Researchers report association between nature-based greenness at schools and ADHD

Natural green environments surrounding schools may reduce ADHD symptoms in young children, according to study results published in JAMA Network Open.

“Given that attention is a critical prerequisite for learning, greenness in school settings may be of great public health significance,” Bo-Yi Yang, PhD, of Sun Tat-sen University School of Public Health in Guangzhou, China, and colleagues wrote. “Our findings, therefore, are relevant to policy makers and health care authorities for translating evidence into feasible and achievable target interventions (eg, planning for green spaces around schools and kindergartens) to mitigate the burden of ADHD in children.”

The population-based cross-sectional study included 59,754 children and adolescents across 94 randomized schools and kindergartens, with the data evaluated from April 2012 to January 2013. Researchers used DSM-IV ADHD scales to evaluate ADHD symptoms in the students. Parents completed the ADHD DSM-IV survey of nine inattention symptoms and nine hyperactivity-impulsivity symptoms.

Among the children, 4.3% had ADHD symptoms (mean age of 10.3 years, 49.4% female). Greenness levels varied for each school and kindergarten, with normalized difference vegetation index values ranging from –0.09 to 0.77. The researchers observed that children with ADHD symptoms attended schools with lower greenness levels, and covariate-adjusted models revealed significant associations between lower odds of ADHD symptoms and each 0.1-unit increase in normalized difference vegetation index or soil-adjusted vegetation index within 500 m of a school or kindergarten .

“Well-designed longitudinal epidemiological studies and mechanistic studies are warranted in the future,” the researchers wrote.

In a related editorial, Argelinda Baroni, MD, and Francisco Xavier Castellanos, MD, of the department of child and adolescent psychiatry at Hassenfeld Children’s Hospital in New York, noted that the data in Yang and colleagues’ study has the potential to inform psychiatric treatment and social policies.

“The work reported by Yang et al is important in highlighting the effect of green spaces near schools as places for nature access, especially for economically disadvantaged children who are among those most likely to have nature amnesia or deprivation,” Baroni and Castellanos wrote. – by Erin T. Welsh

Disclosures: Castellanos reports nonfinancial support from Greenwich Biosciences and personal fees from BOL Pharma. Baroni and Yang report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.