How Dungeons & Dragons (and other tabletop roleplaying games) Can Help Us Grow: An OT’s Perspective
Hi, I’m Nicole! During the week, I work as a pediatric occupational therapist, helping kids and teens build important everyday skills. On the weekends, though, I’m off on magical adventures - casting spells, solving mysteries, and exploring new worlds… all through tabletop role-playing games like Dungeons & Dragons.
For those unfamiliar, Dungeons & Dragons (D&D) and other tabletop role-playing games (TTRPGs) are games where players take on characters in a fictional world, using dice rolls and creativity to solve problems, complete quests, and tell stories. It's all about teamwork, imagination, and strategy - played around a table with friends.
Even when I’m playing, I can’t help but notice how these games support so many of the same skills I work on in my therapy sessions - like problem solving, teamwork, communication, and self-regulation. The best part? We’re learning while having a blast. Here’s why I think D&D and similar games can be such a powerful (and fun!) tool for skill development.
1.- Structured Social Practice
Tabletop role-playing games like Dungeons & Dragons offer a supportive, predictable way for anyone to practice social skills in a low-pressure setting. Playing a character allows people to experiment with communication, collaboration, and decision-making without the same stakes as real-life interactions.
This can be especially helpful for neurodivergent individuals, who may find real-world social situations more challenging. One study found that during gameplay, autistic and otherwise neurodivergent adults reported significantly fewer social struggles compared to their everyday experiences (Moskowitz et al., 2024).
2. Emotional Growth Through Play
Kids (and grown-ups!) can safely explore emotions and problem-solving by stepping into a character's shoes. A study by Atherton and colleagues (2025), showed that playing tabletop role playing games like D&D can lead to improved self esteem in autistic individuals!
3. Fine motor skill opportunities GALORE
Taking notes, rolling all those cool dice, moving mini figures around the board, or helping build 3D maps - all of these give players a chance to strengthen fine motor skills in a fun, low-stress way. And if fine motor tasks are tough, no problem- there are tons of ways to adapt the game so everyone can participate comfortably.
4. Inclusive for all kinds of thinkers
Whether someone is artistic, analytical, organized, imaginative, or tech-savvy, D&D has a role for them. In my own group, one person tracks everything we do in a document, another calculates numbers during battles, someone brings the story to life with expressive narration, and others (like me!) create stunning maps and game pieces. We use a mix of tools- apps like D&D Beyond and good old-fashioned paper- so everyone contributes in their own way. It’s a beautiful example of how different minds shine together.
5. Problem Solving & Teamwork
Players practice working together, resolving conflicts, and thinking critically- without real-life pressure.
6. Self-advocacy Practice
Players get chances to speak up, make choices, and assert themselves through their characters. D&D provides opportunities to practice asking for what you need, setting boundaries, and standing your ground, which are invaluable life skills!
7. Strengthening Executive Functioning Skills
D&D requires a range of executive functioning skills, like planning, organizing, and reflecting on actions. It also gives players the chance to explore different accommodations and strategies to support these skills - whether it's using visual aids like maps, leaning on teammates, breaking tasks into smaller steps, or thinking creatively to solve problems. Learning which supports work best for you and how to use them is an important life skill.
8. Opportunities to Deep Dive Into Your Interests
Some neurodivergent thinkers have a tendency to focus strongly on a particular interest, learning about it to the full point of immersion. This can be called “monotropism!” I feel like tabletop role playing games provide ample opportunities to delve into these deep interests, no matter what they are. In fact, it’s a game that celebrates monotropic thinking, in my opinion.
9. Embracing the Benefits of Failure in a Low-Pressure Setting
Our Game Master (GM) often reminds us that character failures can lead to the most exciting and meaningful parts of the story. As someone who tends to strive for perfection, I’ve found it challenging, but also valuable, to practice "failing" in this game environment. It’s been eye-opening to see how those so-called failures can actually enrich the experience, spark great discussions, and create deeper connections with others, all while keeping the pressure low.
10. Ever heard of paracosms?
Paracosms are richly imagined inner worlds- complete with characters, landscapes, and stories- that some people (especially autistic folks) create and explore in their minds. When I first learned about this concept, I immediately thought of Dungeons & Dragons and the kind of world-building it encourages. It also reminded me of a child I once worked with who spent time telling me about their elaborate Minecraft world! And of course, I couldn’t help but think of J.R.R. Tolkien, who famously created entire maps, languages, and histories for the world of Middle-earth. It makes me wonder: could tabletop role-playing games like D&D offer a way to bring these rich inner worlds to life- and to share them with others in a collaborative, supported way? I’m not totally sure, but it’s something I’m excited to keep exploring.
My Final Thoughts
I’ve been playing Dungeons & Dragons for the past three years, and it has become a meaningful and motivating part of my life- a true occupation in the occupational therapy sense. Through this game, I’ve experienced powerful opportunities for self-expression, identity exploration, and social connection. For many kids, especially those who may struggle to find spaces where they feel seen and understood, tabletop role-playing games can offer a creative, supportive environment to grow and connect. It might just become a valuable part of your child’s journey too.
Written By Nicole Raisin, OTR/L