The effect of contact with nature on attention and restoration among children and adolescent affected by Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a childhood-onset disease of the neurodevelopment that can persist across the lifespan (Barkley, 1997, 1998; Brodeur & Pond, 2001), with possible impairments in familial, cognitive, academic and occupational functioning. It is mainly characterised by chronic inattentiveness or attention inconsistency and, additionally but not necessarily, impulsive behaviour (hyperactivity-impulsivity). Based on epidemiological data on developing age, international prevalence of the disease is around 5.29% (Polanczyk, Willcutt, Salum, Kieling, & Rohde, 2014) whereas in Italy the range is between 0.4% and 3.6%, depending on geographical areas and, assuming the lowest value, the pathology would concern about thirty thousand children and adolescents. Moreover, the 88,5% of those affected is constituted by males (Maschietto et al., 2012). Current treatments are both behavioural and pharmacological, notwithstanding complementary interventions that might alleviate symptoms and improve quality of life are highly suggested. Attention Restoration Theory (ART; Kaplan & Kaplan, 1989), already widely empirically tested both among typical children and adults (Berto, 2014; Chawla, 2015; Collado & Staats, 2016; Franco, Shanahan, & Fuller, 2017) offers promising beneficial applications on ADHD as confirmed by published literature (Faber Taylor, Kuo & Sullivan, 2001, 2002; Faber Taylor & Kuo, 2008; Van den Berg & Van den Berg, 2010). By considering ART framework, the present research addresses innovative points. Infact, it investigates if and how ADHD symptoms are alleviated after passive exposure in different built and natural environments among children and adolescents (first central point). It also explores the relationship between mindfulness and psychological restoration or the also defined fascination-meditation hypothesis (Kaplan, 2001), among typical adolescents (second central point), with the wider and future objective to find (active) ways that may increase the benefits of passive exposure to Nature for ADHD children and adolescents. Such aims are reached by 1) evaluating the recovery effect of different types of outdoor environments (natural and built, yet built has two sub-types historical-urban and standard-urban), (2) evaluating the recovery effect of two different types of natural environments that vary in terms of prospect – a clear field of vision on the surroundings – and refuge – the presence of (potential) hiding places that certain types of vegetation configuration might offer (Appleton, 1975; Gatersleben & Andrews, 2013; Luymes & Tamminga, 1995). Indeed, one is characterised by high prospect and low refuge and another one is characterised by low prospect and high refuge, (3) evaluating the recovery effect by considering the frequency of contact with Nature and the system of relations that involve the child, (4) testing a mediational model between mindfulness and reported restoration mediated by perceived restorativeness. In total, four experimental studies are presented, of which two are experimental. In line with previous findings, general outcomes of Study 1 and Study 2 show that a walk in a large open field characterised by high prospect promotes cognitive functioning, whereas two different natural environments of a botanical garden do not lead to recovery and are not even significantly perceived in different ways. In addition, findings of Study 3 reveal that child’s contact with Nature and connection to Nature are related to a system of family relations that influence symptoms severity. Moreover, findings of Study 4 suggest that it is possible to increase benefits of Nature contact by being mindful during passive exposure to Nature, and this is a promising line of research among ADHD children and adolescents who need to enhance the restorative effect they might obtain from exposure to Nature. Implications relate to the implementation of environment-based behavioural treatments with a mindful approach in healthcares for ADHD, outdoor pedagogies and urban design that include nearby Nature.