Coping with AD/HD

A study conducted byA study conducted by

Andrea Faber Taylor and Andrea Faber Taylor and

Frances E. KuoFrances E. Kuo

Natural Resources & Environmental SciencesUniversity of Illinois at Urbana-Champaign

With funding fromWith 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 messageTake home message

Take home messageTake home message

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

Presentation outlinePresentation outline

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

What is AD/HD?What is AD/HD?

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

AD/HD symptoms includeAD/HD symptoms include

• restlessnessrestlessness

• outburstsoutbursts

• trouble listeningtrouble listening

• difficulty following directionsdifficulty following directions

• problems focusing on tasksproblems focusing on tasks

Why Study Coping with Why Study Coping with AD/HD?AD/HD?

Why should we focus on AD/HD?Why should we focus on AD/HD?

• AD/HD is relatively common, occurring in AD/HD is relatively common, occurring in roughly 7% of school-age children.roughly 7% of school-age children.

Why should we focus on AD/HD?Why should we focus on AD/HD?

• AD/HD is relatively common, occurring in AD/HD is relatively common, occurring in roughly 7% of school-age children.roughly 7% of school-age children.

• AD/HD is linked to poor academic AD/HD is linked to poor academic performance.performance.

Why should we focus on AD/HD?Why should we focus on AD/HD?

• AD/HD is relatively common, occurring in AD/HD is relatively common, occurring in roughly 7% of school-age children.roughly 7% of school-age children.

• AD/HD is linked to poor academic AD/HD is linked to poor academic performance.performance.

• AD/HD can have long-lasting effects on social AD/HD can have long-lasting effects on social development.development.

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

New treatment options are needed for New treatment options are needed for AD/HD becauseAD/HD because• Behavioral therapies help, but not much.Behavioral therapies help, but not much.

• stimulant medications are better, but have stimulant medications are better, but have several problemsseveral problems

• They often have serious side effects.They often have serious side effects.

Problems with stimulant medication: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 They help only 9 out of 10 children with AD/HD.AD/HD.

Problems with stimulant medication: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 They help only 9 out of 10 children with AD/HD.AD/HD.

• There is no evidence they improve long-term There is no evidence they improve long-term social and academic outcomes.social and academic outcomes.

Problems with stimulant medication:Problems with stimulant medication:

Cost is a further problem with Cost is a further problem with all current treatments.all current treatments.

But are there any other But are there any other treatment options?treatment options?

Contact with nature Contact with nature restores attention in the restores attention in the general population.general population.

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

According to According to Attention Restoration Attention Restoration TheoryTheory• 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 Restored deliberate attention is then available available when needed. when needed.

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

Perhaps exposure to Perhaps exposure to nature can improve nature can improve AD/HD symptoms?AD/HD symptoms?

The Approach

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

The participants:The participants:

• 96 parents or guardians of children with 96 parents or guardians of children with AD/HD aged 7-12AD/HD aged 7-12

The participants:The participants:

• 96 parents or guardians of children with 96 parents or guardians of children with AD/HD aged 7-12AD/HD aged 7-12

• recruited through ads and flyers in the recruited through ads and flyers in the MidwestMidwest

The participants:The participants:

• 96 parents or guardians of children with 96 parents or guardians of children with AD/HD aged 7-12AD/HD aged 7-12

• recruited through ads and flyers in the recruited through ads and flyers in the MidwestMidwest

• ratio of boys to girls in sample same as in ratio of boys to girls in sample same as in AD/HD populations in general (3:1)AD/HD populations in general (3:1)

The survey asked parents toThe survey asked parents to

• nominate activities that especially affected nominate activities that especially affected functioning – “best activities” and “worst functioning – “best activities” and “worst activities”activities”

The survey asked parents toThe survey asked parents to

• nominate activities that especially affected nominate activities that especially affected functioning – “best activities” and “worst functioning – “best activities” and “worst activities”activities”

• rate the aftereffects of activities, grouped by rate the aftereffects of activities, grouped by setting, on symptomssetting, on symptoms

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

The Findings

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

Likely Setting Best Worst

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 Likely settings of activities nominated as “Best” and “Worst” nominated as “Best” and “Worst” for AD/HD symptoms for AD/HD symptoms

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

Mean symptom ratings for Mean symptom ratings for activities in different greenness activities in different greenness settingssettings

SameSame 3

1

3.2

3.4

3.6

3.8

BetterBetter 4

IndoorsIndoors Built outdoorBuilt outdoor Green outdoorGreen outdoor

Activity SettingActivity Setting

Mean rating Mean rating of AD/HD of AD/HD symptoms symptoms after after activitiesactivities

Much worseMuch worse

So What?

Activities in green Activities in green

settings were more likely settings were more likely

to lead to improved to lead to improved

AD/HD symptoms.AD/HD symptoms.

Activities that led to Activities that led to

worsened AD/HD worsened AD/HD

symptoms were more symptoms were more

likely to occur indoors likely to occur indoors

or in barren outdoor or in barren outdoor

settings.settings.

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

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

Tips for parents, teachers, and Tips for parents, teachers, and caregivers:caregivers:• Encourage children to play outside in green Encourage children to play outside in green

yards or parks and advocate recess in green yards or parks and advocate recess in green schoolyards. schoolyards.

Tips for parents, teachers, and Tips for parents, teachers, and caregivers:caregivers:• Encourage children to play outside in green Encourage children to play outside in green

yards or parks and advocate recess in green yards or parks and advocate recess in green schoolyards.schoolyards.

• Observe which activities and settings Observe which activities and settings improve children’s symptoms. improve children’s symptoms.

Tips for parents, teachers, and Tips for parents, teachers, and caregivers:caregivers:• Encourage children to play outside in green Encourage children to play outside in green

yards or parks and advocate recess in green yards or parks and advocate recess in green schoolyards.schoolyards.

• Observe which activities and settings Observe which activities and settings improve children’s symptoms.improve children’s symptoms.

• Value and care for trees.Value and care for trees.

Caring for trees means caring Caring for trees means caring for people!for people!

To share this information To share this information with otherswith others

• • Copies of this presentation and other, written Copies of this presentation and other, written materials for nonscientific audiences may be obtained materials for nonscientific audiences may be obtained at <www.lhhl.uiuc.edu> at <www.lhhl.uiuc.edu>

• • To quote this information in print, please consult the To quote this information in print, please consult the original scientific journal article: original scientific journal article: Faber Taylor, A., Kuo, F.E., & Sullivan, W.C. (2001). Coping Faber Taylor, A., Kuo, F.E., & Sullivan, W.C. (2001). Coping with ADD: The surprising connection to green play settings. with ADD: The surprising connection to green play settings. Environment & BehaviorEnvironment & Behavior, 33(1), 54-77., 33(1), 54-77.

Available at www.lhhl.uiuc.eduAvailable at www.lhhl.uiuc.edu

On AD/HD incidence, symptoms, and On AD/HD incidence, symptoms, and treatmentstreatments

Barkley, R.A. (1997). Behavioral inhibition, sustained attention, and executive Barkley, R.A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. functions: Constructing a unifying theory of ADHD. Psych BulletinPsych Bulletin, 12, 65-94., 12, 65-94.

Bender, W.N. (1997). Bender, W.N. (1997). Understanding ADHD: A practical guide for teachers Understanding ADHD: A practical guide for teachers and parents.and parents. Upper Saddle River, NJ: Prentice Hall. Upper Saddle River, NJ: Prentice Hall.

Fiore, T.A., Becker, E.A., Nero, R.C. (1993). Interventions for students with Fiore, T.A., Becker, E.A., Nero, R.C. (1993). Interventions for students with attention deficits. attention deficits. Exceptional Children,Exceptional Children, 60, 163-173. 60, 163-173.

Hinshaw, S.P. (1994). Hinshaw, S.P. (1994). Attention deficits and hyperactivity in childrenAttention deficits and hyperactivity in children (Vol. 29). (Vol. 29). Thousand Oaks, CA: Sage. Thousand Oaks, CA: Sage.

National Institute of Mental Health. (1994). National Institute of Mental Health. (1994). Attention Deficit Hyperactivity Attention Deficit Hyperactivity DisorderDisorder (No. 94-3572). Washington, DC: NIMH. (No. 94-3572). Washington, DC: NIMH.

To learn more:To learn more:

On nature and attentionOn nature and attentionHartig, T., Mang, M., Evans, G.W. (1991). Restorative effects of natural Hartig, T., Mang, M., Evans, G.W. (1991). Restorative effects of natural environment experiences. environment experiences. Environment & BehaviorEnvironment & Behavior, 23, 3-26., 23, 3-26.

Miles, I., Sullivan, W., Kuo, F. (1998). Ecological restoration volunteers: The Miles, I., Sullivan, W., Kuo, F. (1998). Ecological restoration volunteers: The benefits of participation. benefits of participation. Urban Ecosystems,Urban Ecosystems, 2, 27-41. 2, 27-41.

Tennessen, C.M., Cimprich, B. (1995). Views to nature: Effects on attention. Tennessen, C.M., Cimprich, B. (1995). Views to nature: Effects on attention. Journal of Environmental PsychologyJournal of Environmental Psychology, 15, 77-85., 15, 77-85.

On Attention Restoration TheoryOn Attention Restoration TheoryKaplan, S. (1995). The restorative benefits of nature: Toward an integrative Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. framework. Journal of Environmental Psychology,Journal of Environmental Psychology, 15, 169-182. 15, 169-182.

To learn more:To learn more:

Other questions?Other questions?

Contact Andrea Faber Taylor, Ph.D. Contact Andrea Faber Taylor, Ph.D. (afabrtay@uiuc.edu)(afabrtay@uiuc.edu)

The University of Illinois at Urbana-ChampaignThe University of Illinois at Urbana-Champaign

Landscape and Human Health LaboratoryLandscape and Human Health Laboratory

1103 S. Dorner Drive, MC-6361103 S. Dorner Drive, MC-636

Urbana IL 61801Urbana IL 61801