How Dungeons & Dragons (and other tabletop roleplaying games) Can Help Us Grow: An OT’s Perspective
Hi, I’m Nicole! On week days, I work as a pediatric occupational therapist, helping kids and teens build important everyday skills. But on the weekends, I’m off on magical adventures! Casting spells, solving mysteries, and exploring new worlds… all through tabletop role-playing games like Dungeons & Dragons.
If you’re new to the game, Dungeons & Dragons (D&D) and other tabletop role-playing games (TTRPGs) are games where players take on characters in a fictional world, use dice rolls and creativity to solve problems, complete quests, and tell stories. The game is all about teamwork, imagination, and strategy!
When I’m playing a D&D game, I can’t help but notice how these types of games support so many of the same skills I work on in my occupational therapy sessions! Skills like problem solving, teamwork, communication, and self-regulation. 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 and pressures of real-life interactions.
This can be especially helpful for neurodivergent folks who may find certain real-world social situations more challenging. One study found that during gameplay, autistic and 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 way! And if fine motor tasks are tough, no problem! There are tons of ways to adapt the game so everyone can participate in the way that works best for them.
4. Inclusive for All Kinds of Thinkers
Because D&D is so multifaceted, it creates a space where a bunch of different types of thinkers can shine in their own way- artistic, analytical, organized, imaginative, tech-savvy…. In my own group, we have one person who keeps track of everything we do in a document, another player calculates numbers during battles, someone brings the story to life with expressive narration and theatrical voices, and others (like me!) use our artsy skills to create imaginative maps and game pieces. We use a mix of tools (apps like D&D Beyond, good old-fashioned paper, maps and 3D visuals) so everyone contributes in their own way.
5. Problem Solving and Teamwork
Players practice working together, resolving conflicts, and thinking critically, without real-life pressure. When the group encounters a problem in the story, we’ll often use problem solving strategies that can be applied to real life situations. For example, players may use each character’s unique strengths to solve the problem, or we’ll break down the big problem into smaller, more manageable chunks, or find someone who we can ask for help.
6. Self-Advocacy Practice
TTRPGs are full of chances to speak up, make choices, and assert ourselves through the voice and actions of our 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 wide 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 - Like 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/ when 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 a bunch of 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 (the person who’s like the narrator and leader of the game) often reminds us that character failures can lead to the most exciting and meaningful parts of the story. I’m someone who tends to strive for perfection, so I’ve found it challenging, but also super helpful, to practice "failing" in this game environment. It’s been eye-opening to see how my “failures” can spark great discussions, hilarious side quests, and create deeper connections with others.
10. Ever Heard of Paracosms?
Paracosms are richly imagined inner worlds, with characters, landscapes, and stories that some people (especially some autistic folks) create and explore in their minds. When I first learned about paracosms, 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 was so proud to tell me about the elaborate Minecraft world they created and the lore that went along with each part. 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 of the word! 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