Can a walk
in the park help children with ADHD?
Can contact with nature enhance attentional functioning in children with ADHD?
that exposure to nature might improve attention problems in children is based
on Attention Restoration Theory - ART. According to this theory, humans
have two types of attention: voluntary attention (also known as directed
attention); and involuntary attention. Voluntary attention is the form
of attention employed when we engage in tasks that require are not inherently
easy to attend to. After prolonged and intense use, voluntary attention becomes
attention, in contrast, does not require conscious effort -- think of settings
or activities in which remaining focused and attentive seems to happen naturally
and without any deliberate effort. According to ART, exposure to natural
environments can help the voluntary attention system recover when it has
become fatigued, in part it draws on involuntary attention thus allowing
the mechanism underlying directed attention to rest and rejuvenate.
led to several studies testing whether children's attention deficit symptoms
would be more manageable after exposure to natural settings. The first was
an interview study conducted with parents of 96 children diagnosed with ADHD.
Parents were presented with a list of different activities that occurred
in indoor activities, in man-made outdoor settings, and in natural outdoor
settings. Parents rated each activity in terms of how well their child
seemed able to attend after participating in the activity.. Results indicated
that children's ability to attend was rated as significantly improved after
activities that occurred in green spaces. You can read a full review
of this study at www.helpforadd.com/2002/july.htm
study was a larger survey conducted with 452 parents of children diagnosed
with ADHD. Similar to the initial study, parents rated 49 common after-school
and weekend activities in terms of whether it made their child's inattentive
symptoms "much worse than usual", "worse than usual", "same as usual", "better
than usual", or "much better than usual" for an hour or so after the activity
were described as occurring in green outdoor settings (i.e., any mostly natural
area - a park, a farm, or just a green backyard of neighborhood space), "built"
outdoor settings (i.e., mostly human made space - parking lots, downtown
areas, a neighborhood space that doesn't have much greenery), or indoor settings.
Once again, children's ADHD symptoms were rated as significantly improved
after participating in green outdoor activities compared to activities.
You can read the full review of this study at www.helpforadd.com/2004/september.htm
studies yielded interesting and provocative findings, the absence of a true
experimental design - including an appropriate control group - prevented
strong conclusions about the impact of nature on children's ADHD symptoms
from being made. The goal in the study reported below [Taylor and Kuo
(2008). Children with attention deficits concentrate better after walk in
the park. Journal of Attention Disorders]
was thus to test the impact of exposure to nature on children with ADHD in
a controlled experimental investigation.
were 12 children 7 to 12 years old with a confirmed diagnosis of ADHD (15
boys and 2 girls). The basic design was to expose children to 3 different
types of environments - an urban park, a downtown area, and a residential
area - and to test their attention/concentration following this exposure.
The prediction was that children would show enhanced attention/concentration
following exposure to nature.
was taken on a roughly 20-minute walk through each of the 3 settings.
These walks occurred on separate days and the order was counterbalanced so
that the walk in each type of occurred in the first, second, and third position
an equal number of times. Children receiving medication treatment did
not receive medicine on these days until after the walk and attentional testing
puzzles before each walk in order to ensure some degree of attentional fatigue.
The child and his/her guide were then driven to their assigned setting and
walked a routed designed to be completed at a relaxed pace in about 20 minutes.
walk, children were returned to a quiet, indoor facility where the child
was tested. The primary test was Digit Span Backwards, a widely used
measure of concentration that is sensitive to deficits in attention and working
memory. The test involves listening to a span of digits and then repeating
them back in reverse order. Following a correct response the next sequence
increases by one digit; the child continues until two consecutive trials
are failed. The longest span of digits successfully reversed is the
were tested after walking in all 3 settings, each child served as his/her
own control. This type of study design, referred to as a 'within subjects
design', provides an excellent method for comparing the impact of different
'treatments' on subsequent performance. In this case, the researchers
examined whether the number of digits children recalled after the nature
walk was higher than the number recalled after walking in the other two settings.
- Results -
predicted, children recalled a significantly greater number of digits on
the Digit Span Backwards Test after walking in the natural setting.
On average, they recalled roughly two-thirds of digit more than after walking
in the downtown or residential area. While this may not seem like a
lot, the authors note that the magnitude is similar to that reported in two
studies testing the impact of stimulant medication on Digit Span Backwards
in children with ADHD. They also note that the difference is similar
to what is typically found between children with and without ADHD.
In addition to performing better afterwards, children reported enjoying the
walk in nature significantly more than the other two settings.
- Summary and Implications -
this carefully controlled experimental study, a 20-minute walk in nature
produced significant gains in children's performance on a standardized test
of attention/concentration. In fact, the gains were comparable to those
associated with stimulant medication treatment. These findings thus reinforce
and extend results from previous interview studies by providing experimental
support for these earlier results. Collectively, these findings make
a compelling case that exposure to nature can yield at least temporary benefits
for children with ADHD.
to nature a potential treatment for ADHD? The authors are appropriately
careful when discussing this issue. They note that they have not yet
examined whether benefits also occur for hyperactive-impulsive symptoms,
the other common feature of ADHD. They also note that they have not
yet tested whether exposure to nature is associated with gains in children's
this is especially important, they emphasize that they examined the effects
on attention only immediately after exposure to natural environments.
Thus, they emphasize that their study provides "...no objective performance
data showing that the effects of nature doses last long enough to be of practical
use in managing ADHD symptoms."
this important limitation, the authors also argue that testing whether "doses"
of nature can help treat ADHD deserves prompt attention. Unlike other
existing treatments, "...spending time in relatively natural outdoor areas
does not entail any unusual risks or negative side effects, nor is there
any social stigma associated with spending time outdoors." One can
imagine that schools could be designed to help children benefit from exposure
to nature were those benefits to be conclusively documented in studies that
build on the current work. Also, given that exposure to natural settings
is suggested to enhance attention by allowing the directed attention system
to 'rest and rejuvenate', it seems that there should be other ways to accomplish
this that could be more easily incorporated into the school day.
while it is premature to conclude that exposure to nature can be a useful
treatment for ADHD, the work of these researchers has raised an intriguing
area to pursue. Let's hope that a follow-up study addressing some of
the limitations associated with the current work will be available for review
in the not too distance future.
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