A substantial body of research indicates that contact with green spaces positively affects a range of physical and mental health indicators, although there is relatively little research related to impacts on behavioral development. Attention deficit hyperactivity disorder (ADHD) is a prevalent behavioral disorder affecting children and youth throughout the world, including approximately 6.8% of children and adolescents in Spain. The major purpose of this study was to examine the association between contact with green (vegetated) and blue (beaches) spaces and behavioral development indicators as well as ADHD symptoms in children.
The current cross-sectional study was part of a larger study carried out at 39 schools in Barcelona and another town in Spain, although the current study was limited to students in Barcelona schools (n=2623, aged seven to ten years old). Parents of participating students completed questionnaires on sociodemographic and household characteristics as well as behavioral outcomes. A questionnaire was used to assess behavioral outcomes; subscales included conduct problems, hyperactivity/inattention, emotional problems, peer relationship problems, and prosocial behavior. Teachers completed assessments on ADHD symptoms; symptoms fall into the categories of inattention and hyperactivity-impulsivity. Contact with green spaces was ascertained through asking parents about their child's time spent playing outdoors in green spaces (annual total hours), residential surrounding greenness, and residential proximity to a major green space. Contact with blue spaces was ascertained through examining time spent at beaches (annual total days) and residential proximity to beaches. Quantitative analyses were run to examine the effect of various green and blue space contact variables on behavioral outcomes and ADHD symptoms
Children whose parents were less educated, unemployed, single, and non-Spanish spent less time playing in green spaces and had greater total difficulties and ADHD symptoms, although there were no differences in residential surrounding greenness based on these demographics. Results showed that increased time spent in green spaces was associated with decreased total difficulties, emotional symptoms, and peer relationship problems. Other associations were found but appear to be partially mediated by physical activity. Residential surrounding greenness was associated with decreased total difficulties, hyperactivity/inattention, total ADHD symptoms, and inattention symptoms. Higher annual beach attendance was associated with decreased total difficulties and peer relationship problems, and increased prosocial behavior. Proximity to major green spaces was not significantly associated with any of the measured outcomes; this could be because proximity to green space was not associated with increased time spent playing in green spaces and the quality of the green spaces in proximity was not assessed.
Overall, the study results provide evidence to indicate that time spent playing in nature-based environments as well as vegetation surrounding residences are associated with improved behavioral outcomes, and proximity to residential greenness is also associated with decreased ADHD symptoms.
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