Introduction: This study describes the self-initiated pretend play abilities of children who had sustained an acquired brain injury. Method: A non-experimental study was conducted with 26 children with acquired brain injury (15 females, mean age 5.08 years, SD 1.58 years), who were out of post-traumatic amnesia, able to sit independently and engage in a play session. The children were assessed individually on one occasion using the Child-Initiated Pretend Play Assessment. Findings: All children in the study presented with pretend play deficits, particularly in symbolic play. Inattention, distractibility and limited concentration were common behaviours of the children. Three quarters of the sample (76.48%) were unable to complete the time of the assessment. For many of the children the cessation of their play was sudden and abrupt, even for those who showed complex play ability. Conclusion: Cognitive fatigue is argued to have impacted on the children's play ability due to the considerable amount of cognitive effort required to engage in pretend play. Implications for intervention are to offer short sessions for children with acquired brain injury and pay particular attention to a child's symbolic play within pretend play ability.

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