Nature-Deficit Disorder

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A generation ago, kids learned about the natural world by going out to play. Today, many have virtually no experience with the unadulterated out-of-doors. Is this separation making our kids sick?

Author and child-advocacy expert Richard Louv, like many baby boomers, spent his childhood tromping through the great outdoors and hanging out in tree houses. Then he grew up, had kids of his own and discovered just how much things had changed: Today’s kids, he realized, were more likely to know about global environmental perils than about the ecosystems within a 10-mile radius of their homes. They were more likely to understand complex video games than to be familiar with creatures they might find crawling around under an actual rock. Such observations led Louv to inquire about what, besides fun, this young generation’s lack of nature-based experience might be costing them.

Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder (Algonquin, 2005) is Louv’s examination of how contemporary society has become increasingly estranged from the natural world. He surveys the physiological, environmental, social, psychological and spiritual implications this estrangement is likely to have for us and for our children.

Louv, who has written for The New York Times, Washington Post and Christian Science Monitor, presents scientific research and expert anecdotal observations supporting the notion that time spent in nature is essential to healthy human development. He argues that our children’s diminished connection with nature may be at least partially to blame for this generation’s struggles with obesity, depression, and learning and behavior disorders. He also suggests that increasing kids’ exposure to nature-based experiences and education may provide at least a partial remedy for these ills.

In the following excerpt, adapted from Last Child in the Woods, Louv considers how nature may help fight Attention Deficit Hyperactivity Disorder (ADHD). – Eds.

“My son is still on Ritalin, but he’s so much calmer in the outdoors that we’re seriously considering moving to the mountains,” one mother says. “There’s just something calming to him about being outside in nature.”

Many physicians and psychologists share her sentiment. “Our brains are set up for an agrarian, nature-oriented existence that came into focus five thousand years ago,” says Michael Gurian, a family therapist and best-selling author of The Good Son (Tarcher, 1999) and The Wonder of Boys (Putnam, 1997). “Neurologically, human beings haven’t caught up with today’s overstimulating environment. The brain is strong and flexible, so 70 to 80 percent of kids adapt fairly well. But the rest don’t. Getting kids out in nature can make a difference. We know this anecdotally, though we can’t prove it yet.”

Some studies, however, do suggest that nature may be useful as a therapy for Attention Deficit Hyperactivity Disorder (ADHD), and that it may be successfully used with, or in some cases instead of, medications or behavioral therapies. As a result, some researchers now recommend that parents and educators make experiences with nature – especially green places – more available to children with ADHD. Such experiences, they suggest, may support these children’s attentional functioning and minimize their symptoms.

Nature’s Nurture

The growing understanding of nature’s role in creating and maintaining healthy childhood development may suggest the use of a new term, “nature-deficit disorder,” to describe the imbalance currently being experienced by many of our children, including but not limited to those diagnosed with ADHD.

I am not suggesting the use of this term in any scientific or clinical sense. Certainly no academic researchers currently use the term nature-deficit disorder; nor do they attribute ADHD entirely to a nature deficit. But based on accumulating scientific evidence, I would argue that the concept – or hypothesis – of nature-deficit disorder is an appropriate and useful description of one factor that may aggravate attentional difficulties for many children.

Consider the diagnosis and current treatments of choice. Nearly 8 million children in the United States suffer from mental disorders, ADHD being one of the more prevalent. The disorder often develops before age 7, and it is usually diagnosed between the ages of 8 and 10. Children with the syndrome are restless, and they have trouble paying attention, listening, following directions and focusing on tasks. They may also be aggressive, even antisocial, and may suffer from academic failure. Once blamed on poor parenting and other social factors, ADHD is now believed to be an organic disorder associated with differences in the brain morphology of children.

Concerned medical experts assert that, while necessary in some cases, the stimulant medications most often prescribed for ADHD treatment, including methylphenidate (Ritalin) and amphetamines (Dexedrine), are vastly overprescribed – perhaps as much as 10 to 40 percent of the time. The number of patients using such medications increased 600 percent between 1990 and 1995, and that figure continues to rise, especially among younger children.

Much about the sudden increase in cases of ADHD remains a mystery. The massive increase in ADHD diagnoses and treatment may, in fact, simply be a matter of recognition: Some experts believe ADHD has been a problem for years but went undiagnosed until it had a name.

Another explanation for the increase in diagnoses boils down to the availability of treatment: Three decades ago the medications now used to treat ADHD were not widely known, not as intensely marketed by pharmaceutical companies and not yet fully trusted by physicians. But whatever the opinions about these drugs may be, the fact is they do little to address the root causes of ADHD.

Tree Climbing vs. TV Watching

While we still don’t fully understand the causes of ADHD, there is mounting evidence that it has at least some ties to specific types of childhood experiences, including television viewing. The first study to link television watching to ADHD was published in April 2004 in the journal Pediatrics. Researchers at Children’s Hospital and Regional Medical Center in Seattle determined that each hour of TV watched per day by preschoolers increases by 10 percent the likelihood that they will develop concentration problems and other symptoms of attention-deficit disorders (ADDs) by age 7.

This information is disturbing. But television is only one small part of the much larger environmental and cultural change that has taken place in our lifetime, including the very rapid move from a rural culture to a highly urbanized one.

For most of human history, families had every reason – and every opportunity – to encourage their children toward work, learning and play that was steeped in nature. This was where life skills and strengths were developed; this was where the most fun and action could be had. Today, due to a variety of intersecting factors – the disappearance of open spaces, the rise of electronic entertainments, the emergence of safety concerns, the introduction of longer school hours and busy, two-wage-earner family lifestyles – our kids’ access to (and motivation toward) nature-based outdoor experience is in much shorter supply.

Not Enough Data

There is notably little scientific data specifically measuring the decline of children’s time spent in nature, in part because the problem emerged so quickly. Good longitudinal studies that span the decades are missing. “We don’t have older data to compare,” explains Louise Chawla, a Kentucky State University environmental psychology professor and a tireless champion for increasing children’s experience in nature. “No one thought to ask these questions 30, 40 or 50 years ago.”

The other problem is that no one is likely to fund such studies, even now. For years, James Sallis has been studying why some children and adults are more active than others. He is program director of the Active Living Research Program at the Robert Wood Johnson Foundation, a multiyear effort to discover how to design recreational facilities and whole communities so they stimulate people of all ages to be more active. The studies are focusing on sites such as urban parks, recreation centers, streets and private homes.

“Based on previous studies, we can definitely say that the best predictor of preschool children’s physical activity is simply being outdoors,” Sallis says, “and that an indoor, sedentary childhood is linked to mental-health problems.” But when I asked what they had learned about how children used woods, fields, canyons and vacant lots – in other words, unstructured, natural sites – he told me: “We don’t ask about those places.”

The reason such research is unlikely to be conducted, he noted, was that there’s no economic interest involved. But there is a strong interest on the part of many parents in doing whatever they can to improve the prospects for their children’s mental and physical health, including finding ways for their kids to enjoy more direct exposure to the natural environments that appear to do them the most good.

The “Restorative Environment”

Many parents notice significant changes in their hyperactive child’s behavior when that child hikes in mountains or enjoys other unstructured, nature-oriented outings. And science is beginning to give us some insight as to why such outdoor activities dampen the effects of ADHD.

Husband-and-wife research team Stephen and Rachel Kaplan developed the well-established attention-restoration theory. Environmental psychologists at the University of Michigan, the Kaplans were inspired by philosopher and psychologist William James. In 1890, James described two kinds of attention: directed attention and fascination, or involuntary attention.

In the early 1970s, the Kaplans began a nine-year study for the U.S. Forest Service. They followed participants in an Outward Bound–like wilderness program, which took people into the wilds for up to two weeks. During these treks or afterward, subjects reported feeling a sense of peace and an ability to think more clearly; they also reported that just being in nature was more restorative than the physically challenging activities, such as rock climbing, for which such programs are mainly known.

The positive effect of “the restorative environment” was vastly greater than the Kaplans expected. According to their research, too much directed attention (the kind children are expected to exhibit in the classroom, for example) leads to “directed-attention fatigue,” marked by impulsive behavior, agitation, irritation and inability to concentrate.

Directed-attention fatigue occurs because neural inhibitory mechanisms become fatigued by blocking competing stimuli. As Stephen Kaplan explained in Monitor on Psychology, “If you can find an environment where the attention is automatic, you allow directed attention to rest. And that means an environment that’s strong on fascination.”

Nature is an ideal example of such an environment. Indeed, according to the Kaplans, nature can be the most effective source of such restorative relief.

Nature’s Ritalin

Attention-restoration theory applies to everyone, regardless of age. But what about children, especially those with ADHD?

Some of the most important work in this area has been done at the Human-Environment Research Laboratory (HERL) at the University of Illinois. Researchers Andrea Faber Taylor, Frances Kuo and William C. Sullivan have found that green outdoor spaces foster creative play, improve children’s access to positive adult interaction – and relieve the symptoms of ADD and ADHD. The greener the setting, the more relief. By comparison, indoor activities, such as watching TV or being outdoors in paved, non-green areas increase the symptoms.

In a survey of families with children ages 7 to 12 diagnosed with ADD, parents or guardians were asked to identify afterschool or weekend activities that left their child functioning especially well or particularly poorly. Activities were coded “green” or “not green.” Green activities, for example, included camping and fishing. Not-green activities included watching television, playing video games, doing homework. Some activities, such as inline skating, were labeled “ambiguous.”

The controls in this study were more complex than space allows me to describe, but suffice it to say the research team was careful to account for variables. They found that greenery in a child’s everyday environment, even a view of green spaces through a window, specifically reduces attention-deficit symptoms. While outdoor activities in general help, settings with trees and grass are most beneficial.

As the researchers reported in Environment and Behavior, “compared to the aftereffects of play in paved outdoor or indoor areas, activities in natural, green settings were far more likely to leave ADD children better able to focus [and] concentrate. Activities that left ADD children in worse?shape were far more likely to occur indoors or in outdoor spaces devoid of greenery.”

They also found that the positive influence of near-home nature on concentration may be more pronounced for girls (ages 6 to 9) than for boys. On average, the greener a girl’s view from home, the better she concentrates, the less she acts impulsively and the longer she can delay gratification. This helps her do better in school, handle peer pressure and avoid dangerous, unhealthy or problem behaviors. She is more likely to behave in ways that foster success in life, according to the researchers.

Taylor’s and Kuo’s more recent research findings are equally provocative. According to an unpublished study (which Taylor emphasizes is “a work in progress”), attention performance for unmedicated children clinically diagnosed with ADHD was better after a simple 20-minute walk in a park with a natural setting than it was after a walk through well-kept downtown and residential areas.

On the Horizon

Expanding such knowledge about the benefits of green spaces, and applying it in practical ways, will be the next challenge. Although today’s medications for ADHD offer temporary gains, including sustained attention and academic productivity, these medications may do little for a child’s long-term success, either socially or academically. The medications can also have unpleasant side effects, among them sleep disruption, depression and growth suppression of approximately half an inch per year on average, as reported in a large randomized trial funded by the National Institute of Mental Health. A second class of treatment, behavioral therapies, teaches children how to self-monitor attention and impulsive behavior, but the success of these therapies has been mixed.

More time in nature – combined with less television and more stimulating play and educational settings – may go a long way toward reducing attention deficits in children, and, just as important, increasing their joy in life. As Kuo points out, prescribing “green time” for the treatment of ADHD has [its] advantages: It’s widely accessible, free of side effects, nonstigmatizing and inexpensive.

Despite the apparent promise of nature-based experience as a beneficial therapy, it’s important to note that research on the impact of nature experiences on attention disorders and on wider aspects of child health and development is still very much in its infancy, and it is easily challenged. In fact, scientists doing some of the best research in this area are the first to call attention to this limitation.

“For many of us, intuition emphatically asserts that nature is good for children,” write Taylor and Kuo in an overview of the research to date, and so it is tempting, they note, to draw conclusions that are not, as yet, conclusively born out by clinical evidence. But if it is true that nature therapy reduces the symptoms of ADHD, then it’s worth considering that the converse may also be true: ADHD may be a set of symptoms aggravated by lack of exposure to nature. And if, as a growing body of evidence recommends, “contact with nature is as important to children as good nutrition and adequate sleep,” then, as Taylor and Kuo conclude, “the current trends in children’s access to nature need to be addressed.”

Even the most extensive research is unlikely to capture the full benefits of direct experience with nature within a person’s lifetime. As the sign over Albert Einstein’s office at Princeton University read, “Not everything that counts can be counted, and not everything that can be counted counts.”

Clearly, more research is needed to lend deeper insight into the data already gathered, but we don’t have to wait for more research to act on our parental instincts and common sense.

As Taylor and Kuo argue, “given the pattern of statistically reliable findings all pointing the same direction and persisting across different subpopulations of children, different settings and in spite of design weaknesses,” it is fast becoming a matter of logical efficiency “to accept the fact that nature does promote healthy child development.”

Adapted from Richard Louv's most recent work, Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder (Algonquin, 2005). For more on this and the author's other books, visit www.richardlouv.com.

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