CHILDREN AND NATURE

What We Know and What We Do Not

Dr. Robert Gifford

Dr. Angel Chen

University of Victoria

Prepared for the Lawson Foundation

March 31, 2016

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EXECUTIVE SUMMARY
This literature review summarizes empirical research on the links between nature and
benefits for child development, focusing on the most compelling scientific findings. The
goal was to survey current knowledge, so as to identify where research needs to proceed.

In his ground-breaking work, Last Child in the Woods, Richard Louv coined the term
“nature deficit disorder,” not as a medical diagnostic term, but to describe cumulative effect
of alienation from nature, including the loss of open space and increasingly sedentary
lifestyle of children that can lead to adverse psychological and health consequences. Is the
belief in nature’s salutary value empirically supported? Concern about diminished contact
with nature has stimulated research from diverse disciplines to answer this question.

The general pattern of findings is that access to nature, whether in the form of wilderness
immersion or merely window views of trees, supports healthy development. Engagement
with high-quality green space is associated with several positive health outcomes, including
lower body mass index, decreased blood pressure, healthier immune functioning, reduced
myopia, morbidity, and cardiovascular-related diseases. Natural playgrounds contain
diverse features that offer opportunities for control and mastery, support more imaginative
and constructive play than constructed grounds, and indirectly promote social affiliation.
Greater access to nature also yields improved moods, resilience in response to stress,
greater self-discipline and impulse control, improved concentration, better academic
achievement, and reduction of attention deficit and hyperactivity disorder symptoms. In
addition, consistent exposure to nature and interactions with nonhuman species are
important ingredients for fostering ecological knowledge, identity, and ethics.

Many studies have one or more methodological weaknesses that should be addressed in
future research. Among these is a reliance on self-reports, the uncontrolled presence of
potentially confounding variables, and selection effects (e.g., active children choose to play
outdoors more often). These limitations can partly be addressed through the use of large-
scale epidemiological studies and complementary mixed methodologies. However, more
rigorously controlled experiments are necessary to establish evidence of a causal relation.

Research in environmental psychology, ecology, health, and planning varies in its approach
to the question. However, this interdisciplinary work is necessary to develop a more
complete and nuanced understanding of nature’s benefits for children. Theoretical
knowledge, research principles, and successful practices should be well-integrated.
Collaboration between planning agencies, community organizations, and school districts
should consider and incorporate natural features in children’s facilities while considering a
range of psychological and socio-economic barriers.

The imposition of territorial boundaries and preferences for manicured green spaces by
some adults conflict with children’s desire for creativity and free-range exploration. When
adults support children’s gravitation to nature, and their assistance in designing managed
natural spaces, children benefit more and can help provide an important contribution to
society. This will come with well-chosen new research initiatives.
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We conclude that more or better research is needed in these nine areas:

1. Establishing causality. Most research in this area is correlational, which leaves the
question of what truly causes what unclear. Some examples include: Does green space
cause increased physical activity, or do more active children seek green space? Do
empathetic, socially oriented children form bonds with their pets, or do pre-existing
family contexts or preferences lead to the choice to have pets?
2. Establishing effectiveness. For example, can the benefits of wilderness be
differentiated from or found superior to traditional non-nature therapies? The same
may be asked about animal-assisted therapy (AAT). Does AAT offer only a short-term
affective fix rather than long-term behavioural change?
3. The role of parents. To what extent do parents restrict their children’s use of nature?
How are children’s experiences of nature influenced by their parents? Can children’s
behaviour in nature influence their parents? What are the gaps between parents’
perception of, and children’s experiences of, outdoor play?
4. The role of animals. Does animal companionship promote a greater capacity for
emotional regulation over the lifespan, as children become more independent or when
a pet is not available?
5. The design of managed nature. Are urban green spaces designed with the needs of
local children in mind? Future work should investigate the role of children as
decision-makers in the research and design process.
6. Inequality. To what extent is access to nature for low-income and minority children,
especially in urban parks, less about proximity to green spaces and more about
perceived safety, poverty, and related social factors? What are some potential
solutions for inequality of access to nature or ways to remove existing social barriers
to safe urban parks?
7. Health and stress. What is the mechanism and the extent to which biodiversity affects
immune functioning and diseases? To what extent does nature experience ameliorate
the impact of stressful life events, such as family relocation or bullying?
8. Cognition and beliefs. How does children’s folkbiology, that is, their everyday
untutored understanding of nature, affect their behaviour during their childhood, but
also their later environment-related choices as adults? Is environmental generational
amnesia (EGA), the phenomenon that as environmental degradation increases across
historical time, each generation’s standard for environmental quality is weakened?
9. Virtual nature and technology. Is simulated nature as beneficial as real nature? Will
children accept it as an adequate substitute for enriching their experiences of real
nature, or will it have no benefits or, worse, negative impacts on children? Might real
and virtual versions of nature be combined to maximize benefits to children? Might
such technologies as global positioning system (GPS) tracking and mobile phones
generate valuable real-time data about children’s behaviour while they in natural
settings?
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TABLE OF CONTENTS

INTRODUCTION: THE SHRINKING NATURE EXPERIENCE OF CHILDREN ................. 6

Diminishing Access to Nature ............................................................................................. 6
Barriers to Children’s Access to Nature ................................................................................ 7
Parents as gatekeepers ...................................................................................................... 7
Media and technology ....................................................................................................... 7
Socio-structural constraints ............................................................................................. 8
Breaking the barriers ....................................................................................................... 8
INNATE BONDS WITH NATURE: ......................................................................................... 8
THEORETICAL PERSPECTIVES ........................................................................................... 8
Ecopsychology and the “Ecological Unconscious” .............................................................. 8
Evolutionary Perspective: The Biophilia Hypothesis .......................................................... 9
STUDYING CHILDREN AND NATURE ................................................................................ 10
Defining Nature .................................................................................................................. 10
Research Methods............................................................................................................... 11
Qualitative approaches.................................................................................................... 11
Quantitative approaches ................................................................................................. 12
BENEFITS OF NATURAL PLAYGROUNDS.......................................................................... 13
CREATIVITY AND PLAY ....................................................................................................... 13
SOCIAL AFFILIATION .......................................................................................................... 14
PHYSICAL HEALTH .............................................................................................................. 15
Stress Buffer and General Health Enhancer....................................................................... 16
Physical Activity .................................................................................................................. 16
Obesity and Weight Control ............................................................................................... 17
Fitness Skills ....................................................................................................................... 19
Neonatal Weight ................................................................................................................. 19
Asthma and Immunity ....................................................................................................... 20
Myopia ................................................................................................................................ 21
Poverty-related Health Disorders ....................................................................................... 21
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MENTAL HEALTH ............................................................................................................... 22

Distress and Psychological Health..................................................................................... 22
Psychological Restoration and Improved Mood................................................................ 23
Concentration and Self-control ......................................................................................... 24
NATURE THERAPIES .......................................................................................................... 26
Wilderness Therapy ........................................................................................................... 26
Children and Animals ........................................................................................................ 28
Pet ownership and companionship ................................................................................ 28
Animals in therapeutic context ...................................................................................... 29
COGNITIVE DEVELOPMENT AND UNDERSTANDING NATURE ................................... 30
Folkbiology: Children’s Naïve Understanding About Nature ............................................ 31
Moral Development and Environmental Values ............................................................... 32
Environmental generational amnesia .............................................................................33
Technically-simulated nature ........................................................................................ 34
RECOMMENDATIONS FOR FUTURE RESEARCH ............................................................ 36
Methodological Directions ................................................................................................. 36
The need for more controlled studies ............................................................................ 36
The need for balanced methodology .............................................................................. 36
The need for interdisciplinary work................................................................................ 37
The need for methodological innovation ........................................................................ 37
Children as part of participatory research ..................................................................... 38
Gaps in Research ............................................................................................................... 38
Nature and benefits to adults ......................................................................................... 38
Family systems ............................................................................................................... 39
Targeted, magnitude effect-oriented reviews ................................................................ 39
Environmental Equity .................................................................................................... 40
CONCLUSIONS ...................................................................................................................... 41
APPENDIX: METHODOLOGY ............................................................................................. 43
REFERENCES ....................................................................................................................... 44
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“Natural environments represent dynamic and rough

playscapes…The topography, like slopes and rocks, afford
natural obstacles that children have to cope with. The
vegetation provides shelters and trees for climbing. The
meadows are for running and tumbling.” Fjørtoft (2001), p. 111

INTRODUCTION:
THE SHRINKING NATURE EXPERIENCE OF CHILDREN

Although nature obviously can be detrimental to children (and others) through natural
disasters, disease vectors, accidents, and some predatory animals, this report focuses on the
benefits of nature. Its goal is to set out what science already knows about nature’s benefits
for children, thereby helping to clarify what is not yet known.

Concerns about increasing disconnection from nature were expressed over a century ago by
the influential American philosopher William James. In his essay entitled “On a Certain
Blindness in Human Beings,” which appeared radical at the time, James (1899/2008)
asserted that humans are desensitized by materialistic concerns in their contrived settings,
and that the antidote is to reawaken sensibility by returning to “a more profound and
primitive level” (p. 135).

How does this unprecedented separation from the natural world impact children's
development? Until recently, James’ assertion had not undergone scientific scrutiny. This
report reviews evidence about the role of access to nature in children’s well-being. It begins
with problems associated with children’s increasingly sedentary lifestyle, which is
characterized by controlled, interior spaces, electronic distractions, and substitution of
virtual knowledge for direct-contact knowledge. Theoretical perspectives are presented to
explain our innate affinity with nature and why living in disconnection of our ecological
context may be psychologically damaging. The main methodological approaches on the
study of children and nature are described. Next, the report reviews the benefits of time and
activities derived from spending time in nature, including enhanced creativity, social
affiliation, physical health, mental health, concentration, cognitive development, and moral
development, as well as therapies based on nature. The report dedicates a section to
discussing whether companion animals and virtual (simulated) nature are beneficial to
child development. Finally, we suggest a number of methodological directions and gaps in
knowledge that should serve as fruitful starting points for future research.

Diminishing Access to Nature

Over the last five decades, children’s recreational activities have radically changed, given
that they spend considerably less time outdoors than their predecessors (e.g., Bodrova &
Leong, 2003; Evans, 1995; Hofferth & Curtin, 2005; White, 2004). Evidence for this trend
has been collected through online surveys, children’s time-use diaries, and data on visits to
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specific nature destinations. For example, in a survey of 830 mothers in the United States,
87% reported playing outdoors every day as children, but only 31% of their 3- to 12- year-
old children did so (Clement, 2004). A survey of 1,150 English adults found similar
generational differences (England Marketing, 2009). The National Kids Survey, which
collected data between 2007 and 2009 on 3,000 households, found that nearly two-thirds
of children were spending at least two hours a day outside (Cordell, Betz, & Green, 2009),
but nature-based recreation activities (e.g., hiking and camping) were less commonly
reported than other outdoor alternatives (e.g., sports, hanging out with friends, and using
electronic devices outdoors). However, that study is relatively recent. In a much longer (30-
year) longitudinal study of a representative US sample, researcher-administered time
diaries revealed that time spent in outdoor activities among children under the age of 13
declined by 16% between 1981 to 1997, followed by further decline of 10% among children
ages 6 to 12 between 1997 to 2003 (Hofferth, 2009; Hofferth & Sandberg, 2001). Pergams
and Zaradic (2008) provided further evidence for a fundamental shift away from nature-
based activities: from 1939, the number of visits to U.S. National Parks ceased trending
upward and has fallen steadily at about 1.2% annually since the mid-1980s, despite
increased numbers of protected lands.

Barriers to Children’s Access to Nature

Parents as gatekeepers

Several constraints on children’s use of outdoors should be noted. Research has shown that
parents are the “gatekeepers” (Beets, Vogel, Chapman, Pitettie, & Cardinal, 2007) whose
perception and fear are the major factor on restricting children’s use of outdoor nature
(Carver, Timperio, & Crawford, 2008; Gaster, 1991; Rasmussen, 2004; Weir, Etelson, &
Brand, 2006), not objective indicators of neighbourhood safety (Beets & Foley, 2008).
Increased media coverage of criminal activities (Pyle, 2002), fear for potential play injuries
(Groves & McNish, 2008), strangers and gangs (Veitch, Salmon, & Ball, 2008), liability
lawsuits (Clements, 2004), and anxieties about insect-borne illness, ultraviolet rays, and
pollution (White, 2004) may all contribute to the recent culture of “paranoid parenting”
(Furedi, 2008).

Media and technology

The proliferation of digital media and technology is another major obstacle to children
spending time in nature (Clements, 2004; Rideout, Vandewater, & Wartella, 2003). Data
vary on the amount of time preschool children spend in “screen time,” from 4.6 hours (The
Nielsen Company, 2009) to 2.2 hours per day (Rideout, Foehr, & Roberts, 2010). The
American Academy of Pediatrics (AAP, 2011) advises no screen time for children under the
age of two, and less than two hours a day for older children. Digital screening has been
associated with reduced social interaction, less time spent doing homework, less outdoor
and creative play (Vandewater, Bickham, & Lee, 2006), attentional problems (Christakis,
Zimmerman, DiGiuseppe, & McCarty, 2004), poor academic achievement (Comstock, 1995;
Hofferty & Curtin, 2005), loss of self-confidence (Henderson, Zimbardo, & Graham, 2001),
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loneliness and depression (Kraut et al., 1998), snacking on unhealthy food (Christakis,
2006), childhood aggression and diminished prosocial behaviour (e.g., Anderson &
Bushman, 2001), as well as more materialistic values and less environmental concern
(Good, 2007).

Socio-structural constraints

Socio-structural constraints on access to nature include increased residential density,

disappearing open space, poor urban planning, and neighbourhood design (Churchman,
2003; Handy, Cao, & Mokhtarian, 2008; Varney and van Vliet, 2005), household size
(Baum, Hayes, van Gellecum, & Hoon, 2006), and poverty (Sutton, 2008; Thomas &
Thompson, 2004). For example, in Melbourne, 8- to 12-year old children with lower-SES
must travel more than twice as far as higher-SES children to reach their nearest parks
(Veitch, Salmon, & Ball, 2008). In the UK, racial and economic inequality of access to
nature has also been documented: neighbourhoods with over 40% of black or ethnic
minority residents have 11 times less local green space in their neighbourhoods than
relatively affluent, predominantly white communities (CABE, 2010). This highlights the
importance of considering all subgroups of children and different socio-spatial contexts.
The development of green spaces should be tailored at least in part to local demographic
needs. Evidence that this is routinely done is lacking.

Breaking the barriers

In 2005, Richard Louv published his influential book, “Last Child in the Woods: Saving Our
Children from Nature Deficit Disorder.” It alarmingly highlights the health, social, and
environmental costs of the increasingly sedentary lifestyle led by American children. A
rapidly growing literature documents that children in contemporary societies are deprived
of experiences in nature that offer sensory stimulation, physical challenges, exploration and
creative play in support of optimal development (e.g., Faber Taylor & Kuo, 2006). Since the
publication of Louv’s book, public interest has grown in tandem with scientific journals
such as Children, Youth, and Environments and non-profit organizations such as the
Children and Nature Network, to support grassroots movements to re-connect children
with nature.

INNATE BONDS WITH NATURE: THEORETICAL PERSPECTIVES

Ecopsychology and the “Ecological Unconscious”

One theoretical perspective that proposes we have an innate bond with nature,
ecopsychology, adopts a therapeutic orientation, emphasizing the potential for mutual
healing between planetary and personal well-being. According to Theodore Roszak (1992),
the core of the human mind is the ecological unconscious, defined as a primal bond between
humans and the natural world in which we evolved. A fundamental premise of
ecopsychology is that modern living suppresses the conscious recognition of this innate
interconnectedness with nature, as we exploit and dominate nature and mistakenly pursue
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extrinsic goals to fulfill our intrinsic needs (Kanner & Gomes, 1995). To simultaneously
awaken the ecological unconscious and help restore the ecology, ecopsychologists utilize
techniques such as ecotherapy (the practice of psychotherapy in nature settings), outdoor
meditation, wilderness retreats, environmental restoration, and contact with animals
(Roszak, Gomes, & Kanner, 1995). Because ecopsychology is more speculative than
empirical, its work is largely overlooked in mainstream scientific, evidence-based
psychology (Reser, 1995).

Evolutionary Perspective: The Biophilia Hypothesis

According to the evolutionary perspective, because we humans evolved in wild habitats for 2
million years, we are better adapted in natural environments than cities, which are only
about 10,000 years old. Because of our ancestral roots in nature, the biophilia hypothesis
proposes that humans have universal, unlearned affiliation with nature and an “innate
tendency to focus on life and lifelike processes” (Wilson, 1984, p. 1).

Empirical evidence for the biophilia hypothesis focuses primarily on positive affective
responses to natural settings and many other species. People from diverse cultures
generally prefer natural over built settings (e.g., Korpela, Hartig, Kaiser, & Fuhrer, 2001;
Newell, 1997; Thomashow, 1995) and report intense spiritual awakening while in nature
(e.g., Frumkin, 2001; Hartig & Staats, 2007; Maller, Townsend, Pryor, Brown, & St. Leger,
2006). Children also value play settings that are relatively free of restrictions and human
intervention (Chawla, 1990; Hart, 1979; Kellert, 2002; Pyle, 1993). Certain landscape
features that are aesthetically appealing, such as bodies of water, vegetation, and expansive
views, are both therapeutic and evolutionarily beneficial for survival (Gullone, 2000; Ulrich,
1993; Kahn, 1999; Wilson, 1984).

Further evidence for biophilia concerns children’s instinctive nurturing tendencies towards
animals (Beck & Katcher, 2003; Myers & Saunders, 2002). Young animals elicit tender
reactions and caretaking not only because they share many neotenic (baby-like) features
(e.g., proportionally large eyes and high forehead) that are commonly perceived as cute
(Gaulin & McBurney, 2003), but because primitive humans were more attached to and
dependent on their pets for survival, for example as watchkeepers for predators (Inglod,
1994; Katcher & Wilkins, 1993).

The feeling of kinship with nature also encompasses the automatic aversion to some aspects
of nature (Kahn, 1997; Wilson, 1984). Biophobia, or repulsiveness to certain dangerous
natural stimuli, such as snakes and spiders, evokes fight-or-flight responses that are
evolutionarily adaptive, given that humans are vulnerable to predators and other poisonous
species (Bixler & Floyd, 1997; Orr, 1993; Ulrich, 1993) Biophobic responses are readily
acquired in children and are more resistant to extinction than culturally conditioned
dangerous objects, such as guns (Öhman, Dimberg, & Öst, 1985).

However, children can simultaneously exhibit fearful orientations and moral affiliation
toward potentially threatening natural objects. In one interview with 6- to 12- year old
children who were leaving a bat exhibit in Brookfield Zoo, although some feared bats, they
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still cared about them, attributed feelings to them, accorded their right to live free, and
“kind of liked” the thrilling visit (Kahn, Saunders, Severson, Myers, & Gill, 2008). However,
along the biophobia-to-biophilia continuum is a large range of degrees, qualities, and
complexities of emotions that have not yet been mapped for children.

Some researchers argue that without additional learning about, cultural connections to, and
experience of nature, genetic factors alone are insufficient to optimize biophilic tendencies
(Kahn, 1999; Kellert, 2002). The nature versus nurture debate has subsided; the prevailing
paradigm is that human development is shaped by intricate interplay between inherited
(nature) and environmental (nurture) influences (e.g., Keating, 2011). Genetic biophilic
predispositions, which trigger instant reactions conducive to ancestral survival are
suppressed by contemporary lifestyles unless they are awakened by active engagement in
nature (Dubos, 1980; Ulrich, 1993). The wild landscapes may be considered an
“environment of evolutionary adaptedness” (EEA), a term used by evolutionary scientists to
define the contexts in which our ancestors evolved. EEA describes a set of selection
pressures that shape adaptations (Gangestad & Simpson, 2007). To re-establish our
connection with nature, more frequent unsupervised play in natural environments is not
only necessary to foster biophilia but also for providing an optimal avenue for child
development (e.g., Orr, 1993)

Prospect-refuge theory (Appleton, 1975), another evolution-based idea, predicts that people
prefer places which allow them to see without being seen, as the result of our primitive
desire for safety (refuge) while keeping close watch on our surroundings (prospect).
Characteristics of children’s favorite places also tend to be associated with autonomy and
escape from adult supervision (Mergen, 2003), opportunities for exploration and adventure
(Derr, 2006), as well as refuge and a corresponding sense of privacy and security (Kirkby,
1989).

Importantly, however, empirical data on these theoretical bases of the child-nature relation
primarily focus on how children understand and evaluate nature, rather than on how nature
influences their growth. In order to better examine whether children need nature can be
empirically established, several methodological approaches typically used in empirical
studies are described next.

STUDYING CHILDREN AND NATURE

Defining Nature

Most “natural environments” are in some measure affected by human artifice and control
(Tuan, 1978). Others that are relatively uninfluenced by human inhabitants are known as
“wildness.” Clayton and Myers (2009) classified nature into four categories: Domestic
nature (e.g., indoor plants, companion animals), nearby nature (parks, gardens, urban
greenery), managed nature (e.g., forests, zoos, fisheries), and wild nature, including remote
areas (e.g., the open ocean). Louv (2008) construed nature as being beyond restrictive
terms, while emphasizing biodiversity and abundance: “For children, nature comes in many
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forms. A newborn calf; a pet that lives and dies; a worn path through the woods; a fort
nested in stinging nettles; a damp mysterious edge of a vacant lot-whatever shape nature
takes, it offers each child an older, larger world separate from parents” (p. 7). This review
considers nature to be a domestic-managed-wild continuum, with the presence of some
natural process as the common denominator (Carver, Evans, & Fritz, 2002; Nash, 1982).

In different studies, definitions of nature vary, depending on the context within which
nature is operationalized and measured. In an urban context, for example, nature can be
defined as any natural element accessible to children, such as their green schoolyard. What
constitutes “contact” also varies across studies. Contact might be slides of savannah-like
landscapes in a child development laboratory, “boot camp” activities for young clients in a
juvenile justice system, or children holding companion puppies on their laps. These various
conceptualizations of nature reinforce the notion that nature can be experienced in many
ways (Clayton & Opotow, 2003). In general, an encouraging pattern of results has emerged
from the use of various measures, designs, and populations in the literature; it
demonstrates that children’s experience in nature settings, across various forms of contact,
is beneficial to their development (Clayton & Opotow, 2003; Kahn, 1999; Kahn & Kellert,
2002; Kellert, 2002).

Research Methods

Qualitative approaches

In general, research studies may be classified as qualitative or quantitative. Qualitative (or,

sometimes “ethnographic”) methods include observation, interviewing, autobiography,
document analysis, reports of parents and teachers, or giving children cameras and asking
for their interpretation of “nature.” Observational methods, which describe children’s
typical behaviour patterns in natural settings are often credited for their ecological validity.
Classic studies by Hart (1979) and Moore (1986) utilized participant-observation methods:
the researcher strolled along with children and asked them to show, map, and talk about
familiar places. These studies described children’s preferences for wilderness and
unstructured landscapes for play. In other “walk-along” studies, the researchers
accompanied children in their neighbourhood, walking through familiar routes while
interviewing them about their activities and place engagements (Lim & Calabrese Barton,
2010). These child-participatory methods empower young people to express their concerns
and to contribute ameliorating suggestions for their communities (Hart, 1997).

Although observational methods are interwoven with contextual description and provide a
rich “written photograph” for the situation under study (Erlandson, Harris, Skipper, & Allen,
1993), the data nevertheless lack information about children’s specified feelings and
experiences. One approach is to use psychometric instruments to measure constructs such
as ecological knowledge or relatedness to nature. Another method is to ask adults to
reflectively re-construct their childhood experiences and meaning. One series of studies on
“significant life experiences” among dedicated environmentalists employed
autobiographical reminiscences of their childhood experiences and found that emotional
affinity formed early in life with nature shaped a life-course trajectory of ecological concern
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and actions (e.g., Corcoran, 1999; Sward, 1999, Tanner, 1980). Because these studies focus
exclusively on environmental activists, further research is necessary to examine long-term
effect of nature experience among the general population. Such work could offer important
insights about the construction of ecological values (Wells & Lekis, 2005).

Quantitative approaches

The putative healing power of nature has drawn diverse disciplinary interests and
practitioners, ranging from ecologists, landscape architects, and nature kindergarten
protagonists to horticultural therapists. The rich diversity of work addressing this topic is
heartening, but the plethora of often- weak findings are sometimes accompanied by
extravagant claims. What is the substantiated evidence for the value of nature in promoting
child development?

In recent decades, the literature on the benefits of “contact with nature” has undergone
rigorous scientific scrutiny and assessments. Studies that rely on what relatively small,
biased, or self-selected samples (e.g., parks advocates or nature lovers) report (or believe)
have been increasingly replaced by quantitative studies that use objective measures with
samples that have no particular pre-relationship with nature (e.g., children from urban low-
income families). In these studies, “nature” has been better quantified, such as objective
distance to the nearest park. Benefits are measured objectively, in terms of such measures
as youth crime statistics, blood pressure, physiological measures of immune system
functioning, performance on standardized tests, and with behavioural tracking methods
such as pedometers and accelerometer.

A major strength of a well-controlled experiment is its ability to establish definitive causal

inferences, the essence of scientifically valid research. However, randomly assigning
children to different experimental conditions is often not ethical or feasible. One solution is
the naturalistic experiment, which came into prominence in environmental psychology in
the 1960s and 1970s, advocated by pioneers such as William Ittelson, Harold Proshansky,
and Roger Barker (see Proshansky, Ittelson, & Rivlin, 1975). Some recent naturalistic
experiments on the effects of natural landscapes on human functioning have been
conducted by Frances Kuo and her colleagues (see Kuo, 2002, for example). Much of their
research was conducted in Chicago public housing neighbourhoods, where demographically
similar residents reside in architecturally identical buildings. Quasi-random assignment in
this work came in the form of applicants on a waiting list taking units as soon as they
became available (i.e., chance mainly ruled the assignment to live in any one of the building
units). This automatically varied the presence or views of trees, bushes, grass, or other
natural elements around or from a unit or building. This series of naturalistic experiments
demonstrated that residents, including children, who had a view of vegetation performed
better on several social, psychological, and physical health measures (for a list of studies,
see Kuo, 2002). Chicago public housing research has stimulated many other studies that
compared children’s mental and health outcomes among different levels of vegetation or
distance to green spaces (for reviews, see Chawla, 2015; Lester & Maudsley, 2007; McCurdy,
Winterbottom, Mehta, & Roberts, 2010; Muñoz, 2009; Pretty et al., 2009; Ward Thompson,
Travlou, & Roe, 2006; Woolley, Pattacini, & Ward, 2009).
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BENEFITS OF NATURAL PLAYGROUNDS

The right of children to play is ordained in Article 31 of the United Nations Convention on
the Rights of the Child (Office of the United Nations High Commissioner for Human Rights,
2008). Play is spontaneous, personally directed, intrinsically motivated, and free from
externally imposed rules or social demands (Rubin, Fein, & Vandenberg, 1983). It is said to
be the mechanism through which maturation occurs (Moore, Goltsman, & Iacofano, 1992),
and the means by which children learn without being taught through doing, exploring, and
discovering. The American Association of Pediatricians emphasizes the need for frequent
unstructured, free play time for children’s optimal development (Ginsburg, 2007).

Children have a unique attraction to natural environments. Many studies have

demonstrated that children generally prefer to play in natural areas over playing on turf or
asphalt (e.g., Department of the Environment, 1973; Korpela, 2002; Lucas & Dyment, 2010;
Sebba, 1991; Sobel, 1993). For example, in a classic ethnographic study by Moore (1986),
when children who live in urban areas were asked to draw or map their favorite places, 96%
of the illustrations were of outdoor places depicting lawns, schoolyards, local parks, and
single trees.

Natural playgrounds differ from artificial environments in several ways. The terrain is more
varied and uneven and has a wide range of irregular obstacles that offer unique physical
challenges for cultivating fitness and motor skills (Fjørtoft, 2001; Pellegrini, 2005). Natural
landscapes are also inherently complex, dynamic, and often disordered (Bixler, Floyd, &
Hammitt, 2002; Heft, 1988). A large supply of diverse objects, changing natural
phenomena, and close encounters with other creatures provide mental and sensory
stimulation while offering multiple avenues for diverse activities, exploration, divergent
thinking, imagination, and creativity (Cobb, 1977; Faber Taylor, Kuo, & Sullivan, 2001).

CREATIVITY AND PLAY

Green space has often been linked to more imaginative, constructive, and creative play and
longer sessions of play than on built equipment or constructed playgrounds. This has been
empirically supported by several studies on school grounds, residential courtyards, and
childcare centres where children’s behaviour was observed in different settings (with less or
more vegetation), or before and after a site was green-designed (Blizard & Schuster, 2004;
Cloward Drown & Christensen, 2014; Cosco, 2007; Fjørtoft & Sagaie, 2000; Grahn,
Martensson, Lindblad, Nilsson, & Ekman, 1997; Herrington & Studtmann, 1998; Kuh,
Ponte, & Chau, 2013; Luchs & Fikus, 2013; Moore & Wong, 1997; Samborski, 2010; Stanley,
2011).

In one of the Chicago urban public housing studies (Faber Taylor, Wiley, Kuo, & Sullivan,
1998), the level of vegetation in 64 outdoor spaces in a relatively poor neighbourhood of
predominantly African-American families was measured from aerial imagery. Three- to 12-
year-old children who were observed in the green spaces engaged in more play, performed
more creative play, and had more access to adults (who indirectly foster social development)
 Children and Nature - Page 14

than children in less-vegetated spaces. The authors suggested that physical environment
might ameliorate risks associated with poverty by supporting creative activities that are
crucial to development.

Similarly, Nedovic and Morrissey (2013) conducted an action research project that involved
re-development of a daycare centre in Melbourne. During the planning phase, when 3- and
4-year old children were consulted on what they would like to see in their outdoor play area,
their responses overwhelmingly showed a preference for natural elements. After the
implementation of the new features, teachers described positive changes in the children’s
behaviour, particularly richer and more imaginative play. As one staff member observed,
“The children have become dinosaurs and the pebbles are their food. The children have
become babies and the pine cones are their bottles. The children have become lizards and
they must find water to survive” (Nedovic & Morrissey, 2013, p. 288– 289).

Nature landscapes not only offer developmentally significant play behaviours that are
functional (running, climbing) or symbolic (dramatic and role-playing), but also
constructive (e.g., building huts and objects; Frost, 1992) As prospect-refuge theory
(Appleton, 1975) predicted, children tend to seek out naturally occurring shelter or actively
shape or construct shelters that afford safety and protection (Hart, 1979; Matthews, 1992).
In a Seattle preschool yard, children engaged in more dramatic play in green spaces
compared to built areas, particularly in places that afforded a greater sense of enclosure
(Kirkby, 1989). The most popular play area was a cluster of shrubs at a corner of the
playground, where children created hideouts and transformed the shrubbery into imaginary
spaces such as forts, a house, or a spaceship. Over the years, children had built rooms,
pathways, and tunnels throughout the vegetation. Kirkby argued that children in private
spaces were less distracted and more engrossed, which enhanced their ability to engage in
play.

A school’s philosophy about the use of outdoor environment is also important, not only the
actual physical design of the environment. In a study by Malone and Tranter (2003), eight-
to ten-year-old children’s play behaviour was observed in several Australian primary
schools. Children exhibited more exploration, imaginative playing (role-play, drama,
fantasy), and construction of huts and objects when the schoolyard had natural spaces and
when the school valued the outdoor school environment.

SOCIAL AFFILIATION
Children’s play can enhance their social competence and emotional maturity (Piaget, 1962;
Rubin, Fein, & Vandenberg, 1983). Through pretend or dramatic forms of play, children
develop peer relationships as they learn important skills, such as cooperation, altruistic
behaviour, self-control, social roles, conflict management, language, problem-solving, and
emotional regulation (Howes, 1988; Howes & Matheson, 1992).

Nature playscapes are associated with more dramatic social play (Dyment & Bell, 2008;
Herrington & Studtmann,1998). For example, Fjørtoft (2004) reported that among five- to
seven-year-old children, a widely branched juniper bush was highly favored because it
 Children and Nature - Page 15

offered possibilities to hide, with access to the outside. A group of 12 children performed
several forms of social play there, including games of house, Indians and cowboys, pirates,
and Star Wars.

Nature playscapes differ from traditional playgrounds in several ways that support social
development. Play in green settings appears to be more socially inclusive; boys and girls
tend to play more together and are less age-segregated (Fjørtoft, 2004). Traditional
playgrounds primarily address children’s physical development, whereas the introduction
of natural materials promotes additional cognitive, social, and emotional skills. In one
“landscape-based” study, Herrington and Studtmann (1998) examined the relations
between landscape type and children’s social play. In an equipment-based playground,
physical prowess was the means for establishing the social hierarchy among 2- to 6-year-old
children. Leaders in the social strata were usually children who were stronger, faster, and
able to climb higher. After the installation of plant material, the use of play equipment
decreased, and the vegetated space became a prime place for socialization and fantasy play.
The basis of social hierarchy changed to “a child’s command of language and their creativity
and inventiveness in imagining what the space might be” (Herrington & Studtmann, p. 203).

PHYSICAL HEALTH
Despite the expansion of pediatric health care and advances in biomedical science in the
past few decades, childhood chronic health conditions, including obesity, asthma, are still
increasing (Mithal et al., 2009; Perrin, Bloom, & Gortmaker, 2007). Children with these
health conditions are at risk of developing pulmonary and cardiovascular disease in
adulthood. One of the major culprits is increasingly sedentary indoor lifestyle. If this trend
is not abated, the current generation of children may be the first to have shorter life
expectancy than those of their parents (Olshansky et al., 2005). Thus, more work is urgently
required to promote long-term prevention methods such as promotion of outdoor activities
in nature.

In the neuroscience literature, outdoor elements have been found to provide benefits that
can serve as important preventive ingredients in children’s health. For example, Vitamin D
is essential for healthy development of bones, muscles, and neurons, as well as lessening
depressive symptoms and increasing feelings of vitality (Knippenberg et al., 2014). Vitamin
D deficiency from a lack of sun exposure can lead to rickets in children (Ginde, Liu, &
Camargo, 2009). Another example comes from a strain of healthy bacterium,
Mycobaterium vaccae, that are found in healthy soil. Through gardening, playing, or
ingestion (e.g., eating unwashed organic foods), contact with soil can actually help children
avoid asthma and atopy (Ege et al., 2011), alleviate symptoms of depression and chronic
fatigue (Dinan, Stanton, & Cryan, 2013; Messaoudi et al., 2011), and improve cognitive
functioning (Montiel-Castro, González-Cervantes, Bravo-Ruiseco, & Pacheco-López, 2013).
Thus, contact with natural elements operates as important preventive “ingredients” or
natural interventions for children’s health.
 Children and Nature - Page 16

Stress Buffer and General Health Enhancer

Many studies with adults have shown nature to buffer stress, using blood pressure
reductions and cortisol levels as biomarkers for assessing stress (see review, Hartig,
Mitchell, de Vries, & Frumkin, 2014). Other physiological measures, along with subjective
sense of health and well-being, have recently been incorporated in studies focusing on
children. For example, Soderstrom et al. (2013) examined how the quality of the outdoor
environments of 9 Swedish child day care centres affected the health of children aged 3 to 5.
Health outcomes were measured by body mass index, waist circumference, saliva cortisol,
length of night sleep, and parental report. The quality of environment was assessed by the
total outdoor area and the amount of trees, shrubbery, and hilly terrain. Children in higher-
quality environments retained healthier body shapes, slept longer at night, and maintained
better wellbeing. In another study, urban German ten-year-olds who lived in areas with
more residential greenness, assessed by vegetation cover from satellite images, had lower
blood pressure, independent from potential confounding environmental stressors, such as
temperature, air pollution, and noise (Markevych et al., 2014b). In a pre-post quasi-
experimental study, the re-design (greening) of a rural Austrian schoolyard decreased blood
pressure and enhanced self-reported psychological well-being among middle school (13-15
years of age) pupils, whereas students in the control school (no intervention) displayed
slightly increased physiological stress over the same time period (Kelz, Evans, & Röderer,
2015).

Similar findings were revealed in other large-scale studies using parental reports or
children’s self-assessments of general subjective wellbeing. In a nationally representative
Scottish sample of 3586 children (averaged 5.9 years of age), mother’s perceived walking
distance from home to the nearest green space was associated with children’s general health.
Specifically, children living more than 20 minutes walking distance from a green space
spent more than 2 hours of weekly TV time, had worse general health ratings, but were
more likely to live in lower socioeconomic households (Aggio, Smith, Fisher, & Hamer,
2015). However, after controlling for the socioeconomic status of 1837 10- to 15-years old
Finnish children, perceived health and reported well-being were associated with larger
amount of green structure around their homes (Kyttä, Broberg, & Kahila, 2012).

Physical Activity

Driven by the epidemic prevalence of pediatric obesity in the United States and other
developed nations, level of physical activity is the most frequently studied topic in the
literature of children’s engagement with nature. The principle is that regular physical
activity helps build and maintain healthy bones and muscle, which in turns helps energy
expenditures and reduces the risks of osteoporosis and obesity (Andersen, Hasselstrom,
Gronfeldt, Hansen, & Karsten, 2004; US Department of Health and Human Service, 2008).

The positive relation between neighbourhood green space and levels of physical activity is
most strongly supported by empirical evidence (Gill, 2014). Christian and colleagues (2015)
conducted an extensive review of 22 studies on the relation between neighbourhood green
 Children and Nature - Page 17

space and early health development from birth though age of seven. In most of these studies,
physical activity was positively associated with neighbourhood density of vegetation
(Grigsby-Toussaint, Chi, & Fiese, 2011; Lovasi et al., 2011), access to parks (Roemmich et al.,
2006), community playground (Quigg, Reeder, Gray, Holt, & Waters, 2011; Sallis et al.,
1993), and urban housing outdoor green space (Aarts, Wendel-Vos, van Oers, van de Goor,
& Schuit, 2010; Faber Taylor, Wiley, Kuo, & Sullivan, 1998). Moreover, studies by De Vries,
Baker, van Mechelen and Hopman-Rock (2007) in the Netherlands and by Janssen and
Rosu (2015) in Canada also found that the proportion of neighbourhood green space is
associated with greater physical activity. Although most of these studies are correlational in
nature, longitudinal and interventional studies are necessary to examine whether a causal
relation exists.

Proximity to green space is an important prerequisite for physical activity. Although

definitions of “proximity” vary across studies, they generally refers to distances within 500
to 800 meters. In one review of 32 studies that examined characteristics and components of
parks that motivate young people (8-21 years old) to be active, the ease of access to green
space, measured either as the distance from one’s home to public parks or the percentage of
green coverage in their neighbourhood, was the most frequent predictor of physical activity
(Gardsjord, Tveit, & Nordh, 2014).

Schoolgrounds with greater diversity of environmental features encourage children to get

moving. For example, a study of 11 Swedish pre-schools revealed that 4- to 6-year-old
children took more steps in environments that contained richer vegetation of trees, shrubs,
and uneven ground than preschool outdoor sites with limited vegetation (Boldemann et al.,
2006). Greening schoolgrounds can diversify the play repertoire by providing a wider array
of physical activities, such as jumping, climbing, digging, lifting, raking, building, and role
playing, that nurture all aspects of their development. In a study of 59 schools across
Canada that underwent greening projects, reports from teachers, parents, and
administrators indicated that through greening, schoolgrounds provide various
opportunities for boys and girls of all ages, interests, and abilities to be more active
(Dyment & Bell, 2008). Thus, green schoolgrounds increase the range of enjoyable, non-
competitive, open-ended forms of light to vigorous play, in contrast to more structured,
competitive, rule-bound sports and games on asphalt and turf grounds.

Obesity and Weight Control

The association between proximity to green spaces and healthy weight among children has
been empirically supported by many studies (e.g., Alexander, Huber, Piper, & Tanner, 2013;
Bell, Wilson, & Liu 2008; Dadvand et al., 2014; Fan & Jin, 2014; Kim, Lee, Olvera, & Ellis,
2014; Liu, Wilson, & Ying, 2007; Lovasi et al., 2013; Ohri-Vachaspati, Lloyd, DeLia, Tulloch,
& Yedidia, 2013; Veugelers, Sithole, Zhang, & Muhajarine, 2008; Wall et al., 2012; Wolch et
al., 2011). Proximity to green space can also assist weight control among children who are in
long-term treatment for pediatric obesity. In a study of 8- to 12-year old overweight children
who underwent two-year family-based behavioural weight management program,
neighbourhood environment moderated the relation between obesity treatment and weight
 Children and Nature - Page 18

loss. In particular, across all interventions, access to parkland (within a 5-minute walk) and
fewer convenience stores were associated with greater BMI reduction (Epstein, Daniel,
Wilfley, & Roemmich, 2012).

Environments with more diverse landscape features may be more conducive to weight loss
than outdoor barren space. In one study, children who played in environments with more
trees, shrubbery, and hilly terrain spent longer time outdoors, took significantly more steps
per minutes, and more often had normal BMI and slimmer waists (Soderstrom et al., 2003).
Interestingly, children’s body shape was affected by everyday outdoor play in high-quality
environments, but not necessarily by physical activity itself. The authors suggest that fitness
interventions, a common approach to prevent childhood obesity, is complicated, time-
consuming, expensive, and often results in an impact of negligible clinical significance
(Puder et al., 2011). A more economically sound solution may be introducing environments
with lusher vegetation where physical activity increases naturally because children play
longer.

Notably, Potwarka, Kaczynski, and Flack (2008) argued that the availability of certain park
facilities, such as unpaved trails, play equipment, bike paths, and athletic fields that directly
support physical activity may play a more important role in maintaining healthy weight in
children. In their study, Canadian children who lived near a park facility that contained
playground equipment within 1 km of their homes were almost five times more likely to be
at a healthier weight than children without a park facility nearby. However, proximity to
park space alone or the number of parks nearby a children’s residence was not associated
with healthy weight status in this study (Potwarka, Kaczynski, & Flack, 2008). That is, park
facilities matter more than mere green space. Other studies also report that parks with
recreational facilities increase physical activity of young children (e.g., Epstein, Raja, Gold,
Palch, Pak, Roemmich, 2006; Roemmich, Epstein, Raja, Yin, Robinson, & Winiewicz, 2006).

However, some studies find no association between the distance to a park and weight status
(Burdette & Whitaker, 2004; Davison & Lawson, 2006; Liu, Wilson, Qi, Ying, 2007;
Potestio et al., 2009). Perhaps this is partly because the association between nearby green
spaces and physical activity often varies with gender, race, ethnicity, income, perception of
neighbourhood safety, and other factors (Pont, Ziviani, Wadley, Bennett, & Abbott, 2009).
To target chronic disease prevention and increase physical activity in general, Ding, Sallis,
Kerr, Lee, and Rosenberg (2011) suggest that policy should address a cluster of
environmental variables, including walkability, traffic speed and volume, residential density,
access to recreational facilities, in addition to proximity to green space itself.

Pediatric obesity is a complex, dynamic problem that results from a combination of multiple
causes and contributing factors. It should be examined in an ecological, political, socio-
economic context. A robust body of research demonstrates that, in many nations, residence
in low-income neighbourhoods and ethnic minority status result in children having less
access to green space or well-maintained parks, in particular parks with amenities, relative
to more advantaged households (Bolivar, Daponte, Rodriguez, & Sanchez, 2010, Estabrooks,
Lee, & Gyurcsik, 2003; Gordon-Larsen, Nelson, Page, & Popkin, 2006; National Recreation
and Parks Association, 2011; Powell, Slater, & Chaloupka, 2004; Wen, Zhang, Harris, Holt,
 Children and Nature - Page 19

& Croft, 2013). For example, in eight European cities, higher levels of obesity among low-
income children were linked, in part, to less access to green spaces and diminished physical
activity (Evans, Jones-Rounds, Belojevic, & Vermeylen, 2012). This is an environmental
justice issue, because access to parks is not equitably distributed in most cities, but is highly
stratified based on income and ethno-racial characteristics (Jennings, Johnson-Gaither, &
Gragg, 2012). Children, who comprise a vulnerable part of the population in terms of health
(Flaskerud & Winslow, 1998), are particularly at risk from unequal access to these
resources (Strife & Downey, 2009). Surprisingly, with the increasingly recognized need for
high-quality green spaces, relatively little research has focused on potential solutions for
inequality of access to nature or the active removal of existing social barriers to equal
opportunity for safe and well-maintained parks.

Fitness Skills

A few studies have demonstrated that experiences in natural environments might stimulate
greater motor ability, as children move around in rugged terrain and cope with physical
challenges (Fjørtoft, 2004; Frost, 2006; Grahn, Martensson, Lindblad, Nilsson, & Ekman,
1997). In a natural experiment, Fjørtoft (2001) measured the fitness skills of two groups of
Norwegian children: those who played freely in the forest next to their kindergarten
(experimental group) and children who used traditional playgrounds. Both groups were
tested with EUROFIT (Adam, Klissouras, Ravazollo, Renson, & Tuxworth, 1988), a set of 9
physical fitness tests covering flexibility, speed, endurance, and strength. For example, the
flamingo balance test (standing on one foot) measures general balance, plate tapping (rapid
tapping of two plates) assesses speed and coordination of limb moment, and the sit and
reach test measures the flexibility of the lower back and hamstring muscles. At the pre-test
(beginning of school year), the experimental group scored lower than the reference group.
At the post-test, nine months later, however, the children who played in the natural forest
scored significantly better on all test items. These results lead to the reasonable conclusion
that versatile play in a stimulating natural playscape has causal effect on motor fitness.
Similarly, a case study by Grahn and colleagues (1997) showed that kindergarten children
who had access to natural environmental elements within their playground area performed
better on the EUROFIT tests than children in a kindergarten with more traditional urban
playground. In another study, free-form play in a complex natural play setting (higher
diversity of topography and vegetation, as indicated by landscape ecology analysis) resulted
in greater physical motor development in comparison to a less-varied, manicured play
setting (Fjørtoft, 2004).

Neonatal Weight

Birth weight is a leading cause of neonatal and infant mortality, and an important predictor
of childhood adverse outcomes. In the past few years, the effects of urban greenery on foetal
development have gained considerable research interest on public health (e.g., Agay-Shay et
al., 2014; Hystad et al., 2014; Kihal-Talantike et al., 2013; Laurent, Wu, & Milesi, 2013;
Markevych et al., 2014a). A review of eight studies that examined the effects of residential
greenness of pregnant women’s living environment on the birth weight of their babies
 Children and Nature - Page 20

included 214,940 mothers from Europe, North America, and Asia. Seven of the eight studies
reported a positive association between neighbourhood greenness and birth weight. The
eighth study found this effect only for mothers in the lowest educational group, suggesting
that the benefits of residential greenness may be stronger for more disadvantaged groups
(Dzhambov, Dimitrova, & Dimitrakova, 2014). A number of possible mechanisms may
underlie the relation between green space and positive pregnancy outcomes, including
improved air quality, less noise, lower temperatures, psychological restoration, stress
reduction, and increased opportunities for social contracts and physical activity
(Richardson, 2014). Future studies that take into account of green space functionality and
quality, and mothers’ emotional connection to nature, may yield a clearer and more precise
explanation of this result.

Asthma and Immunity

Ethnic and socioeconomic disparities in asthma are substantial: children who live in poor
urban neighbourhoods have greater asthma morbidity and hospitalization rates (Gupta,
Carrión-Carire, & Weiss, 2006). Time spent outdoors may be linked to healthy immunity
development. In one study, Lovasi, Quinn, Neckerman, Perzanowski, and Rundle (2008)
collected tree density information and the prevalence of asthma incidence on 4- and 5-year-
old children living in New York City. After controlling for potential confounds (SES,
population density, and proximity to pollution sources), increases in tree density were
associated with a lower prevalence of childhood asthma. However, future work is needed to
evaluate whether a tree-planting intervention will establish a stronger causal inference to
the reduction of pediatric asthma.

A typical method for measuring amount of vegetation in studies of immunity and green
space is to use aerial imagery. However, this does not fully capture the biodiversity of
nearby nature. According to the biodiversity hypothesis, the rapid increase in the
prevalence of allergies, asthma, and other chronic inflammatory disorders in urban
populations is caused by the loss of biodiversity, which reduces contact to beneficial
environmental microbes which aid in essential immunoregulatory functions (Rook, 2009;
von Hertzen, Hanski, & Haahtela, 2011). In support of the biodiversity hypothesis, Finnish
adolescents who lived near greater biodiversity, assessed by the number of species of
vascular plants, had a higher diversity of healthy skin bacteria and less allergic disposition
(Hanski et al., 2012). Additionally, the relative abundance in human skin microbiota of
Estonian children and adolescents was explained by the proportion of forest and
agricultural land around their homes (Ruokolainen et al., 2015).

Future work is necessary to clarify the underlying mechanism and the extent to which
biodiversity affects immune functioning and diseases. Undoubtedly, the processes that link
human health and contact with environmental features are complicated, multifaceted, and
difficult to examine experimentally, yet the notion that microorganisms play a key role has
profound implications. Public health is at risk with rapid urbanization, deforestation and
reductions in the diversity of species. At the individual level, pediatric immune disorders
 Children and Nature - Page 21

can persist for a long time, and might cause disability and require continuous medical
treatment.

Myopia

Myopia, or nearsightedness, is a common condition in which images of distant objects are

out of focus. The prevalence of children diagnosed with myopia varies from 9.2% among 5-
to 17-years old American children (Kleinstein et al., 2003) to 49.7% in Swedish children
aged 12- to 13- years old (Villarreal et al., 2000). Increased illuminated screen viewing may
exacerbate increases in the prevalence of myopia. An Australian study among 12- year old
children revealed that higher levels of time spent outdoors, rather than sports and other
activities per se, were associated with less myopia, after controlling for parental myopia and
ethnicity (Rose et al., 2008). Consistent with this finding, a study in Singapore with 1249
children found that increased hours of outdoor activity were less likely to be myopic (Dirani
et al., 2009). In a natural experiment conducted in Taiwan, Wu, Tsai, Wu, Yang, and Kuo
(2013) compared 7-12-year old children in two elementary schools—one with an
intervention program, in which children were encouraged to engage in daily 80 minutes
outdoor activities during recess time, and the control school did not have this program
during recess. After one year, the progression and new cases of myopia were significantly
lower in the intervention group than the control group.

Poverty-related Health Disorders

Finally, access to green space may reduce income-related health inequalities by offering a
protective buffer against poverty-related stress. Mitchell and Popham (2008) classified
more than 40 million people in England on level of income and access to natural
environment, and obtained their mortality records. The association between income
deprivation and mortality varied with different amounts of exposure to green space. In
particular, the inequality in cardio-respiratory disease mortality related to income
deprivation was lower in urban populations with greater exposure to green space than those
with poor access (Mitchell & Popham, 2008). Similarly, in a Japanese longitudinal study,
living in an urban neighbourhood with relatively plentiful walkable green space was
correlated with a lower mortality risk (Takano, Nakamura, & Watanabe, 2002). The relation
between green space and health appears to be stronger for people with lower socio-
economic status and children (De Vries, Verheij, Groenewegen, & Spreeuwenberg, 2003;
Maas et al., 2009; Maas, Verheij, Groenewegen, De Vries, & Spreeuwenberg, 2006; Mitchell
& Popham, 2007). Urban life exposes children to many stressors, including traffic noise,
crowding, and pollution, so natural environments that promote good health might play an
important role in reducing socioeconomic health inequalities.
 Children and Nature - Page 22

MENTAL HEALTH

Distress and Psychological Health

Exposure to natural environments appears to have beneficial effects on psychological health.

Maas and colleagues (2009) gathered the medical records of 345,143 citizens and
investigated the relation between morbidity and the amount of residential green space.
After controlling for socioeconomic and demographic variables, they found that living
within a 1 km radius of a green space was significantly correlated with reduced risk for 15
out of 24 disease categories, including neurological disease, mental illness, and
cardiovascular disease. The association was strongest for anxiety disorder and depression,
especially for children.

Several studies using large databases have examined the relation between nearby green
space and children’s emotional adjustment. For example, among urban English children
who live in poverty, those with a higher percentage of green space in their neighbourhood
had fewer emotional problems from age 3 to 5, relative to their counterparts in less green
neighbourhoods (Flouri, Midouhas, & Joshi, 2014). In Lithuania, among children of
mothers with less education group, mental health problems (hyperactivity, peer problems,
and total difficulties) were negatively associated with residential distance to city parks,
whereas among children of mothers with more education, prosocial behaviour was
associated with residential greenness (Balseviciene et al., 2014).

Cumulative childhood stress can affect cognitive development and trigger later mental
health issues (Hanson et al., 2015). Contact with nature may contribute to resilience of
children, particularly for children who face childhood adversity or tremendous disadvantage
(Evans & Kantrowitz, 2002). Wells and Evans (2003) examined the amount of nature in
their residential environment and the psychological well-being of 330 children in grades 3
to 5 who lived in rural New York. Nature was defined as the amount of nature in the window
view, the number of indoor plants, and the materials in their outdoor yard. Stressful life
impacts were assessed by parental report of psychological distress and the children’s ratings
of self-worth. The impact of stressful life events, such as family relocation or bullying, was
lower among children with higher levels of nearby nature. The authors speculate that social
relationships and the attention restoration afforded by nature could account for some of
this outcome; longitudinal research could establish a more rigorous causal conclusion.

Apart from stressful life events, the value of green refuges and rehabilitation has also been
demonstrated in other studies of children facing numerous types of challenges, including
children with a background of poverty (Hung, 2004; Wells 2000), children with temporary
disabilities caused by accidents, operations, or psychological trauma (Moore, 1999),
children with learning disabilities (Faber Taylor & Kuo, 2009; Kuo & Faber Taylor, 2004),
behaviour disorders (Katcher & Teumer, 2006), new immigrants (Cutter-Mackenzie, 2009),
juvenile offenders (Cammack & Waliczek, 2002; Cammack, Waliczek, & Zajicek, 2002), and
those in war zones (Chawla, 2014).
 Children and Nature - Page 23

What are the ingredients of nature’s protective forces? The ethnographic work of Moore
(1986) and Kreutz (2015) demonstrated that natural areas provide opportunities for
positive adaptations, including creative play, bonding with animals, self-tests of developing
strength and skill, and quiet retreat. Masten and Reed (2002) highlighted three strategies
that foster resilience in children across all protective factors: reducing risks (e.g., inhibiting
impulsiveness and delaying of gratification), building assets (e.g., improving concentration,
problem-solving, or interpersonal skills), and mobilizing adaptive systems (e.g., connecting
children to friends).

Psychological Restoration and Improved Mood

The first empirical investigation of psychological restoration in nature took place in

relatively wild areas. Kaplan and Talbot (1983) incidentally found that participants who
took part in the Outdoor Survival Program experienced positive emotions after being in the
woods for more than a week. Inspired by the idea of the environment as restorative, many
subsequent studies have demonstrated positive effects on mood with relatively shorter
durations (a few hours or less) even in managed settings, such as parks or garden. For
example, Cooper Marcus (2006) found that 95% of patients in a children’s hospital reported
a positive change in mood after spending time outdoors, from feeling depressed and
anxious, to a more calm and balanced outlook. The specific qualities that were influential
for inducing mood change were natural elements (flowers, fragrance, water features)
because they represent a contrast to the experience of being inside a hospital (e.g., fresh
versus controlled air; rich sensory experience versus predominant straight lines; continuity
and cycle of life versus evoking thoughts of illness and death). Many other studies
corroborate the general pattern of improved mood. For example, young adults who
completed a demanding task displayed less anger after walking in a nature preserve than an
urban setting (Hartig, Evans, Jamner, Davis, & Gärling, 2003). Gardeners who performed a
stressful task rebounded better, in terms of mood and cortisol levels, after spending 30
minutes of gardening work rather than passive indoor reading of the same duration (van
den Berg & Custers, 2011).

Simply viewing vegetation through a window can also derive somewhat similar restorative
benefits as venturing out into natural environment. In a classic study by Roger Ulrich
(1984), surgery patients who were assigned to rooms with windows looking on a natural
scene had shorter hospital stays, received fewer negative comments from nurses, and
required less pain medication than patients with similar rooms with windows facing brick
walls. Even images of nature may promote psychological restoration (Berto, 2005; Hartig,
Böök, Garvill, Olsson, & Gärling, 1996; Laumann, Gärling, & Stormark, 2003). Participants
who ran on a treadmill while viewing rural photographs demonstrated significant
reductions in blood pressure, increases in self-esteem, and more positive effects on mood
than participants exposed to urban scenes (Pretty, Peacock, Sellens, & Griffin, 2005). Office
workers experienced less anger when art posters with natural content were present in their
offices (Kweon, Ulrich, Walker, & Tassinary, 2008).
 Children and Nature - Page 24

Why is nature restorative? Two predominant theories are attention restoration theory (ART;
Kaplan & Kaplan, 1989; Kaplan, 1995) and the psycho-evolutionary theory (Ulrich, 1983;
Ulrich et al., 1991). Both are drawn from the biophilia hypothesis and the evolutionary
theory (Staats, 2012), but they differ in how they conceptualize restoration. The psycho-
evolutionary theory of stress reduction is concerned with recovery from psychophysiological
stress and negative affect. After a stressful experience, visually appealing natural scenes are
restorative because they elicit positive affective responses such as interest, pleasantness,
and calmness. In contrast, ART focuses on cognitive processes; it explains the restorative
effects of green space on overused or prolonged directed attention (mental fatigue).
Restorative environments, which are characterized by the qualities of being away,
fascination, coherence, and compatibility, help capture involuntary attention, ameliorate
attention fatigue, and recover the ability to concentrate.

Concentration and Self-Control

Reduction of attention deficits. Mental fatigue from prolonged concentration is

characterized by feelings of distracted, impulsiveness, and irritability. As noted above, ART
predicts that nature effortlessly engages the mind away from stressors and enables
restoration and reflection (Kaplan, 1995). The theory is supported by experiments in which
participants’ attentional capacity is replenished by nature after having been depleted by
cognitively demanding tasks (e.g., Berman, Jonides, & Kaplan, 2008). In children, ART is
supported by studies that have examined nature’s capacity to help relieve symptoms of
Attention Deficit Disorder (ADD) and Attention Deficit-Hyperactivity Disorder (ADHD).
Mental fatigue and ADHD appear to involve disruption of the same underlying brain
mechanism (Glosser & Goodglass, 1990; Mole, Marshall, Pietrowsky, & Lutzenberger, 1995).
ADHD is a neurobehavioural disorder primarily characterized by a deficit in directed
attention. Its symptoms include an inability to focus on unappealing tasks, inability to
complete tasks, inability to listen and follow instructions, and being easily distracted. These
symptoms can cause significant functional impairments in learning and socialization (Loe &
Feldman, 2007; Nijmeijer et al., 2008). ADD and ADHD are typically treated with
stimulants such as Ritalin and Strattera. However, reduction of symptoms is often
temporary and these medications come with side effects such as sleep disruption and
appetite suppression.

Using a multimethod approach, a research team led by Frances Kuo has demonstrated that
nature can potentially offer a safer alternative medication or complementary therapy for
ADD and ADHD. In two correlational studies, parents of children with ADD were surveyed
in a Midwestern (Faber Taylor, Kuo, & Sullivan, 2001) and nation-wide samples (Kuo &
Faber Taylor, 2004). Parents were presented with a list of after-school activities in 3
settings: indoor (e.g., windowless room), built outdoor (e.g., downtown), and green outdoor
(e.g., farms) to indicate the severity of postactivity attentional functioning of their child.
Parents reported better functioning in their children after they engaged in activities in green
outdoor settings than in either indoor or built outdoor settings, even after controlling for
the social setting and the activity itself, such as passive reading. Furthermore, the more tree
cover in a child’s play area, the less severe his or her attention deficit symptoms.
 Children and Nature - Page 25

To address the causal role of green settings on the reduction of attentional deficit symptoms,
Faber Taylor and Kuo (2009) conducted a field experiment in which children who were
diagnosed with ADHD received a sequence of different treatments. Upon completing a
series of puzzles designed to induce attention fatigue, 17 children completed 20 minutes of
guided walks in three settings (an urban park, a downtown area, and a residential area) that
differed in the extent to which natural or urban elements dominated. Walking through the
greenest setting (the urban park) significantly improved concentration in a subsequent
cognitive demanding task to a degree comparable to the effects of a widely used medication
for ADHD. Thus, the link between green space and the reduction of ADHD symptoms has
been empirically supported by the use of controlled comparison across settings in the field
experiment, which establishes causality, and the use of national sample in the large survey-
based work, which addresses generalizability.

Other researchers have also demonstrated the role of natural environments in improving
attentional functioning. Using a longitudinal design, Wells (2000) tracked the effect of a
pre- and post-move from substandard housing to better-quality housing in 17 low-income
children in the United States. Children who experienced the greatest increase in natural
elements (the amount of nature in the window view and grass yards) had highest levels of
attentional functioning following the move. In the Netherlands, two groups of children
diagnosed with ADHD built a cabin in a woodland in one day and made an expedition to a
small town the following day. Children in both groups performed better on a concentration
task and demonstrated cooperative social behaviour in the woods, but displayed more
aggressive, inattentive, impulsive and hyperactive behaviour in the town (Van den Berg &
van den Berg, 2011). The beneficial association between green space and reduction of
hyperactivity and inattention are also supported by other studies conducted in 36 Barcelona
schools (Amoly et al., 2014), 11 Swedish preschool playgrounds (Martensson et al., 2009),
metropolitan residences in Munich (Markevych et al., 2014c), and in urban English
neighbourhoods (Flouri, Midouhas, & Joshi, 2014).

Self-discipline and academic achievement. Self-discipline draws on limited quantities of

directed attention (Muraven & Baumeister, 2000). The failure of self-discipline in children
can lead to academic underachievement, juvenile delinquency, teenage pregnancy, and
other negative social and personal outcomes (Baumeister, Heatherton, & Tice, 1994).
Directed attention may be renewed through contact with nature (Wells, 2000; Faber Taylor,
Kuo, & Sullivan, 2002). In a study that investigated the effects of vegetation around Chicago
public housing, the more natural a girl’s view from home, the better her performance on
three forms of self-discipline: tests of concentration, impulse inhibition, and delay of
gratification (Faber Taylor, Kuo, & Sullivan, 2002). For boys, however, no significant
associations was found between self-discipline and near-home nature. Perhaps they
typically spend more time playing further from home than girls (Wohlwill & Heft, 1987).

Students often experience academic stress. Nature exposure may reduce mental fatigue and
enhance overall student academic achievement and behaviour. For example, after
controlling for SES and school characteristics for 101 public high schools in Michigan,
greater views of trees and shrubs from cafeteria and classroom windows were positively
associated with standardized test scores, graduation rates, likelihood of planning to attend a
 Children and Nature - Page 26

four-year college, and (fewer) occurrences of criminal behaviour, while featureless

landscapes (e.g., athletic fields, parking lots, and large empty lawns) were negatively
associated with these outcomes (Matsuoka, 2008). In Massachusetts, grade three students
scored higher on standardized tests of English and mathematics when more trees and
vegetation were in the vicinity of their schools (Wu et al., 2014). In Barcelona, the cognitive
development of grade two to grade four students in 36 primary schools was assessed
periodically over a 12-month period in relation to the amount of surrounding vegetation
around their home, school, and during commuting. Greater improvement in working
memory and reduced inattentiveness were associated with surrounding greenness,
particularly with vegetation in and around schools (Dadvand et al., 2015).

NATURE THERAPIES
Contact with nature in a variety of forms has been utilized in the treatment and prevention
of diseases and other mental health concerns. Nature-assisted therapy (NAT) is defined as
an intervention that involves plants, natural materials, and outdoor environments to treat,
hasten recovery, or rehabilitate patients (Annerstedt & Währborg, 2011). NATs also serve as
catalyst for the synthesis of sustainability, mental health, and education. NATs have been
used with a variety of client groups, in the field of mental health and ecotherapy,
environmental social work, environmental education, and include wilderness and adventure
therapy, horticultural therapy, and animal-assisted therapies. For example, horticultural
therapy utilizes gardening to aid people with depression, who are often suffering from
distortion of attention and rumination (Gonzalez, Hartig, Patil, Martinsen, & Kirkevold,
2010; Messer Diehl, 2009). Relational therapy uses structured psychotherapy in an outdoor
setting where shy, withdrawn child clients can feel safe and relaxed in a reciprocal mutual
relationship with their therapist, while memories of traumatic experiences are believed to
be “transcended” or relieved through outdoor activities (Santostefano, 2004; 2008).

This section focuses on NATs that have important developmental outcomes—wilderness

program and animal-assisted therapy.

Wilderness Therapy

The wilderness and adventure therapy (WT/AT), also known as outdoor behavioural
healthcare (OBH), is the oldest form of NAT (Gass, Gillis & Russell, 2012; White, 2012). The
popularity of WT/AT may be due to increasing mental health problems among young
people (Werhan & Groff, 2005). The primary client group is children and adolescents who
have substance abuse, anxiety, depression, avoidant personality disorder, and other
antisocial behavioural problems such as defiance, impulsivity, and anger-management
issues (e.g., Banderoff & Scherer, 1994; Romi & Kohan, 2004). Most clients are under 18
and over 60% are male (Russell, 2012).

Although no standard protocol for WT/AT exists (Friese, Hendee, & Kinziger, 1998), the
general approach is to integrate counselling techniques with intense wilderness experiences
 Children and Nature - Page 27

lasting a month or longer, while learning relevant technical skills and teamwork, such as
rafting and preparing food (Wilson & Lipsey, 2000).

Experimental outcome research on the effectiveness of WT/AT programs is limited,

primarily because conducting experiments in which young, at-risk clients are assigned to a
wilderness therapy condition while a control group receives alternate or no treatment is
difficult and ethically questionable (Russell, 2012). However, a few empirically sound
quantitative and qualitative studies have demonstrated positive outcomes of some
programs (e.g., Harper, Russell, Cooley, & Cupples, 2007; Russell, 2003; 2005). For
example, in one outcome-assessment study on OBH, adolescents (aged 16-18) who were
primarily diagnosed with Oppositional Defiant Disorders, substance disorder, and
depression attended seven wilderness therapy programs that averaged 45 days that
included group living and activities. At admission, the clients exhibited symptoms at levels
similar to those of hospital inpatients. Treatment outcomes, evaluated by parents and
clients’ self-assessments, included significant reductions of behavioural and emotional
symptoms at discharge (Russell, 2003). To check whether some transfer of learning
occurred, two-year follow-up post-treatment interviews were conducted, which indicated
that the program was perceived as beneficial, that the majority of youths reported good
academic performance and improved family communication, and that aftercare services,
which facilitate the transition from an intensive wilderness immersion to family, peer, and
school environment, were utilized by most of the clients (Russell, 2005). Thus, skills and
lessons learned during wilderness immersion seem to have been applied to everyday lives.
Other studies also report associations between participation in wilderness therapy and
children’s physical health, personal autonomy, self-esteem, self-awareness, interpersonal
skills, and (decreased) antisocial behaviours (e.g., Behar & Stephen, 1978; Kellert & Derr,
1998; Kaplan, 1977; Kaplan & Talbot, 1983).

Although wilderness therapy has been recognized as a promising intervention for

behavioural and cognitive developmental changes (Werhan & Groff, 2005), several
limitations must be addressed. One methodological limitation is the exclusive reliance on
self-report measures. Participant reports may be biased by their own perceptions, rather
than objective treatment outcomes. Positive comments may be biased by the desire to
please researchers or to support the programmes.

Second, wilderness experience itself may be confounded by the program’s activities. In

other words, the need for self-reliance in unfamiliar and changing environments, regardless
of setting, may promote positive effects. Further, it is not clear which specific aspects of WT
and how much wilderness immersion is necessary to accrue those benefits. Some WT
programs are based on the outdoor adventure challenge model (i.e., the “boot camp”
approach), whereas others employ standard psychotherapeutic techniques, such as
cognitive-behavioural therapy, in wilderness settings. To date, no researchers have yet
systematically isolated the wilderness effect (Greenway, 1995) from traditional
psychotherapy or other potential confounds.

Third, others have criticized potential injuries that might results from outdoor activities,
particularly water-based or high-altitude sports. Some programs are not licensed or
 Children and Nature - Page 28

accredited, and a few programs have been condemned for alleged physical and emotional
abuse (Krakauer, 1995; Kutz & O’Connell, 2007). Also, certain activities may not be suitable
or ethical for patients with physical disabilities or severe mental health issues.

Fortunately, these concerns have prompted the formation of the Outdoor Behavioural
Healthcare Council in 1997, and it promotes program standards, ethics, and risk
management. Nevertheless, due to relative high cost of these programs and the variability in
therapeutic methodology across programs, more scientific evidence is needed to establish
program effectiveness, and more research is required on which components of AT are
appropriate for specific populations.

Children and Animals

According to Gibson (1986), animals are an inseparable part of nature, and no organism can
exist without a natural environment. Until recently, developmental research had largely
overlooked children’s perception, relationship, and interaction with animals, even though
animals, represented in a variety of forms (live, stuffed, imaginary), play a significant role in
children’s lives. A few developmental psychologists argue that, in order to understand
children’s play patterns, sense of self, empathy, and ecological concerns, researchers should
focus on biocentric approach (informed by the concept of biophilia), rather than traditional
anthropocentric (human only) framework on children’s development (e.g., Melson, 2001,
2003; Myers, 2007; Myers & Saunders, 2002). Children’s affiliations with and abiding
attraction to animals are based on several underlying emotional mechanisms (Vining,
2003), including companionship and social support, reinforcement of self-worth via
unconditional love, provision of self-concept, psychological and physiological healing,
connection with nature, and a sense of awe and wonder. Although empirical research on the
beneficial effects (if any) of undomesticated wildlife is nonexistent, research on the
developmental benefits of contact with animals falls into two categories: pet ownership and
companionship and animals in therapeutic context.

Pet ownership and companionship

Self-worth and empathy. Pet ownership may have positive impacts on sense of self. Youth
who own pets reported having more responsibility and scored higher on a self-esteem
measure than those who did not own a pet (Covert, Whiren, Keith, & Nelson, 1985). Adults
had more positive self-concept if they had their first pets when they were less than 6 years
old or during their teenage years (Poresky, Hendrix, Mosier, & Samuelsson, 1988). Four
studies demonstrated that children with stronger relationships with their pets scored higher
on measures of empathy (Melson, Peet, & Sparks, 1991; Poresky, 1990, 1996; Vidovic, Stetic,
& Bratko, 1999). To date, these findings were mostly derived from correlational studies and
therefore causality is unclear: Do empathetic, socially oriented children form bonds with
their pets, or do pre-existing family contexts or preferences lead to the choice to have pets,
or does having pets cause these benefits?

Emotional self-regulation. Companion animals may support emotional self-regulation, an

important recipe for children’s socio-emotional well-being. Interviews with children show
 Children and Nature - Page 29

that during stressful situations, many seek out their pets for reassurance, emotional support,
and unconditional love (Covert, Whirren, Keith, & Nelson, 1985; McNicholas & Collis, 2006;
Rost & Hartmann, 1994; Triebenbacher, 1998). Pre-schoolers with pets were less likely to
feel anxious and withdrawn during transition to public schools (Melson & Schwartz, 1994).
The rationale for pets as an important resource in social support system may be that
animals are perceived to offer unconditional love and non-judgmental acceptance. In fact,
greater alleviation of cardiovascular stress responses and lower cortisol levels were
associated with interaction with a companion animal than with people (e.g., Friedmann et
al., 1983; Allen, Blascovich, & Mendes, 2002; Odendaal & Meintjes, 2003). However,
whether animal companionship and attachment promote a greater capacity for emotional
regulation over the lifespan, as children become more independent or when a pet is not
available, remains to be learned.

Animals in therapeutic context

In animal-assisted therapy (AAT), animals play a vital role in assisting children with
behavioural problems or emotional disturbance by improving their cognitive, physical,
social, and emotional well-being. Katcher and Wilkins (1993, 1998, 2000) have used
animal-assisted interventions for children diagnosed with autism, attention-deficit disorder,
conduct disorder, and oppositional–defiant disorder. Animals are capable of stimulating a
high level of interest, and because of their slightly unpredictable reactions, they evoke
curiosity and sustained attention, and provide opportunities for affection and nurture play
(Katcher & Wilkins, 1998).

Furthermore, mastery of fear of animals and learning to care for them give children a sense
of competence and self-esteem. In one longitudinal study, children were assigned to either 5
hours per week of an Outward Bound course, which consisted of supervised activities such
as rock climbing, canoeing, and swimming, or 5 hours per week of a nature and
companionable zoo (CZ) program. When the school term was over, children who had the
animal contact demonstrated significantly fewer aggressive episodes and pathological
behaviours. After zoo visits, autistic children demonstrated improved attention, social
interactions, and positive emotions, and children with ADHD were able to sustain attention
and showed better impulse control. Beneficial effects of CZ were carried over to regular
school program. Compared to an outdoor challenge program, children underwent AAT
showed accelerated learning, improved school attendance, and reduced teacher-rated
severity and frequency of behavioural symptoms (Katcher & Wilkins, 1993; 2000).

Other studies demonstrated enhancement of social behaviour with animals in therapeutic

setting. Children with Down’s syndrome displayed greater sustained focus towards, and
more cooperative interaction with, their therapist when a live dog was present than when an
imitation dog of similar in size and color was present (Limond, Bradshaw, & Cormack,
1997). Martin and Farnum (2002) undertook similar analyses of children with pervasive
developmental disorders, a class of disorders characterized by delays in the development of
socialization, including autism and Asperger’s syndrome. The children’s social behaviour
varied with the study’s conditions. Compared to a non-social toy (ball) and a stuffed dog,
the presence of a dog facilitated more playful moods (indicated by laughing and giving
 Children and Nature - Page 30

treats), increased awareness of social surroundings, and more meaningful discussion with
therapist. In another study, children with mental disabilities engaged in more verbal
responding with therapist when a dolphin was present than when their favorite toy was
present (Nathanson & de Faria, 1993).

AAT may also favorably influence the development of communication skills (Beck &
Katcher, 2003). During talking, singing, or talking to companion animals or inanimate
objects, stuttering is almost absent (American Psychological Association, 1994). Pet owners
were also more skilled at decoding human nonverbal facial expression, particularly among
boys (Guttmann, Predovic, & Zemanek, 1985). In a more controlled study, Dismuke (1984)
examined the influence of a 12-week structured horseback riding program for children
suffering language-speech pathology. Pre-, mid-, and post-test of speech and language skills,
sensorimotor integration, and self-esteem revealed significant improvement in all areas,
including complexity of language structure, appropriateness, and efficient use of speech in
children who participated in the rehabilitative horseback riding program in conjunction
with communication therapy, compared to non-riding control group with the same
language curriculum in their classroom setting. The strengths of this study were the use of
random assignment to the conditions and that the raters were blind to the condition in
which the children received treatment. However, the use of different therapists and teachers
in each condition may have confounded the results.

Although limited preliminary research is suggestive of AAT’s positive effects, several

limitations and methodological weakness must be addressed, because they may provide
insights to future research directions. First, many studies that have been published in
support of AAT were practice–based (Marino & Lilienfeld, 1998). They use small sample
sizes, rely on potentially biased raters, and may be flawed by a host of potentially
confounding factors (e.g., socializing, placebo effect, subjective evaluations). From a
scientific perspective, more randomized and rigorously controlled studies are necessary to
establish more valid evidence for therapeutic outcomes of AAT. Second, a lack of published
longitudinal research for evidence of long-term improvement of clinical population suggests
that AAT may only offer a temporal affective fix, that is, short-term relief, rather than long-
term behavioural change (Lilienfeld & Arkowitz, 2008). Third, some children may become
attached to therapeutic animals that are not their pets. It may be ethically questionable to
subject a child to disappointment and possible relapse once AAT discontinues.

COGNITIVE DEVELOPMENT AND UNDERSTANDING NATURE

An important aspect of intellectual development is the ability to discriminate, identify, and
classify objects based on prototypes. Nature provides extensive opportunities for children to
acquire these abilities through a wide range of observable objects, features, and behaviours
(Kellert, 1997; 2002). The complexity and diversity inherent in natural environments
creates stimulating and memorable learning contexts, and ever-changing natural
phenomena afford children to perceive nature as dynamic and timeless (Prescott, 1987). For
example, weather patterns (ice forming as the temperature drops) and animal habitats
 Children and Nature - Page 31

(caterpillar becomes butterfly) advances understanding of relation among natural stimuli.

Dull and static environments can delay or block cognitive development (Moore, 1986).

Folkbiology: Children’s Naïve Understanding about Nature

Folkbiology is a term used to describe intuitive understanding and reasoning capacity about
the natural world (Coley, 2000). It is developed in each culture, even without formal
schooling (Medin & Atran, 1999). Research has identified several implicit principles or
biological fundamentals that children use when they think about nature. One is essentialism,
the idea that certain categories have an underlying reality or property that one cannot
observe. For example, 10-year old children believe that a raccoon painted black with a white
stripe with a pouch of “smelly stuff” does not change its identity despite its similar outward
appearance to a skunk (Keil, 1989). Preschoolers also assume that the identity of an animal
will not change across different environments and upbringing. For example, they believe
that a baby cow, raised by pigs, would come to “moo” and not “oink” because its essence is
that of a cow (Gelman & Wellman, 1991). Another principle is “vitalistic causality,” a form of
construal in which the primary causal concept is “life force.” For example, 4-year-olds
readily understand that biological causal mechanisms, not human intervention, underlie the
growth of plants and animals (Hickling & Gelman, 1993). They also recognize that animals
and plants draw vital power from food and water to provide energy, make them grow, and
help them recover (Inagaki & Hatano, 2004).

The amount and quality of children’s intuitive understanding about nature is shaped both
by cultural construction and their experience in nature (Medin & Atran, 2004; Ross, Medin,
Coley, & Atran, 2003), suggesting an interplay between genetic and experiential factors.
With formal instruction, native biological concepts are often replaced by more sophisticated,
scientific understanding (e.g., evolution replacing essentialism). The influence of cultural
experience on folkbiology was analyzed Ross, Medin, Coley, and Atran (2003). Rural Native
American, urban European American, and rural European American children were told that
an imaginary substance called andro resides in all living things. One group of children was
told that the substance is inside humans, and then were asked if other animals also possess
it (“Do wolves have andro, like humans do?). In another condition, children were told that
the substance is inside other animals and were then asked if humans also contain the
substance. Some children demonstrated anthropocentric thinking, making projections of
similarity from humans (the central exemplary of living things) to other animals (e.g., “if
humans have it, wolves must have it too”). Others demonstrated biocentric (nature-centred)
thinking, or bidirectional projections of similarity (from humans to animals, and vice versa).
The three cultural groups showed distinct developmental trajectories of folkbiological
induction. Relative to non-native children, Native American children made more biocentric
projections. Although both groups of non-native children share anthropocentric beliefs, the
typically richer experience of rural children led them to make more biocentric projections
than the urban children did. Thus, cultural beliefs about ecological affinity, as well as
personal experience with nature, facilitate the acquisition of biocentrism. If they lack
sufficient exposure to nature, children cannot fully develop nuanced understanding of living
things and natural systems (Coley, Solomon, & Shafto, 2002). For example, 6-year-old
 Children and Nature - Page 32

urban children are able to assign living things to appropriate taxonomic categories (e.g.,
mammals, plants. and insects), but they had less-developed understanding of organisms’
ecological and habitats than those from rural backgrounds.

Research appears to indicate that people’s general knowledge about their local nature is
decreasing. Local ecological knowledge (LEK), or indigenous knowledge, is a vital part of
our capacity to manage and conserve ecosystems. LEK is negatively correlated with income
levels in local communities in India, Indonesia, and the United Kingdom, and across
countries that vary in per capita GDP (Pilgrim, Cullen, smith, & Pretty, 2007). In particular,
where a community has become more industrialized and independent of local
environmental goods and services, knowledge of species’ names and function is lower. LEK
acquisition is rapid at young ages in resource-dependent countries, but not in the UK,
where it is slow and delayed. In the UK, high school youth demonstrated limited ability to
identify common flowers, and they viewed such identification skills as relatively
unimportant (Bebbington, 2005).

Despite this, children do have a strong capacity for recognizing natural and man-made
creatures. Sadly, children’s ability to identify cartoon characters increased from ages 4 to 11
years of age, more than their capability to identify common natural wildlife types. By age 8,
children were able to recognise nearly 80% of 150 Pokémon characters (Balmford, Clegg,
Coulson, & Taylor, 2002). Another poignant illustration is depicted in the documentary film
Play Again (2010). During one scene, when children were asked to identify a variety of
pictures presented to them, they readily identify corporate logos, but were struggling to
name common plants, as several children refer to the dandelion as “wish flower” or “some
kind of weed.” To conclude, research on children's folkbiology will not only broaden
understanding of cognitive development in general, but should also help us to better
understand why and how adults' nonsustainable behaviours may be influenced by
anthropocentric thinking and ignorance about ecology (Medin & Atran, 1999).

Moral Development and Environmental Values

Children’s understanding of nature may also influence their moral reasoning and
development of environmental values. Peter Kahn and colleagues (Kahn, 1997, 2002; Kahn
& Friedman, 1995) have conducted extensive cross-cultural interviews with children, asking
them about their views about environmental degradation. They found the two primary
forms of environmental moral reasoning that resemble those described earlier.
Anthropocentric moral reasoning reflects concerns for human wellbeing, including
aesthetics, personal interests (e.g., no animals to play with), and human health and welfare
(e.g., pesticide contamination). Biocentric moral reasoning, on the other hand, focuses on
the intrinsic value and rights of natural systems, which are thought to deserve respect
comparable to that for humans. This perspective involves seeing similarities among all
living things and evokes feelings of empathy for natural species (Gebhard, Nevers, &
Billmann-Mahecha, 2003). For example, one child commented “if nature made birds,
nature does not want to see birds die…[the birds] need the same respect we need” (Kahn,
2003, pp. 116-117).
 Children and Nature - Page 33

In general, Kahn and others find that children tend to be more morally concerned about
people than other species (e.g., Hussar & Horvath, 2011). Interviews with children from
three diverse cultures (inner-city Houston in Texas, the Brazilian Amazon, and Lisbon)
revealed that most children conceive of environmental disaster as a violation of a moral
obligation, and offer anthropocentric justifications (Kahn, 1999; Kahn & Lourenço, 2002).
For example, Kahn (1997) interviewed children’s ethical reasoning concerning the 1989
Exxon Valdez oil spill in Alaska which dumped nearly 11 million gallons of oil into Prince
William Sound, destroying beaches and killing thousands of marine species. Although
children did cite the harm to wild animals, fish, and recreational users, anthropocentric
reasoning was used with higher frequency than biocentric reasoning (58% vs 20% of
reasons given).

Children also show a developmental progression of biocentric reasoning: Older children are
more likely to exhibit biocentric reasoning, perhaps because of their more sophisticated
grasp of ecological systems. For example, one interview study revealed age differences in
mental construction of animals’ need. Younger children were able to grasp animal’s basic
physiological needs for food and water, but older children (after age 10) recognized their
ecological habitat and conservation needs, such as outlawing hunting or reducing pollution
(Myers, Saunders, & Garrett, 2004). When children do exhibit biocentric reasoning, they
emphasize animal welfare more than that of plants, possibly because their awareness of
plants as “alive” occurs later in their development (Melson, 2013). As noted earlier, innate
affiliation with animals encourages caring and concerns for non-human species and serves
as a foundation for broader environmental concern (Myers, 2007; Myers & Saunders, 2002).
In sum, children are more likely to adopt biocentric values with more fully developed
understanding of ecology as well as positive childhood experience in nature.

Environmental generational amnesia

Children in industrialized societies with limited interaction with wild places may experience
an extinction of experience (Pyle, 1978; 1993), which describes a cycle of
impoverishment that is initiated by reduced diversity of natural elements, followed by a
sense of apathy, alienation, and disaffection, which in turn, begets more depauperated
environments and deeper isolation from nature. Similarly, Kahn (2002) argued that lack of
environmental concern is not merely a result of giving the environment secondary priority
relative to the immediacy of material needs, but the gradual perception of one’s slowly
ecologically deteriorating condition as a normal experience. Kahn suggests the term
environmental generational amnesia (EGA) for describing the phenomenon that the
natural environment that people encounter during their childhood serves as a benchmark
against which they evaluate future degradation. As environmental degradation increases
across historical time, each generation’s standard become more denuded, which results in
decreased sensitivity to the magnitude and scope of the ecological crisis, and numbing
awareness for proactive responses. This normality of degradation is illustrated in interviews
with African American children growing up in Houston, one of the most polluted cities in
the United States. Despite their general knowledge about water pollution, about most
children believed that their local waterway was not polluted (Kahn, 2007).
 Children and Nature - Page 34

Although the notion of EGA is intuitively compelling, empirical data in support of

environmental generational amnesia is relatively scarce. One related study examined
responses to pollution in Los Angeles from long-term residents (lived there 5 years or more)
versus new arrivals (within 3 weeks) with comparable levels of socioeconomic status.
Compared to the recent immigrants to the city, long-term residents were less likely to
mention smog as a community problem and felt themselves less vulnerable to it. When
presented with slides of California scenes depicting differing levels of smog, long-term
residents were less sensitive in detecting the presence of smog in the photographs (Evans,
Jacobs, & Frager, 1982). Although this finding supports the notion that people may adapt to
air pollution, whether the pollution was viewed as part of the ambient environment, or that
the negation of pollution served as a justification mechanism for a problem that is perceived
to be outside of residents’ control is unclear. Nevertheless, evidence supporting EGA will
require cross-generational data and documented changes to biological systems to determine
whether baseline perceptions collectively shift over time (e.g., Papwroth, Rist, Coad, &
Milner-Gulland, 2009).

That being said, EGA has the potential to affect children’s perceptions by obliterating the
true extent of the ecological crisis. Children from the industrialized world may not realize
what they are missing, and they lack the perspective of previous generations who lived
before the era of pollution and denuded landscape. Direct experience in wild nature is
critical for targeting generational amnesia. As children begin to better understand that
human and environmental welfare are intimately linked, they will recognize a sense of
ecological self, which gives rise to biospheric values.

The ecological self is developed through a process of self-actualisation, as one transcends

from an isolated, primarily autonomous egoistic self that parallels industrialization
(Baumeister, 1987) to a self that identifies oneself as part of the larger ecological whole
(Naess, 1985). People frequently experience this ecological self in wilderness settings
(Coburn, 2006; William & Harey, 2001). Research on the significant life experiences of
active environmentalists reveals several key factors that contribute to exemplary
commitment to environment, including positive childhood experience in nature, bonding
with local environments, and supportive role models (e.g., Chawla, 1998; Monroe, 2003;
Tanner, 1980). Importantly, nature experiences must be repeated and recurrent; rarely does
a singular event breed familiarity or emotional affinity. According to Naess (1985), the
development of ecological self leads to environmentally responsible behaviours, on the basis
of genuine love and common identity rather than self-sacrifice.

Technically-simulated nature

Modern children’s declining access to nature has been increasingly replaced by virtual
experiences of it (Kahn, 2011). Vicarious nature refers to non-firsthand experience, through
acquaria, zoos, and electronic media or simulated nature (Kellert, 2002). In general,
vicarious nature can provide excellent information and narrative creativity, and therefore
can serve an important role in education and conservation campaigns. Newer technologies
allow interaction with nature, such as a bird identification portable device, geocoaching
 Children and Nature - Page 35

(finding hidden objects using GPS), remote-controlled vehicles for underwater exploration,
and online communities for sharing nature videos and photos (i.e., iNaturalist.org).

As with novel aspect of any new technology, children and youth typically respond to
technically-mediated nature activities with enthusiasm (Chavez 2009; Harmon & Gleason,
2009). Harrington (2009) conducted an observational study to compare guided-real and
virtual reality field trips among 4th graders. The virtual field trip allowed child-initiated
exploration and navigation by mouse or keyboard, while offering simulated events in sound,
video, as well as facts about different species. Responses after both trips revealed increased
student initiative. Although most students found the virtual trip exciting because it allowed
them to “fly” around or pretend to be another creature, more overall positive emotions were
reported from the real trip. Multisensory experience and unplanned, out-of-curriculum
learning are more memorable and occurred more in the real environment. Future research
should explore how the real and virtual learning environments might be combined as a
complementary fashion to maximize intrinsic motivation and discovery-based learning.

Kahn (2011) conducted a series of studies that compared the experience of a natural entity,
its absence, and a technological simulated version of it (e.g., views from natural windows,
technological windows, and no windows in offices). Some studies of children compared
responses to a highly responsive robotic dog (Sony’s AIBO) with those to a live dog.
Although children said they could be friends with AIBO, more children conceptualized the
live dog, compared to AIBO, as having physical essence, mental states, sociality, and moral
standing (Kahn, Friedman, Pérez-Granados, & Freier, 2006). Age differences in children’s
interaction with the robotic dog were found: preschoolers treated AIBO and the real dog
similarly (e.g., petting and talking), but older children were nearly five times more likely to
give more affection to a live dog than to AIBO (Melson, Kahn, Beck, & Friedman, 2009).
Thus, a pattern emerges from these studies which suggests that simulated life forms are not
complete substitutes for real ones, and that built spaces, even those with biophilic designs,
do not function identically to natural landscapes. Kahn (2011) concluded that “technological
nature is better than no nature, but not as good as actual nature” (p. xvi).

However, technological representations may be useful to some degree where it is not

suitable or difficult to incorporate “real” nature, as in extreme environments or for children
who suffer from pet allergies. Given the fast pace of technological changes, research on its
effect on child development might be difficult, but future studies should consider broader
questions such as whether children accept even better-simulated nature as an adequate
substitute for enriching their experiences of real nature, or whether dangers exist, such as a
loss of basic humanity, if we rely on technology to replace nature.
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RECOMMENDATIONS FOR FUTURE RESEARCH

Methodological Directions

The need for more controlled studies

Studies about the effects of nature on children are more often qualitative than experimental.
Experimental studies are needed to scientifically bolster the general notion in causal terms
that contact with nature benefits child development. These studies would use random
assignment of participants to condition or different interventions, objective evaluations of
outcomes, control of extraneous variables (such as the activities themselves), and raters
who are blind to experimental conditions. Quantitative methods also help answer the
question such as how much, in terms of quantity, richness, and type of interaction (e.g.,
passive vs. active, or real vs. simulated) is the amount of nature exposure necessary to
produce beneficial effects. Thinking in parallel with medicine, how much of a “dose” of
nature as a “medication” is required for each deficit (e.g., obesity, depression, or inattention)
in development.

More rigorously controlled designs are particularly important for health and psychological
claims to be considered and utilized. Policymakers are much more likely to be persuaded
about a treatment’s utility by data from quantitative, experimental methods. As Kuo (2002)
argued, research is likely to be applicable to planners and policy makers if it is conducted
within realistic and well-controlled experimental context (to demonstrate causal relations)
with dependent (outcome) variables that are important to decision-makers (e.g., burglary
rates as opposed to self-reports of territorial defensibility) and independent variables that
can be feasibly controlled (e.g., the number of trees in a play setting as opposed to than
individual preferences for nature).

The need for balanced methodology

Of course, each method has its own advantages and limitations. Experimental studies are
often limited by small sample sizes and are hampered by ethical and financial barriers.
These limitations can be addressed by the use of large, epidemiological studies based on
objective health data. Furthermore, ethnographic work offers unique advantages over
experiments, such as in-depth theoretical and descriptive materials on how children
experience and make sense of the outdoors (Greene & Hill, 2005). Qualitative research is
valuable in understanding the subjective and even spiritual features of our relationship with
nature. It is useful for developing new ideas about what might be happening, which should
then be tested with experimental designs. It can also provide an assessment of children’s
overall wellbeing, beyond narrow-scope results typically delivered by experiments.

Longitudinal research on children and nature is lacking. Longitudinal work is particularly

useful in the examination of trends, preferences, and developmental benefit of different
experiences overtime (see Handy, Cao, & Mokhtarian, 2008 for an example of using such
technique). However, as with other non-experimental studies, it is subject to other
confounds (social background, personal characteristics, rater bias, etc.). Cross-sectional
 Children and Nature - Page 37

studies, which examine different groups at one point in time, can demonstrate a link
between experiences and benefits, but they cannot make causal inferences. Thus, future
research could aim for a balance among qualitative, experimental designs, longitudinal, and
cross sectional methods.

The need for interdisciplinary work

In addition to comprehensive knowledge, it is also important to develop and test theory and
practical intervention strategies. Researcher-practitioner partnerships in educational and
design-oriented work can create positive, realistic outcomes for children. In the health
domain, collaboration between social scientists and medical or biological scientists can
create a stronger knowledge base by integrating behavioural and social understanding of
child development with measured health benefits. Children’s health status and their health-
related behaviours are determined by a multifaceted process involving a myriad of, and
potentially interacting, sociocultural, psychological, and environmental factors (Karpati,
Galea, Awerbuch, & Levins, 2002). To understand short- and long-term benefits of contact
with nature, interdisciplinary research presents both opportunities and challenges.
Interdisciplinary reserachers are required to generate shared understandings of “nature”
and “wellbeing.” An extensive effort must be made to learn and integrate different analytical
and methodological approaches. Neverthless, successful interdisciplinary findings will
provide a strong evidence base for policy makers to implement new ways of encouraging
children’s active partipation in the outdoors and facilitating more nature access.

The need for methodological innovation

Along with attention to the basics of sound research design and selecting practically useful
research objectives, flexibility and innovation are other important factors in crafting future,
potentially high-impact research (Kuo, 2002). Findings from innovative methodology or
measurements can help to refine or elaborate theories as well as to discover other
underlying mechanisms or benefits associated with nature that are otherwise unknown to
now.

Looking back a bit for example, a few studies utilized new-at-the-time methods in their
investigation of children and nature. Social geographers Tucker and Matthews (2001)
uncovered the “everyday” world of children, including their existing friendship and social
conflicts over the use of rural spaces by analyzing child-taken photographs, child-led video
tours, and in-depth discussion groups. In Iran, Gharahbeiglu (2007) demonstrated the
power of children’s conceptualization and imagination of spaces from their paintings of
their ideal playground in comparison to photographs of existing open spaces. Mikkelsen
and Christensen (2009) integrated ethnography, global positioning system (GPS) tracking,
and mobile phone surveys to generate data about activities and social relationships in real
time, enabling researchers to virtually follow the movements of the participants. What
might the new wave of technology or imagination provide as innovative tools?
 Children and Nature - Page 38

Children as part of participatory research

Aries (1962) noted that “childhood is a modern invention.” Modern children became
increasingly regulated and subject to surveillance and they engage in spaces specifically
designated for their use, while spontaneous play and interaction are diminishing. In a
similar vein, Elsely (2004) argue that children generally occupy space within a world
constructed by adults. Natural elements are missing from most adult-designed playgrounds
(Frost, 2006), even though children prefer natural features (Burke, 2005; Groves & McNish,
2008; O’Brien, 2005).

Most research has examined adults’ perspectives on the suitability of play spaces, given that
parental influence is a primary determinant of geographical and social boundaries for
children’s outdoor behaviour choice of play (Herrington, 2008; Valentine, 2004). Children
have little influence over the development of public space, because they usually rarely have
the opportunity to contribute their views as to what kinds of spaces that work for them
(Elsley, 2004). Research is needed that tackles not only the physical design and accessibility
of spaces in general, but also the gaps between parents’ perception of, and children’s
experiences of, outdoor play. Future work should also investigate the role of children as
decision-makers and focus on greater involvement of children as key actors in the research
and design process (Lolichen, 2007; Murayama, 2007). This would give children a sense of
agency and greater engagement with spaces that, after all, are meant for them and their best
interests. In one rare study, primary school children took the role as “community expert” by
taking photos of their environment over a one-week period and then reflected on their
preferred spaces for play (Burke, 2005). The author argued that this photo-diary technique
helps children to generate data that can be useful for influencing planning and policy for
play.

Gaps in Research

Nature and benefits to adults

The number of studies of nature and children’s well-being is small compared to that aimed
at adult benefits. Although some benefits of nature are particularly important to children,
such as reduction of attention deficits and levels of physical activity associated with outdoor
play, the question of whether children share many of other benefits from nature that adults
do is largely missing in the literature. For example, studies of adults have demonstrated that
patients with a view of trees frequently received weaker pain medications, such as aspirin or
acetaminophen, while patients with brick wall-view required stronger pain medications
such as narcotics (Ulrich, 1984). Another study examined adult patients who underwent
flexible bronchoscopy. Patients with nature scene murals placed at their bedside while
listening to nature sounds before, during, and after the procedure were more likely to report
better pain control than patients with no nature scenes and sounds (Diette, Lechtzin,
Haponik, Devrotes, & Rubin, 2003). Thus, future research should consider this
nonintrusive strategy for children who undergo painful, invasive procedures.
 Children and Nature - Page 39

Family systems

Currently, research that examines the influence of nature contact on family systems seems
to be absent. Presumably, children indirectly benefit from adults around them who enjoy
some of the positive outcomes associated with nature. For example, green neighbourhoods
are associated with stronger neighbourhood social ties, greater sense of community, and
willingness to help. Highly cohesive neighbourhoods appear to compensate for family
problems (e.g., parental stress, family instability, poor parenting behaviours) by providing
the child with access to service and social support (Furstenberg, 1993; Silk, Sessa, Morris,
Steinberg, & Avenevoli, 2004). Parents and other adults in neighbourhoods may act as role
models for children (Jencks & Mayers, 1990), such as demonstrating altruism. What are the
spinoff benefits for children?

In contrast, less green environments are associated with higher rates of aggression, violence,
crimes, loneliness, joblessness, and inadequate social support (for review, see Kuo, 2010).
These social and economic stressors can affect children’s emotions and family dynamic
(Caughy, Nettles, & O’Campo, 2008). Research is needed to address potential influences of
nature on both children and their caretakers, and whether nature experience from either
side may influence the other. For example, how are children’s experiences of nature
influenced by their caretakers? Can children’s behaviour in nature influence their caretakers?

Targeted, magnitude-effect oriented reviews

Research on the benefits of nature is abundant, but so far it has not been particularly well-
organized or comprehensive, so general conclusions have been difficult. A few review
articles on children and nature have been published in recent years (e.g., McCurdy,
Winterbottom, Metha, & Roberts, 2010; Muñoz, 2009), but they mainly focus on physical
health. The goal of this review has been to identify, appraise, and synthesize all relevant
studies on nature’s benefits for children. It is uniquely comprehensive because it addresses
research on a wide range of affordances of nature and it considers a variety of
methodologies and research designs, theoretical viewpoints, and studies that examine
nature’s level, scale, and setting (from wilderness to window views), children’s
demographics and characteristics (different countries, age ranges, socio-economic
backgrounds), and degree of engagement (from free play to highly structured activities).

An important lesson for this is that the reader should be cautious about drawing the
conclusion that a particular benefit from one style of engagement in one type of setting for
one group of children will translate to other styles of engagement, settings, or groups of
children. More narrowly focused reviews, or meta-analytic reviews, tend to screen studies
based on limiting criteria (e.g., only children before the age of 12 within urbanized settings)
and utilize statistical summary techniques, such as effect size, to describe the weight of
evidence (Roberts & Petticrew, 2006). However, they often omit some theoretical and
descriptive or qualitative material, thus under-emphasizing children’s holistic wellbeing
and their subjective relationship with nature. Nevertheless, we and others (e.g., Gill, 2014)
offer several suggestions that may warrant exploration in targeted reviews that focus on
estimating the magnitude of an effect (rather than its statistical significance):
 Children and Nature - Page 40

• A particular quality of environment (e.g., landscape quality, biodiversity, ambience,

amount of tree cover) on a particular benefit. For example, certain natural elements in
air quality are required for respiratory-related health.
• A particular engagement with nature for a particular outcome. Although no reviews have
been dedicated to comparing the degree of engagement, more playful styles are generally
associated with physical health benefits and less playful styles are generally associated
with educational benefits.
• The effect of time spent in natural settings for a particular outcome. Although green
environments must be experienced repetitively or for a long period of time to yield
maximal benefits, other studies have suggested that brief exposure can produce similar
beneficial outcomes. For example, simply viewing green pictures can generate the same
cognitive effects as a long hike (Kuo, 2010).
• A particular benefit for a particular group of children, including older children and those
in developing countries. We could not find a quantitative review dedicated to differences
in children’s relationship with nature and benefits by children’s gender, ethnicity,
socioeconomic position, or age.

Environmental equity

Quantitative studies of children’s access to nature and positive outcomes have been largely
restricted to high-income nations. However, their opportunities for contact with nature,
ways of encountering nature, and experiences of nature are strongly patterned by social,
economic, racial, cultural characteristics (Richardson et al., 2012). As the earlier discussion
of childhood obesity makes clear, children in minority and low-socioeconomic communities
disproportionately suffer health conditions and other long-term developmental
consequences of overexposure to environmental toxins and limited experiences in nature
(Kellert, 2005). Ethnic and race-based environmental inequalities among adults are well-
documented in literature. However, the need to further explore inequalities among children
is urgent for several reasons. First, children are more vulnerable than adults to the negative
effects of pollution because children’s physiology and metabolism are fundamentally
different from adults (Crom, 1994; Pastor, Sadd, & Morello-Frosch, 2002).

Second, in addition to examining children’s unequal access to nature, examining cultural

barriers and perception to green access is important. For example, poor urban Hispanic
children have limited opportunities to experience pristine natural settings because of
economic constraints and limited transportation options. Even if they have access to urban
community green spaces, a majority of them express fear of gang violence, crime, and
stranger danger in these spaces (Strife, 2008). Fear of neighbourhood violence not only
restricts physical activities outdoors, it also erodes community trust and increases stress
that, when sustained over time, further exacerbates poor health. Thus, for low-income and
minority children, access to nature may be less about proximity to and availability of local
green spaces, as measured by most quantitative studies in more affluent communities, but
more about social-environmental issues, including safety perception, racial segregation,
poverty, and ability to travel (Lopez & Hynes, 2006). Future research that focuses on these
 Children and Nature - Page 41

interlinked factors may necessitate more holistic and multi-sector public health policy
responses and interventions.

Third, studies of children and nature should not be limited to those in developed countries
because a large portion of the world’s children are growing up in the developing world.
According to UNIC (2015), of the 2.2 billion of children in the world, 1.9 billion of them live
in developing countries and 1 billion live in poverty. Population growth and rapid
urbanization are projected to increase for more than two-thirds of all people by 2050, with
nearly 90 percent of the increase occurring in Asia and Africa (United Nation, 2014a). Given
the growing number of children who live in high-density urban slums with increasingly
limited resources, asking how access to nature can be provided for them is imperative. For
example, in their book, Greening in the Red Zone, Kransey and Tidball (2014) described
several historical cases in which people assisted the renewal of ecosystems in “red zones” of
extreme poverty, war, and natural disaster. These included the creation of community
gardens, development of horticultural practices, and turning degraded open space into
parks.

CONCLUSIONS
An impressive array of research, drawing from multiple disciplines, has attempted to
investigate basic questions about the putative beneficial effects of nature on child
development. Despite some methodological concerns, substantial evidence speaks positively
about the potential benefits of contact with nature, particularly on short-term effects of
stress relief and the reduction of attention fatigue. Obviously, anyone who believes in
evidence-based policy will not assume that nature is always and automatically good for
children. Much remains to be understood about for whom, when, how, and in which
contexts it offers benefits. This review details what we know, and offers suggestions for
exciting future research directions.

Children should be prime stakeholders in community-driven initiatives. They should be

empowered to describe their thoughts and experiences in efforts to enhance nature and
human advances. Interdisciplinary research, collaboration between different fields, and
cross-cultural research and national comparisons should be initiated as we move toward
fuller understanding of children-nature relations. More controlled, evidence-based research
is needed to inform environmental design, urban planning, and policy changes. Part of this
investigation should include demonstrating how nature’s benefits may complement or
promote, other benefits, such as species preservation and the reduction of carbon emissions,
in ways that justify public investments in research and interventions. In closing, we
recognize that contact with nature is not merely a remedy to children’s “nature deficit
disorder” but also a bridge to social equality, ecosystem integrity, and long-term viability of
environmentally sustainable cultures.
Children and Nature - Page 42
 Children and Nature - Page 43

APPENDIX: METHODOLOGY
We reviewed the literature on children and nature with an emphasis on this question: Does
contact with nature promote healthy child development? The goal was to summarize the
state of current knowledge, in terms of what is already known, the quality of research, and
identifying areas where opportunities to increase knowledge exist. The review encompasses
two other realms---animals and technologically vicarious nature---as part of this
assessment. We began our search for relevant referred articles and academic book chapters
in recent literature reviews, focusing on children and youth as well as adults. We scanned
work from non-governmental organizations, including the Research Resources database of
the Children and Nature Network (https://www.childrenandnature.org/research/) as well
as the scientific databases Web of Science, PsychInfo, Academic Search Complete, ERIC,
and Google Scholar, using the key words “child*,” “youth,” and “adolescents” in
combination with “well-being,” “health,” “development,” “benefits,” and “green*,” “green
space,” “natural environment,” “schoolyards,” “green space,” and “parks.” We also searched
the non-indexed, non-peer-reviewed (grey) literature and online reviews via Internet
searches. A spreadsheet table available by request presents a non-exhaustive list of
methodologically sound studies, with a particular focus on nature’s contribution to
developmental benefits.
 Children and Nature - Page 44

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