Children with exposure to more greenspace often demonstrate fewer behavioral problemsWhile much research suggests that nature exposure can positively impact children’s behavioral difficulties, some studies have failed to detect beneficial relationships. To clarify current understanding, this systematic review explored the existing literature on the relationship between exposure to greenspace and behavioral problems in children. The review also aimed to assess methodological issues, which may explain contradictory findings across studies.
A search of academic databases was conducted through this systematic review to identify research focused on the association of greenspace exposure and behavioral outcomes in children (0-18 years old). Studies selected for the review were written in English and reported quantified estimates of greenspace exposure. Studies that only focused on non-healthy populations (such as children with autism) were excluded from the review. The search yielded 29 studies which were mainly conducted between 2015 and 2021. The majority of studies were conducted in Europe and utilized a cross-sectional design. Researchers assessed the quality of the studies to limit risk bias and determined most to be of fair to good quality. Behavioral outcomes were measured by the studies using different assessments, with the Strengths and Difficulties Questionnaire (SDQ) utilized most frequently. There was also variation in the methods used to quantify green space around children’s homes or schools. Studies used measures of availability (surrounding greenness or greenspace), accessibility (distance to greenspace), or questionnaire assessments of greenspace quality or availability. The normalized difference vegetation index (NDVI) was most commonly used to measure greenspace exposure.
Behavioral outcomes identified by the review as being associated with greenspace included: total behavioral difficulties, ADHD symptoms and severity, conduct problems, ADHD diagnosis, prosocial behavior, emotional symptoms, peer-relationship problems, externalizing disorders (such as hyperactivity, impulsivity, and aggression), and internalizing disorders (such as anxiety, depression, and withdrawal). The far majority of the associations between greenspace exposure and total behavioral difficulties suggested that children with more exposure to greenspace had fewer behavior issues. However, in a few cases greenspace was associated with increased behavioral difficulties. Greenspace exposure was also related to reduced ADHD symptoms in the majority of studies. ADHD diagnosis showed some indication of beneficial association with greenspace exposure, but findings differed by exposure type. Findings regarding conduct problems were mixed. Nearly half of the associations suggested exposure to greenspace was related to fewer conduct problems, while the other half pointed to an increase in conduct problems. Prosocial behaviors more consistently demonstrated a positive association with greenspace exposure, with the majority of studies indicating increases prosocial behaviors. Greenspace exposure was linked to decreased emotional problems in most studies, though some studies detected increased emotional problems. The majority of studies also reported that higher levels of greenspace exposure were associated with reduced peer relationship problems, though a couple of studies found increased peer relationship problems. Finally, all studies reporting on externalizing disorders found that these types of behaviors were less prevalent in children with more greenspace exposure. Results for internalizing disorders were mostly suggestive of a similar positive effect.
Overall, findings highlight “the protective role of greenspace exposure” on an array of children’s behavioral outcomes and support the beneficial role of nature in children’s behavioral development. The review also clarifies instances of conflicting findings and suggests that inconsistencies in research methods, especially differences in greenspace exposure and behavioral outcome assessments, may explain mixed findings. Though further research is needed, prioritizing greenspaces in children’s home and school environments will likely support the development of positive behaviors.
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