Pretend Play and Executive Function in Preschool-Aged Children with an Acquired Brain Injury

Oct 15, 2026

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The study compares pretend play and executive function in preschool children with acquired brain injury (ABI) and in neurotypical peers. Findings show that producing logical, sequenced pretend-play actions and object substitutions in play correlates strongly with executive function in both groups, while working memory is the most reliable predictor of pretend play. The results support incorporating pretend play into rehabilitation to develop executive function for all children.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages34

Reading Time1 h 26 min

AccessFree to download

Background

Acquired Brain Injury

Pretend Play

Pretend Play and Executive Function in Preschool-Aged Children with an Acquired Brain Injury • Adrienne Thorne, Karen Stagnitti, and Judi Parson The authors compare pretend play and executive function both in preschool children with an acquired brain injury and in neurotypical preschool children. They find the ability to produce logical, sequenced pretend play actions and object substitutions in play correlates strongly with executive function ability in both groups, and working memory emerges in their study as the most reliable predictor of pretend play in both groups of children. Their investigation highlights the need to include pretend play in rehabilitating children with brain injuries and the importance of pretend play for developing executive function in all children. Key words: acquired brain injury; executive function; pretend play; rehabilitation for children. Background Kids Rehab at The Children’s Hospital at Westmead is the largest pediatric multi-disciplinary rehabilitation team in Australia. As part of this program, children with an acquired brain injury (ABI) attend the Brain Injury Clinic at regular intervals to be assessed and to receive therapeutic intervention. Approximately 10 percent of the children with an ABI in Kids Rehab are preschool aged. Through clinical involvement with these children, we discovered many could perform developmentally appropriate structured tasks but were unable to produce age-appropriate spontaneous pretend play. There is emerging evidence that children with ABI have difficulty producing age-appropriate pretend play (Dooley, Stagnitti, and Galvin 2019; Thorne, Stagnitti, and Parson 2021) . Pretend play requires complex cognitive abilities (Francis and Gibson 2023; Wah 2020) such as the inhibition of reality (Vygotsky 2016), the use of symbols, the remembering of roles, and then the skill of add- 63 American Journal of Play, volume 16, number 1 © 2024 by The Strong [Contact Adrienne Thorne at adrienne.thorne@health.nsw.gov.au](Contact Adrienne Thorne at adrienne.thorne@health.nsw.gov.au) ing to the construct in play with others (Rakoczy 2006; Russ 2014; Stagnitti 2017) . These abilities appear congruent with executive function, in particular with inhibition and working memory (Carlson, White, and Davis-Unger 2014; Thibodeau et al. 2016) . The literature addressing cognitive deficits in children with an ABI reports the pervasive presence of deficits in executive function (Anderson et al. 2010; Crowe et al. 2013). To broaden our understanding of the relationship between pretend play and executive function we assessed these abilities in children with an ABI and in their neurotypical peers. We did so to detail the difficulties faced by children with an ABI and the possible opportunities for improved outcomes through rehabilitation. Acquired Brain Injury Acquired Brain Injury refers to any damage to the brain that occurrs after birth. Causes of ABI include traumatic injury, stroke, brain tumor, cerebral anoxia, or encephalitis (Chevignard et al. 2010; Ilmer et al. 2016; McKinlay et al. 2016). ABI is recognized as a major disability group by the Australian government (Australian Institute of Health and Welfare) (AIHW 2007). The Australian government’s Bureau of Statistics 2018 Survey of Disability, Ageing, and Carers, revealed that there are in Australia about twenty thousand children under the age of fifteen (approximately 0.5 percent of all children) with an ABI. Children who sustain an ABI are likely to have persistent long-term disability (AIHW 2007) across a wide range of developmental areas (Ilmer et al. 2016; O’Keeffe et al. 2017; Rivara et al. 2011). Specifically, these developmental areas include fine motor skills, gross motor skills (Recla et al. 2019), social skills (Ryan et al. 2016), cognitive abilities (Anderson et al. 2011; Recla et al. 2019), and play skills (Dooley, Stagnitti, and Galvin 2019; Thorne, Stagnitti, and Parson 2021). In these areas,

FAQs

What was compared in this study?

Pretend play and executive function were assessed in preschool children with an acquired brain injury and in neurotypical preschool children.

Which pretend-play abilities related most strongly to executive function?

Logical, sequenced pretend-play actions and object substitutions in play correlated strongly with executive function in both groups.

What role did working memory play?

Working memory emerged as the most reliable predictor of pretend play across both groups of children.

Oct 15, 2026

Upload by Mabel