Why Gaming Works (Autism + PDA)

Harnessing the Power of Gaming in Occupational Therapy for Autistic and PDA Individuals

Gaming can be a powerful, neuroaffirming bridge into therapy for autistic and PDA individuals. Learn how gaming-informed OT supports regulation, executive function, social connection, and real-world skill transfer.

Intro

For many autistic people and individuals with Pathological Demand Avoidance (PDA), gaming is not “just a hobby.” It is a meaningful occupation: a place of competence, predictability, social connection, and identity. When occupational therapy respects that reality, engagement improves and therapy becomes more relevant, more practical, and more effective.

This article explains how gaming-informed OT can support:

• rapport and trust

• sensory and emotional regulation

• executive functioning

• social communication and teamwork

• transfer of skills into school, work, and daily life

Quick summary (for skimmers)

• Gaming can be a strong therapeutic entry point when traditional therapy feels too demand-heavy.

• A neuroaffirming approach validates interests instead of trying to remove them.

• Therapy can use games to practise regulation, planning, flexibility, communication, and problem-solving.

• The goal is not “more gaming.” The goal is better function and wellbeing across life domains.

Beyond the stereotypes: why gaming matters

Gaming is often dismissed as screen time or avoidance. For autistic and PDA individuals, it can be:

• a source of mastery and competence (clear goals, feedback, progression)

• a predictable environment (rules and outcomes are consistent)

• a safer social space (more control over communication and pacing)

• a creative outlet (building, storytelling, experimentation)

• a regulated “interest-based” doorway into connection and learning

The power of validation: building rapport through shared understanding

When a therapist shows genuine respect for a client’s gaming interests, it sends a message:

“You make sense. Your interests matter. We can work together.”

Practical ways to validate without being a gamer yourself:

• Ask what they play, why they play, and what “good” looks like in-game

• Learn key terms: roles, ranked vs casual, co-op vs competitive, mechanics, meta

• Invite the client to teach you (low demand, high autonomy)

• Reflect strengths you observe (strategy, persistence, pattern recognition)

Engaging the unengaged: why this works for PDA

PDA profiles often include demand sensitivity, nervous system threat responses, and rapid disengagement when autonomy feels compromised. Gaming-informed OT can reduce threat because it:

• begins with the client’s chosen interest

• increases autonomy (choice of game, role, goal, difficulty)

• uses indirect practice (skills developed inside a game can later transfer out)

• supports regulation before demands increase

A progressive, evidence-informed framework (5 phases)

Phase 1: Build rapport and understand the gaming world (assessment and exploration)

Goals:

• establish trust through interest-based conversation

• map preferences, strengths, triggers, and values

• identify what skills already show up in gaming

What we assess:

• game types and play patterns (solo, co-op, competitive, creative, narrative)

• sensory profile in gaming (sound, light, motion, social input)

• executive function demands (planning, shifting, working memory, inhibition)

• emotional regulation patterns (tilt, frustration, shutdown, demand spike)

• daily routines around gaming (sleep, transitions, meals, movement)

Phase 2: Develop foundational regulation skills (sensory and emotional regulation)

Targets:

• sensory load management inside and outside gaming

• emotional regulation during challenge, loss, and unpredictability

• frustration tolerance and recovery strategies

Examples:

• “pause and reset” routines (breathing, movement breaks, hydration)

• sensory environment upgrades (lighting, sound, seating, fidgets)

• low-demand decompression plans after school or work

• co-regulation plans for younger clients

Phase 3: Enhance performance and wellbeing (ergonomics and lifestyle)

Gaming setups can be optimised like any workstation.

Focus areas:

• posture and seating support

• desk height and screen distance

• hand and wrist load management

• micro-breaks and movement snacks

• sleep timing and shutdown routines

Balanced screen time strategy (non-punitive):

• build a rhythm: focus blocks, breaks, recovery

• plan transitions with clear cues and preferred “off ramps”

• diversify activities without removing the primary interest

Phase 4: Expand horizons (social skills, teamwork, goal setting, achievement)

Games are excellent practice environments for:

• communication (clear requests, turn-taking, feedback)

• teamwork (roles, coordination, shared objectives)

• perspective-taking (reading intent, adapting to others)

• goal setting (short missions to long campaigns)

• flexible thinking (patch updates, changing rules, new strategies)

Examples:

• co-op play to practise negotiation and role clarity

• team-based games to practise communication under pressure

• structured reflection: “What worked? What didn’t? What do we try next?”

Phase 5: Generalise and transfer (real-world skill application)

The OT goal is carryover into real life:

• school: planning, task initiation, group work, transitions

• home: routines, self-care sequences, emotional recovery

• community: participation, confidence, belonging

• work: communication, prioritisation, stamina, problem-solving

How we make transfer explicit:

• name the skill (planning, flexibility, persistence)

• identify where it shows up in-game

• build a small real-world “quest” that uses the same skill

• review outcomes and iterate

Optimising engagement across life domains

Gaming can become a structured occupation rather than an all-or-nothing debate. The aim is wellbeing, not moral judgement.

Helpful principles:

• use strengths first (interest-based entry)

• reduce threat and increase autonomy

• build regulation capacity before increasing demands

• track energy and recovery, not just time

• improve function across the week, not perfection on a single day

Cognitive optimisation and performance: the competitive edge (optional section)

For some clients, gaming is a serious pursuit. We can borrow performance principles:

• micro-cycles (daily): focused skill practice plus recovery

• macro-cycles (seasonal): goal setting, off-season experimentation, milestones

• pre-competition routines: focus, arousal control, confidence cues

• post-session review: celebrate wins, identify one improvement, stop on purpose

Structured gaming pursuits (when appropriate)

Some clients thrive with structured pathways:

• streaming and content creation (planning, communication, creativity)

• speedruns or challenge runs (goal setting, persistence, reflection)

• community participation (belonging, leadership, mentorship)

Lifestyle integration

A balanced routine supports both mental health and performance:

• sleep schedule protection

• nutrition and hydration anchors

• movement anchors (walks, mobility, strength)

• social connection outside the game (low demand options)

• decompression that actually works for their nervous system

Conclusion: the ripple effect

Gaming-informed OT does not replace traditional therapy. It upgrades it by making therapy more relevant, more respectful, and more engaging.

When we treat gaming as a meaningful occupation, we unlock:

• stronger therapeutic alliance

• better emotional regulation

• stronger executive function

• improved participation across school, work, and community

• real-world skill development that sticks

If you or your child is autistic or has a PDA profile and traditional therapy has not “clicked,” gaming-informed occupational therapy may be a better fit.

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