Coping with AD/HD

A study conducted by Andrea Faber Taylor, Frances E. Kuo, and William C. Sullivan Natural Resources & Environmental Sciences University of Illinois at Urbana-Champaign

With funding from The Cooperative State Research, Education and Extension Service, U.S. Department of Agriculture The USDA Forest Service Urban and Community Forestry Program on the recommendation of the National Urban and Community Forestry Advisory Council The University of Illinois at Urbana-Champaign

Take home message

Children’s AD/HD symptoms are better after activities in green settings.

Presentation outline What is AD/HD? Why Study Coping with AD/HD? The Approach The Findings So What?

What is AD/HD?

Attention Deficit Hyperactivity Disorder (AD/HD) is characterized by severe difficulties with inattention and impulsivity.

AD/HD symptoms include restlessnessrestlessness outburstsoutbursts trouble listeningtrouble listening difficulty following directionsdifficulty following directions problems focusing on tasksproblems focusing on tasks

Why Study Coping with AD/HD?

Why should we focus on AD/HD? AD/HD is relatively common, occurring in roughly 7% of school-age children.AD/HD is relatively common, occurring in roughly 7% of school-age children.

Why should we focus on AD/HD? AD/HD is relatively common, occurring in roughly 7% of school-age children.AD/HD is relatively common, occurring in roughly 7% of school-age children. AD/HD is linked to poor academic performance.AD/HD is linked to poor academic performance.

Why should we focus on AD/HD? AD/HD is relatively common, occurring in roughly 7% of school-age children.AD/HD is relatively common, occurring in roughly 7% of school-age children. AD/HD is linked to poor academic performance.AD/HD is linked to poor academic performance. AD/HD can have long-lasting effects on social development.AD/HD can have long-lasting effects on social development.

New treatment options are needed for AD/HD because behavioral therapies help, but not muchbehavioral therapies help, but not much

New treatment options are needed for AD/HD because Behavioral therapies help, but not much.Behavioral therapies help, but not much. stimulant medications are better, but have several problemsstimulant medications are better, but have several problems

They often have serious side effects.They often have serious side effects. Problems with stimulant medication:

They often have serious side effects.They often have serious side effects. They help only 9 out of 10 children with AD/HD.They help only 9 out of 10 children with AD/HD. Problems with stimulant medication:

They often have serious side effects.They often have serious side effects. They help only 9 out of 10 children with AD/HD.They help only 9 out of 10 children with AD/HD. There is no evidence they improve long-term social and academic outcomes.There is no evidence they improve long-term social and academic outcomes. Problems with stimulant medication:

Cost is a further problem with all current treatments.

But are there any other treatment options?

Contact with nature restores attention in the general population.

One explanation comes from Attention Restoration Theory. One explanation comes from Attention Restoration Theory. (Kaplan, S. 1995)

According to Attention Restoration Theory Nature is engaging, so attracts our attention Nature is engaging, so attracts our attention effortlessly. effortlessly. This allows deliberate attention to rest. This allows deliberate attention to rest. Restored deliberate attention is then available when needed. Restored deliberate attention is then available when needed.

Since the underlying problem in AD/HD seems to be one of attention…

Perhaps exposure to nature can improve AD/HD symptoms?

The Approach

Parents of children with AD/HD were asked to complete a survey.

The participants: 96 parents or guardians of children with AD/HD aged parents or guardians of children with AD/HD aged 7-12

The participants: 96 parents or guardians of children with AD/HD aged parents or guardians of children with AD/HD aged 7-12 recruited through ads and flyers in the Midwestrecruited through ads and flyers in the Midwest

The participants: 96 parents or guardians of children with AD/HD aged parents or guardians of children with AD/HD aged 7-12 recruited through ads and flyers in the Midwestrecruited through ads and flyers in the Midwest ratio of boys to girls in sample same as in AD/HD populations in general (3:1)ratio of boys to girls in sample same as in AD/HD populations in general (3:1)

The survey asked parents to nominate activities that especially affected functioning – “best activities” and “worst activities”nominate activities that especially affected functioning – “best activities” and “worst activities”

The survey asked parents to nominate activities that especially affected functioning – “best activities” and “worst activities”nominate activities that especially affected functioning – “best activities” and “worst activities” rate the aftereffects of activities, grouped by setting, on symptomsrate the aftereffects of activities, grouped by setting, on symptoms

The relationship between greenness of activity settings and symptom severity was examined.

The Findings

Was there a relationship between activities that most affect functioning and the greenness of their setting?

Likely SettingBestWorst Green (e.g., fishing, soccer) 85% (17)15% (3) Ambiguous (rollerblading, playing outside) 56% (43)44% (34) Not Green (video games, TV) 43% (53)57% (69) Likely settings of activities nominated as “Best” and “Worst” for AD/HD symptoms

Was there a relationship between greenness of activity setting and ratings of post-activity symptoms?

Mean symptom ratings for activities in different greenness settings Same Same Better Better 4 Indoors Built outdoor Green outdoor Activity Setting Mean rating of AD/HD symptoms after activities Much worse

So What?

Activities in green settings were more likely to lead to improved AD/HD symptoms.

Activities that led to worsened AD/HD symptoms were more likely to occur indoors or in barren outdoor settings.

Outdoor play in green settings should help children with AD/HD function better.

Green play settings are widely accessible, inexpensive to use, and free of side effects.

Tips for parents, teachers, and caregivers: Encourage children to play outside in green yards or parks and advocate recess in green schoolyards.Encourage children to play outside in green yards or parks and advocate recess in green schoolyards.

Tips for parents, teachers, and caregivers: Encourage children to play outside in green yards or parks and advocate recess in green schoolyards.Encourage children to play outside in green yards or parks and advocate recess in green schoolyards. Observe which activities and settings improve children’s symptoms.Observe which activities and settings improve children’s symptoms.

Tips for parents, teachers, and caregivers: Encourage children to play outside in green yards or parks and advocate recess in green schoolyards.Encourage children to play outside in green yards or parks and advocate recess in green schoolyards. Observe which activities and settings improve children’s symptoms.Observe which activities and settings improve children’s symptoms. Value and care for trees.Value and care for trees.

Caring for trees means caring for people!

To share this information with others Copies of this presentation and other, written materials for nonscientific audiences may be obtained at Copies of this presentation and other, written materials for nonscientific audiences may be obtained at To quote this information in print, please consult the original scientific journal article: To quote this information in print, please consult the original scientific journal article: Faber Taylor, A., Kuo, F.E., & Sullivan, W.C. (2001). Coping with ADD: The surprising connection to green play settings. Environment & Behavior, 33(1), Available at

On AD/HD incidence, symptoms, and treatments Barkley, R.A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psych Bulletin, 12, Bender, W.N. (1997). Understanding ADHD: A practical guide for teachers and parents. Upper Saddle River, NJ: Prentice Hall. Fiore, T.A., Becker, E.A., Nero, R.C. (1993). Interventions for students with attention deficits. Exceptional Children, 60, Hinshaw, S.P. (1994). Attention deficits and hyperactivity in children (Vol. 29). Thousand Oaks, CA: Sage. National Institute of Mental Health. (1994). Attention Deficit Hyperactivity Disorder (No ). Washington, DC: NIMH. To learn more:

On nature and attention Hartig, T., Mang, M., Evans, G.W. (1991). Restorative effects of natural environment experiences. Environment & Behavior, 23, Miles, I., Sullivan, W., Kuo, F. (1998). Ecological restoration volunteers: The benefits of participation. Urban Ecosystems, 2, Tennessen, C.M., Cimprich, B. (1995). Views to nature: Effects on attention. Journal of Environmental Psychology, 15, On Attention Restoration Theory Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology, 15, To learn more:

Other questions? Contact Andrea Faber Taylor, Ph.D. The University of Illinois at Urbana-Champaign Human-Environment Research Laboratory 1103 S. Dorner Drive, MC-636 Urbana IL 61801