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Children and Nature‐Deficit Disorder

Journal for Specialists in Pediatric Nursing2009Vol. 14(1), pp. 73–75

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Martha DriessnackColumn Editor: Ann M. Rhodes Ask the Expert provides research-based answers to practice questions submitted by JSPN readers. Question: I recently read an article that talked about “nature-deficit disorder” in children. I had never heard this term before. Is it something pediatric nurses need to know about? Martha Driessnack responds: The term nature-deficit disorder is credited to Richard Louv, the author of Last Child in the Woods (2008). It is not an official diagnosis in the International Classification of Diseases and Related Health Problems (ICD-10-CM). Instead, it is a label used to address the increasing cost to children as they are increasingly deprived of direct contact with nature and the experience of unstructured free play in the out-of-doors. Should pediatric nurses know about it? Yes. Childhood has moved indoors, and children are paying the price. One recent study described today's children as the backseat generation (Karsten, 2005). These are the children escorted by car to and from school, after-school activities, sports team practices and games, dance classes, and other adult-supervised and structured events. Their experience of nature most often occurs from the inside of an automobile looking out or as they watch nature DVDs projected on car headrest screens directly in front of them (Louv, 2008). In 2004, Clements surveyed over 800 mothers in the United States and found that while mothers recognized the diverse benefits of outdoor play, they felt television, computers, and concerns about crime, safety, and injury were keeping their children inside. Louv shared that no child can truly know or benefit from nature if the natural world remains behind glass, seen only through windows or on screens and computer monitors. Today, children between the ages of 8 and 18 years spend an average of 6.5 hr a day with electronic media (Roberts, Foehr, & Rideout, 2005; Roberts & Foehr, 2008). In one study, 8-year-old children were better able to identify Pikachu, Metapod, and Wigglytuff (characters from the Japanese card-trading game Pokémon) than common neighborhood flora or fauna, such as local oak trees (Balmford, Clegg, Coulson, & Taylor, 2002). Others report that young children can define global warming and describe the rainforest and the impact of deforestation in the Amazon Basin, but they have no idea what plants grow in their backyards or what watershed is affected if they litter in the street outside their house. For this new generation of children, direct experiences with nature—whether in the backyard, in a neighborhood field or woods, or along a beach, stream, or lake—are slowly being replaced by indirect experience through electronic media and machinery (Louv, 2008). Children are losing their ability to experience the world directly, which in turn contributes to a growing inability of children to relate to others’ life experience as well (Reed, 1996). In short, children are in some ways on house arrest and in danger of losing their capacity to think or learn about the world directly. Such changes in learning are now being examined as potential sources of stress and anxiety and may even contribute to increasing incidence of depression and other diagnoses in children (Ginsburg, 2007). Research related to children's direct experience with nature is growing. In 2000, Wells reported that proximity to nature and exposure to natural settings enhanced children's cognitive abilities, especially in terms of executive function. She and others (Burdette & Whitaker, 2005) found that direct experience with/in nature increased children's attention spans and abilities to focus, their creative thought processes, problem-solving abilities, self-discipline, and self-regulation. She also found that access to natural play areas helped reduce stress in children (Wells, 2003). There is growing evidence that indicates direct exposure to nature is essential for children's physical and emotional health, improving their cognitive abilities and resistance to negative stresses and depression. It is not surprising that it also appears to reduce symptoms in attention-deficit/hyperactivity disorder (ADHD) (Kuo & Taylor, 2004; Taylor, Kuo, & Sullivan, 2001). These studies on ADHD also report that the “greener” the natural setting, the greater the relief from symptoms. In contrast, indoor activities, such as watching TV, or outdoor play on paved, “nongreen” areas, increase ADHD symptoms (Louv, 2008). Kuo and Taylor also point out that prescribing “green time” as an adjunct in the treatment of ADHD may have other advantages as well. In contrast to prescription medications and behavioral therapy, green time is widely accessible, free from adverse side effects, is nonstigmatizing, and inexpensive, if not free. While direct contact with nature and unstructured free-play opportunities in the out-of-doors bring a host of cognitive, social, and health benefits to children, both direct contact with nature and unstructured outdoor play have decreased at alarming rates over the past 20 years (Burdette & Whitaker, 2005; Kellert, 2005; Taylor & Kuo, 2006). Children are “too busy,” and their lives are too structured and/or scheduled to “go outside and play”—a phrase all too familiar to earlier generations (Clements, 2004). The result, Louv (2008) proposes, is that rates of childhood obesity, attention-deficit disorder, impaired social skills (including increasing violence), and alterations in mental health (including depression) have increased to what many consider epidemic levels. Broken bones and skinned knees, once a rite of passage in childhood, are now being replaced with stress fractures and concussions, received in today's alternative outdoor “safe” play space—organized sports. Concerns about the long-term consequences of these trends have spawned a national movement called Leave No Child “Inside.” In recent months, this movement has been the impetus for Capitol Hill hearings and state legislative action, grassroots projects, such as the Outdoor Classroom Initiate, a U.S. Forest Service initiative called More Kids in the Woods, and the National Wildlife Federation Green Hour Initiative to encourage children to spend 1 hr a day in nature (Charles, Louv, Bodner, & Guns, 2008). In 2007, the World Future Society ranked nature-deficit disorder as one of the top 10 concepts that could impact and shape world health in the years to come. Healthcare providers are an important piece of this movement. While public health experts have traditionally associated environmental health with the absence of contaminants, toxins, and pollution, they may have failed to consider an equally valid alternative—how the environment can improve human health in general and children's health specifically. Not long ago, The Nation's Health, the official newspaper of the American Public Health Association, acknowledged this alternative: The effects of sedentary indoor lifestyles are already evident in children – startling rates of obesity, the onset of one-time adult conditions, such as diabetes, hypertension, and depression, and shortened life expectancy. Thankfully, though, the movement to reconnect kids with nature has seen a rejuvenation in the last few years, and experts predict that good health will be a major motivator in bringing families back to nature. (Kinsberg, 2007, ¶ 3) The Director of the Centers for Disease Control and Prevention's National Center for Environmental Health points out that while “we need more research on the relationship between nature experiences and health . . . we know enough to act” (Charles et al., 2008). This “we” includes pediatric nurses. After all, pediatric nurses have a long history of advocating for children, their health, and their growth and development. Nature-deficit disorder may be part of a much larger problem—the over-organization of childhood—rationalized and shrouded by an almost ubiquitous culture of fear. However, when children come in contact with nature, they learn to deal with fear, they discover their strengths, and they build the cognitive constructs necessary for sustained intellectual development and life-long learning (Louv, 2008). Pediatric nurses can talk with parents about unstructured play out-of-doors for children and about the importance of reconnecting children with nature and its impact on growth, development, learning, and long-term health. For the most current research reports, case studies, best practices, and practical advice concerning the children and nature movement, pediatric nurses (and parents) can visit http://www.childrenandnature.org. This is the official Web site of the Children & Nature Network, a peer-to-peer network of researchers, educators, healthcare providers, and individuals, including parents, dedicated to children's health and well-being. It is current, informative, and easy to navigate. Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder by Richard Louv (2008). Published by Algonquin Books in Chapel Hill, NC. I Love Dirt: 52 Activities to Help You and Your Child Discover the Wonders of Nature by Jennifer Ward, Richard Louv, and Susie Ghahremani (2008). Published by Trumpeter Books in Boston.

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