Role-Playing Therapy and Board Game Therapy for Autism, ADHD

 At Brighter Side Psychology, therapy can include more than talking and worksheets. For many autistic, ADHD and AuDHD children, teenagers and adults, learning is often easier when it is practical, structured, interest-based and engaging.

Role-playing games, Dungeons & Dragons-inspired activities, tabletop games and board games can be used in therapy to practise communication, emotional regulation, flexible thinking, teamwork, problem-solving and social confidence.

These approaches are not stand-alone cures or replacements for evidence-based therapy. Instead, they are evidence-informed tools that can be integrated with approaches such as CBT, ACT, DBT skills, social skills training, narrative therapy, family therapy and neuroaffirming practice.

 Role-playing therapy uses characters, stories, scenarios or games to help people practise real-life skills in a safe and supported way.

This may include practising how to:

• join a conversation
• ask questions and show interest
• manage disagreement
• set boundaries
• cope with mistakes or rejection
• solve problems with others
• regulate emotions
• try new responses before using them in real life

For some clients, it is easier to talk about what a character is feeling before talking directly about themselves. This can make therapy feel safer, less pressured and more engaging.

  Tabletop role-playing games, including Dungeons & Dragons-inspired activities, involve creating characters, making choices, solving problems and working together through a shared story.

In therapy, the focus is not on becoming an expert player. The focus is on practising real-world skills such as:

• teamwork
• turn-taking
• flexible thinking
• perspective-taking
• communication
• emotional regulation
• leadership
• asking for help
• repairing conflict
• coping with uncertainty

The therapist guides the process by helping clients reflect on what happened in the game, what emotions came up, what skills were used, and how those skills might apply at school, home, work, friendships or relationships.

 Many neurodivergent clients benefit from therapy that is active, visual, structured and connected to their interests.

Role-playing and board game therapy can help by:

• reducing pressure compared with direct conversation
• making social expectations clearer
• using predictable rules and structure
• allowing repeated practice
• building confidence through achievable challenges
• supporting creativity and autonomy
• creating opportunities for connection
• making therapy more engaging

For autistic clients, the focus is not on masking or acting “less autistic.” The goal is to support authentic communication, self-understanding, confidence, self-advocacy and meaningful connection.

For ADHD clients, games can provide active practice with pausing, planning, emotional regulation, impulse control and frustration tolerance.

For AuDHD clients, therapy can be adapted to balance structure, creativity, predictability, sensory needs and novelty.

  Role-playing and board game therapy can be adapted using:

• simplified rules
• visual supports
• smaller groups
• clear session routines
• sensory-aware spaces
• no forced eye contact or voice acting
• optional breaks
• explicit social scripts
• trauma-informed pacing
• predictable group rules
• structured debriefing after play

These modifications help make the therapy safer, more accessible and more neuroaffirming.

  Research into tabletop role-playing games, Dungeons & Dragons, board games and therapeutic games is growing. Current research suggests these approaches may support social skills, engagement, confidence, mood, self-concept, communication and motivation.

However, the evidence base is still emerging. The safest and most accurate way to describe these approaches is that they are promising, evidence-informed tools that work best when combined with clear therapy goals, guided reflection and established psychological approaches.

  This approach may be helpful for children, teenagers or adults who enjoy games, fantasy, storytelling, characters, strategy or creative problem-solving.

It may be especially useful for people wanting support with:

• autism social skills
• ADHD emotional regulation
• AuDHD self-understanding
• anxiety and confidence
• friendship skills
• conversation skills
• rejection sensitivity
• flexible thinking
• frustration tolerance
• family communication
• relationship skills
• school or workplace communication

 Is Dungeons & Dragons therapy evidence-based? 

Dungeons & Dragons therapy is best described as evidence-informed. Research is promising, but more high-quality studies are needed. It is most appropriate when used alongside evidence-based approaches such as CBT, ACT, DBT skills, social skills training and narrative therapy.

No. In therapy, games are chosen for a purpose. The therapist uses the game to practise specific skills, then helps the client reflect and apply those skills in real life.

Yes, it may be helpful when adapted carefully. Role-playing and board games can make therapy more practical, structured, visual and engaging, while supporting communication, regulation, confidence and connection.

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