Dungeons & Dragons and … Autism?

When I tell people that I use the role-playing game Dungeons & Dragons in my group therapy sessions with individuals with autism, the question they ask is: “Does this really qualify as therapy? How can a game where you traverse an imaginary world completing imaginary quests and slaying imaginary monsters help a person in real life?”

My answer: By its nature, Dungeons & Dragons embodies all of the characteristics of what I try to achieve in group therapy with autistic individuals and individuals with autism. It is inherently social, inherently cooperative, and inherently interactive. 

In Dungeons & Dragons, a group embarks on a shared quest. While there are a number of things that each player can obtain or overcome on his or her own, the true challenge lies in working with the rest of the players to achieve a common goal: to slay the dragon, rescue the prisoners, bring down a dangerous tyrant, free the forest of its deadly zombie infestation … well, you get the picture.

Skills that we develop in the game include enhancing perspective taking, problem-solving skills, group learning and project work, critical thinking, adjusting our own behavior according to the rest of the group, expression and vocal/facial control, good sportsmanship, frustration tolerance and coping skills, and resolving conflicts with other players and characters in the game. There’s even a good deal of math with calculating your probability of success and the effectiveness of your dice rolls.

Under the oversight of an experienced Dungeon Master with an eye for each target area, participants in these groups can build each of these skills, while at the same time experiencing shared joy with others and learning a game they can play for the rest of their lives.

Never in nearly 20 years of working with autistic individuals have I encountered a method of therapy that so perfectly captures this sense of motivation and engagement as I have with Dungeons & Dragons. Teens and young adults who may typically be guarded, withdrawn or resistant are seated around a table, together, laughing, interacting and building the skills that will help them succeed and obtain the things that they most want and need in life.

And it doesn’t stop there! Of the individuals with whom I have had the pleasure of running therapeutic D&D groups, more than 90% have joined or in some cases created gaming groups outside of the therapeutic environment. These young people are routinely taking on the perspectives of others, navigating complex social scenarios, conquering difficult problems as a team and connecting with each other over a shared experience—not unlike what their peers would be doing outside of a therapeutic session.

In therapy, we are always searching for ways to expand what goes on in the session to the outside, and not just that, but to really make the learned skills valuable and (more importantly) used outside the therapeutic setting.  Dungeons & Dragons does just this.

Robert Harvey is a board-certified behavior analyst and director of intensive behavioral health services at KidsPeace, a multistate provider of mental and behavioral health care primarily to children and young people (including foster care services from its offices in Columbia, Maryland). This article is adapted from his piece in the Spring/Summer 2021 edition of Healing Magazine. He also discusses the use of Dungeons & Dragons in therapy as part of the KidsPeace Stories video series at kidspeace.org/kidspeace-stories.