Is Attention Deficit Hyperactivity Disorder (ADHD) a painful neurological reality for many children? Undoubtedly. But could it be that at least some of the increase in diagnosis and treatment of ADHD may have to do with the fact that we took the calming effects of nature away from kids in the first place?
On December 15th, The New York Times ran a major front page report, “The Selling of Attention Deficit Disorder.” The good news, according to the piece, is “severely hyperactive and impulsive children, once shunned as bad seeds, are now recognized as having a real neurological problem.” Now here’s the bad news. The rate of diagnosis and drug prescriptions may have more to with the force of advertising, and other manipulations, than with the real extent of the disorder.
The story quoted Dr. Keith Conners, a leader in the decades-long fight to legitimize ADHD. Speaking to a group of fellow ADHD experts in Washington, D.C., he pointed to recent data from the Centers for Disease Control and Prevention, revealing that the diagnosis of ADHD or ADD has been made in a staggering 15 percent of high school-age children. And, the Times reported, the number of children on medication for the disorder has “soared to 3.5 million from 600,000 in 1990.”
In fact, ADHD is now the second-most-frequent long-term diagnosis made in children – a close second only to asthma.
Conners, a psychologist and professor emeritus at Duke University, called the rate of increase “a national disaster of dangerous proportions.” He added, “The numbers make it look like an epidemic. Well, it’s not. It’s preposterous. This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”
While several recent reports have questioned the rate of diagnosis and the increase in the prescriptions of stimulants, the Times moved into relatively new territory, reporting the sometimes hair-raising methods of pharmaceutical companies to market ADHD drugs to doctors, parents and educators. Many parents are grateful for the prescriptions, but others feel pressured to medicate their children. In some cases, treating the disorder has evolved into using these medications as smart pills, to improve competitive academic performance, despite dangerous side effects.
The reporting is solid, but here’s what the Times piece does not offer: a deeper look into prevention and treatment alternatives. That is the next logical question in what I hope will become a more public discussion. One potential alternative, or additional therapy combined with other treatments, is nature itself.
Some of the most important work in this arena has been done at the Human-Environment Research Laboratory at the University of Illinois by Andrea Faber Taylor, Ming (Frances) Kuo, and William C. Sullivan. In a series of studies, they found that green outdoor spaces foster creative play, improve children’s access to positive adult interaction — and relieve the symptoms of attention-deficit disorders. The greener the setting, the more the relief. By comparison, activities indoors, such as watching TV, or outdoors in paved, non-green areas, leave these children functioning worse. They found that greenery in a child’s everyday environment, even views of green through a window, specifically reduces attention-deficit symptoms.
As they reported in the journal Environment and Behavior, outdoor activities in general help, but “activities in natural, green settings were far more likely to leave ADD children better able to focus, concentrate.” Taylor’s and Kuo’s more recent research findings suggest that attention performance for unmedicated children clinically diagnosed with ADHD was better after a simple twenty-minute walk in a park, with a natural setting, than a walk through well-kept downtown and residential areas. Other studies in Sweden and the U.S. support these findings.
Even if the increase in ADHD does reflect a real epidemic, an over reliance on pills does nothing to attack the root causes.
Possible environmental reasons for the rise of attention difficulties include toxins in food, air, and water; the proliferation of distracting digital communications; and a sedentary lifestyle enforced by fear, bad urban design and an educational ethic that appears to value sitting for tests more than running at recess.
The Times report is one more reminder that we need a deeper understanding of what is probably too loosely diagnosed as ADHD. In some cases, the symptoms may suggest an advantage. Daniel Goleman has written in his book “Focus” that so-called open awareness is what some people with characteristics of ADHD experience, and that kind of awareness may have been — the theory goes — essential for survival in humankind’s earlier days: the ability to take in all of the surroundings sans filters. That sensitivity to environment may also stimulate creativity. Channeling that ability may be the point, not the eradication of it.
Alternative or additional treatments should be included in the discussion. Also needed is skeptical vigilance. A recent advertisement for a pharmaceutical treatment listed the symptoms for ADHD. Among them, for children: “May climb or run excessively, have trouble staying seated.” Teens: “May lose things such as homework and schoolwork, make careless mistakes and fail to complete task.” And adults? “May feel restless and impatient, like they’re always ‘on the go,’ always need to be busy after work or on vacation.” Reviewing the symptoms listed in this ad, a friend remarked, “Wow, this reads like a horoscope.”
In other words, broad enough to ring true for just about everyone. Regarding the symptoms for adults, she asked, “Um, isn’t this a description of parenthood?” Do we all need Ritalin?
There’s a relative paucity of research into nature experience as an alternative to pharmaceuticals; most of the existing research, as positive and encouraging as it is, is correlative, not causal. That fact has less to do with the relative value of such approaches as it does with where research funding comes from. So, yes, we need more research on the preventive and therapeutic benefits from time spent in nature, nearby or far. But we already know enough to act.