This study compares the self-initiated pretend play abilities of preschool-aged children with an acquired brain injury, with the self-initiated pretend play ability of their neurotypical peers.Method: A non-experimental group comparison was conducted between 22 preschool-aged neurotypical children (M = 52.8 months, SD = 7.1 months) and 21 children with an acquired brain injury (ABI, M = 50.5 months, SD = 11.9 months), who had been discharged from inpatient rehabilitation and who were able to engage in a play session. The children were assessed individually using the Child-Initiated Pretend Play Assessment (ChIPPA).Results: The children with an ABI had significantly lower scores in pretend play ability than their neurotypical peers as measured by the percentage of elaborate play actions in both the conventional (P < .000) and symbolic (P < .000) sections of the ChIPPA, as well as the number of object substitutions (P < .000). The children with an ABI completed significantly less of the play time required compared with their neurotypical peers (P = .001); 66% could not play for the required time. There was no significant difference in the ChIPPA scores of the children with an ABI injured before and after the age of 18 months, nor between children with a severe or moderate injury.
Conclusion:The quality and the quantity of pretend play of preschool-aged children with an ABI are significantly below that of their neurotypical peers. Assessment of pretend play ability and direct intervention in ABI rehabilitation by occupational therapists is essential to enable children with an ABI to participate in pretend play and garner the developmental benefit this affords. K E Y W O R D S brain injury, paediatric rehabilitation, preschool aged children, pretend play, symbolic play 1 | INTRODUCTION Acquired brain injury (ABI) is recognised as a major disability group by the Australian government (Australian Institute of Health and Welfare, 2004). It refers to any damage to the brain that occurred after birth including traumatic injury, stroke, brain tumour, cerebral anoxia, or encephalitis (Chevignard et al., 2010). The Australian Bureau of Statistics (2019, October 24) revealed there are approximately 20,000 children under the age of 15 years, with an ABI in Australia.
