Nature may support neurodiverse children's well-being through both restoration and capacity-building pathwaysNeurodiverse children, including children with ADHD or autism, may experience natural environments differently from their neurotypical peers. As a result, the benefits and challenges of nature exposure may also vary, highlighting the need for research and practice that considers diverse experiences. This scoping review examined the existing research on how nature exposure affects the psychosocial well-being of neurodiverse children. In this review, psychosocial well-being included emotional, social, and psychological functioning, such as mood and anxiety, self-concept, peer relationships, and adaptive behaviors. In addition to clarifying the well-being benefits of nature for autistic children and children with ADHD, the review explored potential causal pathways, underlying theories, definitions of nature, and how neurodevelopmental phenomena are framed within the existing research to provide a broader understanding of how nature may affect neurodiverse populations.
Several academic databases were systematically searched to identify studies examining the relationship between nature exposure and psychological or social outcomes in neurodiverse children and youth (age 0–18). Neurodiversity was defined either by an ADHD, Autism, or Tourette's syndrome diagnosis or by symptom levels assessed using a psychometric instrument. Peer-reviewed studies, PhD theses, and conference proceedings, written in any language, were eligible for inclusion. Quantitative, qualitative, and mixed-methods studies were considered for inclusion. Studies focused on virtual reality, indoor nature exposure, animal-assisted or family-based interventions, the design of therapeutic settings, and sports interventions were excluded. Forty-three studies met these criteria and were included in the review. No relevant studies related to Tourette's syndrome were identified; therefore, the review focused only on children on the autism spectrum or with ADHD. The far majority of studies were published between 2010 and 2023, although the earliest study was published in 1976. Most studies were conducted in North America and Europe, with several also conducted in Asia and Oceania. Individual studies were conducted in South Africa and Brazil. The ages of participating children varied across studies. Two studies focused on early childhood, 17 on middle childhood, seven on early adolescence, and five on adolescence. Twelve studies included children across a broad age range. The included studies also used a range of research methods, including randomized controlled trials, observational studies, qualitative research, and a psychotherapist’s essay. Synthesis of findings examined: (1) positive and negative psychosocial effects of nature exposure, (2) definitions of “nature”, (3) how ADHD and autism were conceptualized, (4) theoretical frameworks, and (5) plausible mechanisms of change.
Among children with ADHD, the strongest evidence suggested that exposure to nature reduced ADHD symptoms and improved well-being. However, findings related to concentration were mixed, and no clear effects were found on intelligence or working memory. For children with autism, greenspace exposure was associated with reduced aggression, increased prosocial behavior, and various emotional responses. Most responses were positive (such as pleasant sensory experiences in nature), although some children experienced increased anxiety or other negative emotions, potentially due to sensory sensitivities or changes in routine. Definitions of “nature” varied considerably across studies. Correlational studies often used satellite-based measures, such as the Normalized Difference Vegetation Index (NDVI), to assess nature exposure. Other studies focused on perceived qualities of nature, while some did not define their conceptualization of nature. Conceptualization of ADHD and autism also differed. Most studies adopted the medical model and classified ADHD and autism as disorders. To a lesser extent, studies framed ADHD as a disease and autism as a disability. Only two studies employed a neurodiversity perspective that framed ADHD and autism as differences from the norm rather than disorders. The reviewed studies' theoretical frameworks mainly focused on the psychological effects of nature. Approximately half of the studies were aligned with Attention Restoration or Stress Reduction theories. Sixteen studies did not reference any theoretical backgrounds, while others discussed a variety of theories such as prospect-refuge theory and the biophilia hypothesis. Finally, the studies’ proposed mechanisms of change were examined. Most commonly, researchers identified restoring capacities, such as stress reduction and attention restoration, as potential pathways to improved outcomes. Building capacities, including the development of social skills and identity, were also frequently discussed. Restoring capacities were most common in studies of children with ADHD, while building capacities were more prominent in studies involving autistic children. Fewer studies examined harm reduction, such as reduced exposure to air pollution, which was primarily discussed in ADHD research. The potential for nature to cause harm, such as discomfort or increased anxiety, was identified only in studies of autistic children. Overall, the relationship between nature and child health may involve multiple pathways operating at the same time.
The review calls attention to the important role of nature in supporting the psychosocial well-being of neurodiverse children and youth. The findings suggest that restoring and building capacities are the main pathways through which nature may benefit neurodiverse children. Restoring capacities were more common in ADHD research, while building capacities were more prominent in research on autistic children. However, the theoretical support for building capacities is less developed than the theories supporting restoration. The review also identified gaps in geographic representation, clear definitions, and connections between neurodevelopmental theories and proposed mechanisms. Addressing these gaps will require more rigorous and theory-based research, as well as greater attention to the lived experiences and perspectives of neurodiverse children and their families, rather than relying solely on a medical model. Nonetheless, the authors suggest that “what benefits these children may be disarmingly straightforward: doing things, with others, in nature.”
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