Could a ‘prescription’ of nature benefit children’s mental health?

Some health care providers have started recommending dosages of nature exposure (a prescription of nature) to clients, much the same way they might prescribe pharmaceuticals (e.g. Coffey & Gauderer, 2016). But can more time spent in nature benefit children’s mental health?

Several reviews (e.g. Bedard, Rosen, & Vacha-Haase, 2003) have found ‘active’ exposure to nature (e.g. gardening, adventure and wilderness therapy) can have a positive impact on mental, emotional and social health. Increasing children’s ‘passive’ exposure to nature (e.g. going for a walk, sitting in a park, having a picnic) can also have immediate emotional, behavioural and cognitive benefits (e.g. McCormick, 2017). Reviews of research literature have suggested that use of, and nearness to, green space by children is linked to:

• increased emotional wellbeing,
• decreased stress,
• reduced depressive symptoms,
• lower behavioural problems; and
• enhanced attention (e.g. McCormick, 2017; Norwood, 2019).

Research has also found that spending time in nature can reduce Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms, as well as improve behaviour in children with ADHD. These effects are even comparable to outcomes from pharmaceutical intervention (Faber Taylor & Kuo, 2009).

Based on the above findings, a prescription of nature may have the potential to improve children’s psychological health. However, it is important to recognise that the research described has often been correlational; that is, it has explored whether there is a relationship between nature exposure and children’s mental health. But it is not possible to say that the positive effects are caused by the natural environment, nor that the effects will be long-term.

The current study:  A review of the effects of passive nature exposure on children

Recently, the authors conducted a narrative and systematic review of research studies exploring the ability of passive exposure to the natural environment to promote emotional, behavioural, and cognitive change in children and young people.

The review included studies that might show cause and effect or long-term outcomes. Only six studies were found that investigated whether nature can promote behavioural, cognitive or emotional change in children (Norwood et al., 2019). Most of the studies included in the review had children walk in nature. The majority also occurred in a school setting.

Key findings

Overall, the review showed that nature appears to have a positive impact on children and young people. Key findings were:

• Greening the spaces surrounding homes and schools, and repeated immersion in nature, may result in reduced levels of inattentiveness
• Greening the spaces surrounding homes and schools, as well as a student’s school commute, may have long-term effects on working memory
• Spending time in a forest-based classroom rather than a standard indoor classroom may improve the mood of students
• Repeated immersion in nature may also have positive behavioural outcomes.

Two studies explored self-esteem in young people but found no changes. Although there were only six studies included that could show cause and effect or long-term outcomes – the authors also reviewed a vast amount of correlational research to support these claims (i.e. research that explores the relationship between the variables but does not indicate cause-effect). Given that there are few experimental studies examining the effects of increasing nature exposure on children and young people, further research is needed.

This review found few studies that measure the effect of regular, passive nature time on children. A recent national study in the UK study suggests between 2-5 hours a week may be sufficient to benefit from nature exposure (White et al., 2019), and a growing number of researchers suggest tree cover is more effective at promoting positive learning outcomes than grassy areas or shrub land (Browning & Rigolon, 2019). However, the lack of studies makes it difficult to theorise about what a ’nature prescription’ might involve.

What future research is needed?

Future research is needed to explore the ideal dosage of nature time, type of nature time, individual differences between children, and which presenting issues might benefit the most from time in nature. Furthermore, longitudinal studies (i.e. studies that follow participants over time) from a variety of cultures and climates are needed to get a complete picture of the potential benefits of nature exposure.

An additional question for research is which type of nature exposure is best – and for which problems. All the research discussed in this article focused on passive exposure to nature. However, research has also suggested that active exposure also has benefits and that these may be different to those offered by passive exposure (e.g. benefits for social health) (Lakhani, Norwood, Watling, & Zeeman, 2018). Would an active nature-based activity be more suitable than passive exposure for different children or problems? These questions need to be clarified by future research before we can maximise the benefits of prescribing nature for children with emotional, behavioural or cognitive issues.

What can we conclude?

Time spent in nature has the potential to have positive effects on a child’s emotional, cognitive and behavioural development. However, experimental and intervention studies are still needed to clarify the details of how effective ‘a prescription of nature’ might be and what exactly it could entail.

References

Bedard, R. M., Rosen, L. A., & Vacha-Haase, T. (2003). Wilderness therapy programs for juvenile delinquents. A meta analysis. Child & Youth Care Forum, 39, 47–61.

Browning, M., & Rigolon, A. (2019). School green space and its impact on academic performance: A systematic literature review. International Journal of Environmental Research And Public Health, 16(3), 429.

Coffey, J.S., & Gauderer, L. (2016). When pediatric primary care providers prescribe nature engagement at a state park, do children “fill” the prescription? Ecopsychology, 8(4), 207-214. doi: 10.1089/eco.2016.0019

Faber Taylor, A., & Kuo, F. E. (2009). Children with attention deficits concentrate betterafter walk in the park. Journal of Attention Disorders, 12(5), 402–409. doi: 10.1177/1087054708323000.

Hartig, T., & Staats, H. (2006). The need for psychological restoration as a determinant of environmental preferences. Journal of Environmental Psychology, 26(3), 215-226. doi: 10.1016/j.jenvp.2006.07.007

Lakhani, A., Prevd, M., Watling, D. P., Zeeman, H., & Kendall, E. (2018). Using the natural environment to address the psychosocial impact of neurological disability: A systematic review. Health & place, 55(2018), 188-201.

McCormick, R. (2017). Does access to green space impact the mental well-being of children: A systematic review. Journal of Pediatric Nursing, 37(2017), 3-7. Available here.

Norwood, M. F., Lakhani, A., Fullagar, S., Maujean, A., Downes, M., Byrne, J., … Kendall, E. (2019). A narrative and systematic review of the behavioural, cognitive and emotional effects of passive nature exposure on young people: Evidence for prescribing change. Landscape and urban planning, 189, 71-79.

White, M. P., Alcock, I., Grellier, J., Wheeler, B. W., Hartig, T., Warber, S. L., … Fleming, L. E. (2019). Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Scientific reports, 9(1), 7730.