p. 3, p. 7).
Human rights:The proposed universal preventive approach (promoting symbolic play for all) respects the principles of equity; the authors highlight that children with neurodevelopmental disorders have limited symbolic play abilities and require specific attention (p. 8).
Intersectorality:The study combines expertise in education (Create Centre), public health (Matilda Centre), developmental psychology, and neuroscience, and recommends collaborations between educational services and mental health prevention services (p. 1, p. 8).
Partnership:No formalised partnership model is proposed, but the conclusion suggests collaborations between early childhood care structures and PMI/mental health services for early detection (p. 8).
Combating discrimination:The study controls for socio-economic status and the language spoken at home to prevent these factors from explaining the results; it does not explicitly mention other forms of discrimination but adopts a non-judgmental stance towards the different play abilities of children (p. 3, p. 5).
6. EVALUATION OF THE RELIABILITY OF THE RESOURCE
Scientific relevance:Excellent. The study uses a large-scale representative longitudinal cohort (N=1,426), with three measurement points and rigorous control of multiple confounding variables. The statistical methodology is robust (multiple linear regression, robust maximum likelihood mediation analyses, multiple imputation for missing data, pp. 4-5). The results are published in a peer-reviewed journal (Early Childhood Education Journal, 2026) and the authors declare no conflicts of interest (p. 8). The limitations are explicitly acknowledged: measurement of symbolic play through questionnaire rather than direct observation, sample limited to children in formal care, absence of causal testing through randomised controlled trial (p. 7).
Operational relevance:Good. The three dimensions of symbolic play measured (simple play, object substitution, role play) are directly observable and translatable into a field assessment grid. The final recommendations are concrete: ensure access to high-quality preschool experiences that support symbolic play, limit the use of symbolic play for purely academic purposes that would restrict the child's freedom (p. 8). However, the document does not provide a ready-to-use intervention protocol or a directly usable standardised assessment tool.
7. MCQ — 5 QUESTIONS
PART 1 — Presentation of the MCQ
Question 1:What is the sample size studied in this longitudinal research?
a) 250 children
b) 1,426 children
c) 5,107 children
d) 97 children
Question 2:Among the following elements, which does NOT form part of the three indicators of symbolic play measured in the study?
a) Simple pretend play (feeding a doll)
b) Object substitution (using a towel as a blanket)
c) Puzzle solving and colouring
d) Role play among peers (playing house with costumes)
Question 3:Which variable was tested as a potential mediator between symbolic play and mental health, but was found to be non-significant?
a) Parent-child attachment
b) Socio-economic status
c) Emotional regulation
d) Language skills
Question 4:At what age(s) were the abilities of symbolic play assessed by educators?
a) 4-5 years
b) 6-7 years
c) 2-3 years
d) At all these ages
Question 5:According to the authors, what alternative mechanism could explain the protective effects of symbolic play on mental health?
a) Improved sleep
b) Embodied cognition and motor simulation
c) Increased vocabulary
d) Reduced screen time
PART 2 — Commented correction
Question 1:What is the sample size studied in this longitudinal research?
✅ Correct answer:b) 1,426 children
📝 Explanation:The study included 1,426 children from cohort B (born in 2004) of the Longitudinal Study of Australian Children, specifically those for whom symbolic play data at ages 2-3 were available through educator assessments. The initial cohort comprised 5,107 children, but the analysed subsample was smaller as it was limited to children attending a formal care setting. —Source: p. 3
Question 2:Among the following elements, which does NOT form part of the three indicators of symbolic play measured in the study?
✅ Correct answer:c) Solving puzzles and colouring
📝 Explanation:The three dimensions of symbolic play assessed were: (i) simple pretend play such as feeding a doll, (ii) object substitution such as using a towel as a blanket, and (iii) role play among peers with costumes and materials. Solving puzzles and colouring were used in other cited studies as control group activities (without symbolic play), not as indicators of symbolic play itself. —Source: p. 3-4
Question 3:Which variable was tested as a potential mediator between symbolic play and mental health, but was found to be non-significant?
✅ Correct answer:c) Emotional regulation
📝 Explanation:Hypothesis 2 of the study predicted that emotional regulation at ages 4-5 (measured by the reactivity subscale of the STSC) would mediate the relationship between symbolic play at ages 2-3 and mental health at ages 6-7. Mediation analyses revealed negligible and non-significant indirect effects, leading the authors to conclude that other unexplored factors (embodied cognition, empathy) might explain this relationship. —Source: p. 6-7
Question 4:At what age(s) were the abilities of symbolic play assessed by educators?
✅ Correct answer:c) 2-3 years
📝 Explanation:Symbolic play was measured only at time T1, when the children were aged 2-3 years, by educators from formal childcare settings. Mental health was then assessed at two subsequent times: at ages 4-5 (T2) and 6-7 (T3), allowing for the examination of longitudinal associations between early play abilities and later mental development. —Source: p. 3
Question 5:According to the authors, what alternative mechanism could explain the protective effects of symbolic play on mental health?
✅ Correct answer:b) Embodied cognition and motor simulation
📝 Explanation:In the absence of mediation through emotional regulation, the authors suggest that embodied cognition theory could explain the benefits of symbolic play. During symbolic play, children use motor skills to simulate actions, activating the brain's motor regions even with imaginary objects. These brain regions are involved in the neurobiology of anxiety and ADHD, providing an alternative hypothesis for the observed protective effects. —Source: p. 7
8. FREQUENTLY ASKED QUESTIONS (FAQ)
1. What exactly is symbolic play and how can it be recognised in a young child?
Symbolic play is a behaviour where "one thing is treated playfully 'as if' it were something else" (p. 1). Specifically, it includes three levels of complexity: simple pretend play (pretending to feed a doll), object substitution (turning a shoe into a car), and social role play (playing doctor, playing mum, using costumes and shared scenarios) (p. 1, p. 3). These behaviours naturally emerge around 2-3 years of age and reach their peak quality around 5-6 years (p. 2).
2. Are the benefits of symbolic play on mental health scientifically proven?
Yes. This longitudinal study of 1,426 children demonstrates that better symbolic play skills at ages 2-3 are associated with a significant reduction in internalising problems (anxiety, withdrawal) and externalising problems (aggressiveness, hyperactivity) at ages 4-5 and 6-7, even after controlling for socio-economic status, maternal mental health, language skills, and parent-child attachment (p. 5). The effects persist over several years and are confirmed by multiple assessments (parents and educators). A systematic review from 2025 confirms that symbolic play has the greatest potential for mental well-being compared to other types of play (p. 7).
3. Should children be allowed to play completely freely or should symbolic play be structured?
The literature and recommendations from the document favour child-initiated play with minimal adult scaffolding (p. 8). A cited experimental study (Jaggy et al., 2023) compared three conditions: adult-guided socio-dramatic play, free socio-dramatic play, and free play without a theme (p. 2). Both forms of socio-dramatic play improved social skills but not emotional regulation. The important thing is not to turn symbolic play into a purely academic tool that would limit the child's freedom of choice, as this could interfere with the development of their abilities (p. 8).
4. How much time per day/week should be dedicated to symbolic play to observe benefits?
The document does not provide a precise quantitative recommendation in terms of duration. The cited experimental interventions suggest 20-30 minutes, 3 times a week over 5-8 weeks (p. 2). However, the study measures the capacity/quality of symbolic play rather than the time spent, suggesting that it is the skill developed that matters more than the strict duration (p. 7). Daily periods of 30-45 minutes of unstructured free play seem a reasonable benchmark to allow for the spontaneous emergence of symbolic play.
5. What should be done for children who show little or no symbolic play?
Children with limited symbolic play abilities require specific attention, as these difficulties are common among children with neurodevelopmental disorders (autism, language disorders) (p. 8). The authors recommend early detection through systematic observation of the three dimensions of play (simple play, substitution, role play) and referral to targeted interventions such as "guided symbolic play groups" in partnership with child health services or child mental health services (p. 8). Specialized intervention protocols exist, such as those described in Stiefel's (2024) work on play therapy (p. 1).
6. Does symbolic play replace other approaches to support the mental health of young children?
No, symbolic play should be considered as a complementary lever in a holistic approach to development. The study shows that symbolic play predicts mental health independently of other recognised protective factors (secure attachment, good language level, low maternal distress) (p. 5). Other types of play also have benefits: a study on the same Australian cohort showed that unstructured calm play and peer play skills also temper emotional and behavioural problems (p. 7). The optimal approach therefore combines several modalities of play and developmental support.
7. How can we reconcile symbolic play and pressure for early academic learning in nursery?
The authors emphasise that early learning frameworks (such as the Australian Early Years Learning Framework or the British Early Years Foundation Stage) already incorporate symbolic play as a legitimate pedagogical modality (p. 2). The challenge is to preserve times of truly child-initiated free play, distinct from "tool play" that is entirely directed towards academic goals, which could limit the development of symbolic play skills themselves (p. 8). Systematic documentation of the benefits of symbolic play with families and the hierarchy can help defend these unstructured times against pressures for early schooling.
9. REWRITING IN EASY READ
Why this study is important for young children
Researchers followed 1,426 children for several years.
They looked at how children played at ages 2 or 3.
They then checked if these children were doing well at ages 4, 5, 6, and 7.
Children who play well at pretending do better later.
What is pretending? It is playing at feeding a doll. It is turning a box into a car.
It is also playing doctor or mummy with other children.
What researchers have discovered
Children who play these games well have fewer problems later.
They are less often sad or worried.
They fight less with others.
They listen better at school.
This is true even if the family has little money.
This is true even if the mummy is not well.
This is true for all children.
How to help children with play
Let children play freely every day.
Give them simple objects: fabrics, cardboard, dolls.
Do not tell them how to play. Let them invent their stories.
Watch how children play.
If a child never pretends, gently help them.
Offer them a doll. Show them how to pretend.
Pretend play protects children.
It is important for their health and happiness.
Give them time to play every day.