Could nature contribute to the management of ADHD in children? A systematic review
Review finds strong evidence of nature’s benefits for children with ADHD
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that is often diagnosed in childhood and is characterized by symptoms of inattention, hyperactivity, and impulsivity. Evidence suggests that children’s exposure to nature may restore attention and cognitive function, which may be particularly beneficial for children with ADHD. To establish a clearer understanding of how nature may impact individuals affected by ADHD, this systematic review provides a synthesis of the existing literature.
A search of the literature was conducted to identify prior research investigating how exposure to nature affects children with ADHD. Only quantitative studies involving children (under the age of 18) with a formal ADHD diagnosis were considered for inclusion in the review. Eligible studies could assess ADHD diagnoses at the population level or symptom severity at an individual level. Included studies also involved an exposure to nature (such as forests, parks, or green spaces), which was assessed by either objective measures (e.g. remote sensing measurements) or subjective measures (e.g. standardized questionnaires). Seven studies, conducted in different countries, met these criteria and were included in the review. The studies varied in their research designs, with five observational studies and two experimental or quasi-experimental studies. Most studies relied on parents’ self-reports of their child’s ADHD diagnosis and symptoms. Due to variation in the studies’ methods and outcome measures, a meta-analysis could not be conducted.
Overall, the reviewed studies reported beneficial effects of nature on ADHD symptoms. Three studies that measured nature exposure based on satellite imaging consistently indicated that in areas with higher densities of green vegetation children tended to have reduced instances of ADHD symptoms. These studies also found that increased surrounding greenness was associated with a decreased risk of ADHD and that children living in rural areas were less likely to develop ADHD. Two studies that relied on parent self-reports found that children who spent time in natural settings had less severe symptoms of ADHD and better concentration capabilities than children who spent their time in indoor or built settings. Additionally, experimental and quasi-experimental studies reported improved concentration when children were exposed to natural settings as compared to built settings. Studies that investigated if other factors influenced their results reported no differences in nature’s beneficial effect based on gender, age, household income, or parental education level.
The researchers conclude that evidence of an overall beneficial effect of exposure to nature on ADHD in children is strong enough to support utilizing nature contact in conjunction with established treatments for ADHD. While the reviewed studies demonstrated a clear positive relationship between exposure to nature and improved ADHD symptoms, it is important to note that findings are based on the analysis of only seven studies, which mainly used observational methods, and further research is needed. To provide children with the benefits identified in this review, it is essential to support children’s increased exposure to nature in the places they frequent every day.
Citation
Hood, M., Baumann, O., (2024). Could nature contribute to the management of ADHD in children? A systematic review. International Journal of Environmental Research and Public Health, 21
