The Centers for Disease Control estimates over 6 million American children have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Since 1997 there has been a 5 percent increase in diagnosis based on parental reports. And of those children diagnosed about 62 percent take some form of medication to control symptoms. But contemporary research into Attention Restoration Theory (ART) is suggesting a future of ADHD treatment without drugs for many children. All it could require is more exposure to nature.
Attention Restoration Theory: In Brief
ART was introduced in the 1980s by University of Michigan psychology professors Rachel and Stephen Kaplan. They found that humans attend to the world in different ways depending on environmental input. Moreover the costs of the ways we pay attention differ depending on the situation.
According to Dr. William Sullivan, head of the Department of Landscape Architecture at the University of Illinois, ART suggests two main types of attention. The first type of attention is called “Bottom Up,” used when attending to the natural world — involuntarily observing things we find fascinating like fire or watching puppies play, for instance. The second, called “Top Down” attention, is goal-driven and used in regimented tasks and environments — like editing spreadsheets, or keeping track of a lecture.
“You can talk about them in terms of the amount of effort they take,” Says Sullivan, who studied under the Kaplans. “Bottom up attention takes no effort. You look at a campfire or a waterfall or little babies and it doesn’t feel like effort.”
But the opposite is true for top down attention. It does cause fatigue. And that’s why jobs that require large amounts of concentration and mental labor, with very little physical labor, can be so tiring. The brain attends to tasks like writing a report, sifting through data, or creating presentations, in a way that is completely different from looking at the natural world. “No one has ever said I’m going to sit down and pay attention to this damn campfire,” Sullivan notes.
What ART suggests, and what research appears to have shown, is that engaging in low-effort bottom up attention can have mitigating effects on the strain caused by top down attention. In other words, looking at nature — whether bees, trees or babies — can relieve the strain of paying attention to modern life.
How much nature does one need to experience these effects? According to Sullivan, not very much at all.
“One of the biggest insights is that exposure to nature, even in cities, obviously built settlements with cars and roads and buildings and density, call on bottom up attention,” he says. “Attention restoration theory predicts that even in built environments, like a city park, our capacity to recover from mental fatigue is increased.”
Nature as an ADHD Treatment Without Drugs
While ART is a theory, there is research-based evidence showing its promise as a non-pharmaceutical therapy for kids with ADHD. Sullivan points to a 2016 study he oversaw with Dr. Dongying Li that sought to understand how exposure to nature might improve performance in concentration tasks in a school setting.
Li and Sullivan studied a group of 94 school-aged children randomized into three different classroom environments. One group of children were in a classroom without windows. A second group was in a classroom with a window that let in natural light but looked out on a barren, built environment. A third group was in a classroom with a window looking out on a school green space and garden.
The researchers subjected all three groups to rigorous, boring, and some might suggest mentally painful top-down attention tasks. These included proofreading dense and impenetrable text documents, and an impromptu five-minute speech. After the tasks children were allowed a short break in their assigned classrooms. Standardized attention tests to determine their ability to concentrate were given Before the task, after the task and after the rest period.
Once the data was collected Li and Sullivan found that measures of attention after the break were not improved for children in windowless rooms or rooms with windows looking onto barren conditions. That wasn’t the case for kids with a green view.
“They improved their capacity to pay attention by about 13 percent,” Sullivan says. “Thirteen percent is what you’d expect from a dose of Adderall. It’s the equivalent of a pharmaceutical dose of a prescription drug given to a young person to improve their capacity to pay attention.”
But theirs isn’t the only study to have found this kind of effect. In a mini-review of scientific literature related to ADHD and ART published in 2020, Italian researchers found “some scientific evidence that being exposed to Nature leads to recovery among ADHD children.” Moreover, the researchers found the evidence compelling enough they recommended nature be prescribed to children with ADHD as a therapeutic means of attention recovery.
How Parents Can Use ART to Raise ADHD Kids
Every child is different and there are surely some children with ADHD, who have severe symptoms or lack access to green and natural spaces, for whom pharmaceutical intervention could be the best path forward. But for children who have access, exposure to nature could be a therapeutic boon — particularly considering that natural and green spaces tend to have fewer side effects, save the occasional bee sting or skinned knee.
But the lesson ART offers can feel counter-intuitive. Adults have a tendency to fight lack of attention with additional rigor. A teacher might turn a kid’s desk to the wall if they’re being disruptive in class. A parent with a kid struggling to concentrate on homework might use coercion, rewards or isolation to get results. The solution to concentration struggles is rarely to send a child outside, or have them look out the windows at the trees, or watch a bird-feeder. But those might be the best ways to restore a kid’s attention.
“I have a ten-year old who has been diagnosed with ADD,” Sullivan says. “I know from my own personal experience with her that it makes a difference.”
The idea then is not to change how the brains of kids with ADHD work, or force them to work better. The idea is to change the environment around them in order for their brains to perform at the most optimum level.
And interestingly, it doesn’t seem to take a lot of nature or a lot of time in it to have the desired effects. Sullivan points out that a view of a green roof in a city has been found sufficient for restoring attention. And the children in his study with Li only spent 10-minutes at rest in a room that looked out at a green space to get their pharmaceutical-grade results.
Sullivan also points out that it’s not just children with ADHD who can benefit from exposure to nature; their parents can benefit too. “It can be exhausting sometimes to be the parent of a child with attention deficits, especially when there’s a huge amount going on in your own life,” he says. “If you’re mentally fatigued you’re more likely to be irritable. And if you’re irritable you’re not your better self and you’re less patient with your child and your spouse.” A little walk might help parents restore their attention, reduce their fatigue and better deal with the challenges of their lives.
Of course, none of this suggests that parents should abruptly change their children’s current course of treatment for a couple of walks outside. Sullivan notes that one of the limitations of nature as ADHD therapy is that researchers don’t know the dose-response relationship. With pharmaceutical interventions doctors know how much of a drug will result in specific outcomes and how long those outcomes will last. As of yet, researchers do not know how much exposure to nature people with ADHD might need and how long the exposure will remain therapeutic.
That said, ART continues to show promise in relation to ADHD. If you’re a parent of an ADHD child, getting outside more often could be a tremendous help … For everyone.