JMIR Publications

ABSTRACT

Background:

Autism affects millions of individuals worldwide and represents a growing demand on healthcare systems. Although researchers have developed numerous interventions targeting the needs of autistic children and adolescents, effective therapeutic approaches for adults remain limited. In this context, social skills training has emerged as a promising intervention for autistic adults. More recently, tabletop role-playing game (TTRPG)-based interventions have shown potential benefits for social interaction, engagement, treatment adherence, and well-being among autistic individuals. However, existing evidence relies primarily on case studies, observational research, and quasi-experimental designs, highlighting the need for randomized controlled trials to establish the effectiveness of these interventions.

Objective:

This study aims to evaluate the effectiveness of a TTRPG-based social communication intervention for autistic adults on social responsiveness, social skills, and other related outcomes.

Methods:

A single-blind, randomized controlled trial with an active control condition will be conducted following the development and pilot testing of a TTRPG-based social communication intervention. We aim to enroll 48 autistic adults aged 18 to 34 years who meet DSM-5 criteria for autism and present elevated social responsiveness difficulties. Participants will be randomly assigned to either the intervention group, which will receive a structured TTRPG-based social communication program, or the active control group, which will participate in unstructured TTRPG sessions. Both conditions will consist of eight weekly 90-minute group sessions. The study will compare changes in social responsiveness, social skills, global clinical improvement, executive functioning, depressive and anxiety symptoms, self-efficacy, and participant satisfaction across baseline, midintervention, postintervention, and 3-month follow-up assessments. Qualitative interviews will also explore participants’ experiences with the intervention and the use of TTRPG as a therapeutic tool.

Results:

Intervention development and pilot testing will be completed prior to study initiation. The randomized controlled trial has received ethical approval and is scheduled to begin participant recruitment following publication of this protocol. The study findings will be reported in a future publication.

Conclusions:

To our knowledge, this study represents the first randomized controlled trial protocol designed to evaluate a TTRPG-based social communication intervention for autistic adults. The findings may contribute to the emerging literature on game-based interventions in autism, provide preliminary evidence regarding the feasibility and potential effectiveness of this approach, and inform the development of accessible, neuroaffirmative, and scalable interventions that support social participation and quality of life among autistic adults. Clinical Trial: Brazilian Clinical Trials Registry RBR-3b2cggn; https://ensaiosclinicos.gov.br/rg/RBR-3b2cggn (Date of registration: 11/28/2025)