Nature Deficit Disorder


Nature deficit disorder (NDD) is a term coined by Richard Louv in his 2005 bestseller, Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder. Louv's theory is that people, especially children, are disconnected from the natural world and spend far too little time outdoors in nature According to Louv, NDD contributes to a range of physical, mental, and behavioral conditions.


Human beings evolved in nature. For almost all of human history, children and adults played and worked primarily in the open air. People were knowledgeable about the natural world. They got their vitamin D from sunlight rather than from supplements. But starting in the nineteenth century and increasingly throughout the twentieth century, millions of people became isolated from nature—and not just from forests and wilderness, but from farms and animals. Spending so much time indoors, especially for children, is new to the human race. The ramifications of this momentous change are beginning to be recognized by scientists, healthcare professionals, and the general public.

The sun rising through the trees near the start of the Aiea Loop Trail, January 31, 2015.

The sun rising through the trees near the start of the Aiea Loop Trail, January 31, 2015.
(© 2015 Kelly A. Quin)

Sunlight is known to help relieve depression, especially seasonal affective disorder (SAD)—depression and anxiety that afflicts people in northern latitudes in the winter. A 2010 Japanese study of shinrin-yoku or “forest bathing' found that forest scenery, the smell of trees, or the sound of a stream lowered levels of the stress hormone cortisol, lowered pulse rate and blood pressure, reduced stress, and relaxed people. Studies have also found that children who participate in regular, unstructured play in nature are happier, calmer, more cooperative, more self-disciplined, and do better in school. Most of all, these children enjoy nature.


NDD is not a recognized medical or psychological condition. However, Louv's work garnered widespread attention, not just from outdoor enthusiasts and environmentalists, but from parents, educators, child and adolescent psychologists, public health officials, and others in the medical community. Louv followed up with a second book in 2011: The Nature Principle: Human Restoration and the End of Nature-Deficit Disorder.

In the United States and around the world, organizations such as The Nature Conservancy, the Audubon Society, and the National Wildlife Federation (NWF) have adopted the NDD concept to promote outdoor education and play. Outdoor schools and camps are proliferating. In the midst of urban decay, community groups are discovering nature in vacant lots. Overcoming NDD is a cornerstone of initiatives by the Obama administration and First Lady Michelle Obama for promoting outdoor physical activity to address the major health problems facing the nation: epidemics of obesity, diabetes, and heart disease.

Risk factors

Spending too little time outside in the natural world puts people at risk for NDD. Contributing factors include long hours spent at school and work and over-scheduling of children with enrichment classes, sports, and other organized activities. Above all, the hypnotic attraction of the screen—video games, Internet, texting, and television—draw children and adults away from outdoor activities. For the majority of American children who live in urban, sometimes even dangerous, neighborhoods, opportunities to be outside at all, much less in a natural environment, may be severely limited. Longer working hours and more household responsibilities keep adults inside, or, if outside, engaging in chores such as mowing the lawn, which is not exactly communing with nature. Medical conditions can also interfere with time spent outside.


In the early 2000s approximately one-third of American children were overweight or obese, double or triple the number in 1990, and childhood obesity rates were highest in poor neighborhoods with few parks. More than one-third of American adults are obese and 66% are either overweight or obese. These children and adults are at significantly increased risk for type 2 diabetes, heart disease, high blood pressure, asthma, sleep apnea, some types of cancer, and various other medical conditions. They are also at increased risk for NDD.

A 2010 Kaiser Family Foundation study found that American children between eight and 18 spent an average of seven hours and 38 minutes every day consuming media—using a smart phone or computer, playing video games, or watching TV—while spending just 4–7 minutes daily in unstructured outdoor play. The amount of time American families spent visiting parks, camping, and fishing decreased by as much as 25% between 1987 and 2008. And these trends were increasing. Louv and others believe that attention deficit/hyperactivity disorder (ADHD) and other behavioral problems are often directly attributable to NDD. An estimated 4.5 million American children have been diagnosed with ADHD, and the diagnoses increased by 3% every year between 1997 and 2006. Prescriptions for ADHD medications and antidepressants for children have skyrocketed.

Causes and symptoms

Symptoms ascribed to NDD include ADHD, depression, anxiety, stress, feelings of isolation and alienation, lack of creativity, poor physical fitness, and obesity. Poor school performance may also be a symptom of NDD, and studies have suggested that outdoor classrooms and experiences can contribute to significant gains in various academic subjects.

Poor eyesight and vitamin D deficiency may also be symptoms of NDD. Myopia (nearsightedness) is becoming increasingly common in young children, with time spent staring at electronic screens cited as one potential cause. Studies have suggested that children who play outside are less likely to be nearsighted and need eyeglasses. The human body produces vitamin D through exposure to sunlight. One study found that 9% of American children are vitamin D deficient, and 61% have insufficient vitamin D, potentially putting them at risk for various health problems.


Since NDD is not a recognized disorder or syndrome, there is no specific diagnosis. Symptoms such as ADHD, depression, or anxiety, accompanied by a sedentary indoor lifestyle, may suggest NDD.


The treatment for NDD is obvious: regular time spent outside in nature. Even if there is another underlying cause for the symptoms, time spent outside in the natural world benefits almost everyone and is unlikely to cause harm. More and more healthcare providers are prescribing nature time for their patients. So-called ecotherapy is used to improve mood and relieve depression, anxiety, and stress and can have physical as well as mental benefits. So-called nature prescriptions are used in the treatment of various chronic conditions, including obesity, high blood pressure, diabetes, and fatigue and other side effects of cancer therapy. Nature treatments for NDD are sometimes called “vitamin G” for “green time.” Some healthcare practitioners write detailed park prescriptions, telling patients where to go, how often, for how long, and what to do when they get there. Treatments for obese children may include prescriptions for the entire family to get out in nature. Attention restoration theory for ADHD incorporates exposure to natural settings.

Attention deficit/hyperactivity disorder (ADHD)—
Conditions characterized by age-inappropriate attention span, hyperactivity, and impulsive behavior.
Psychotherapy that uses nature based methods for treating anxiety and depression.
An abnormal accumulation of body fat, usually 20% or more above ideal body weight or a body mass index (BMI) of 30 or above.
A body mass index (BMI) between 25 and 30.
Seasonal affective disorder (SAD)—
Depression that recurs in fall and winter as the hours of sunlight decrease.
Vitamin D—
A fat-soluble vitamin that is produced by the body through exposure to sunlight and can also be obtained from the diet and supplements.
Vitamin G—
A term used to describe green time—time spent outdoors in nature—that is essential for human health and well-being.

However, treatment for NDD is not always as simple as it sounds. It can require significant lifestyle changes for families and changes in school curricula, the establishment of accessible natural areas in inner cities, and societal investment in wild places. First and foremost, however, treating NDD requires a commitment from parents to unplug their kids and get them outside. The American Academy of Pediatrics suggests limiting children's screen time to no more than one or two hours per day. Such limits alone can encourage children to venture outside in search of something else to do. Parents need to set age-appropriate rules for sending their children out to play, including where they can go and for how long, and these rules will vary with the neighborhood. Connecting with other parents can help ensure safe unstructured neighborhood play. Prearranging outside time with other parents means that the children will have playmates when they venture out. Parents themselves need to set an example, by going for a hike or gardening rather than sitting in front of the TV or computer console. Spending time outside with their children has mental and physical health benefits for parents as well. The NWF's Be Out There Movement asks parents to take a pledge to get their children outside.

Above all, parents should not over-schedule prescribed activities for their children. The NWF recommends that young people be given a daily green hour for unstructured outside play and interaction with nature. They emphasize that the time and freedom to explore nature are important components of child development and advise overbooked families to prioritize play. There are numerous websites with creative ideas for more organized nature exploration and play.

Public health role and response

Most public health response to NDD has been at the grassroots level, with movements such as the Children & Nature Network and the No Child Left Inside Coalition, which lobbies for a federal No Child Left Inside Act to increase environmental education in schools. Environmental organizations are promoting antidotes for NDD, such as the NWF's Green Hour and Be Out There campaign. The program 100,000 Kids in the Outdoors asks adults to share outdoor time with children who would otherwise not be able to go out in nature.

The U.S. government has also begun to address NDD, with its America's Great Outdoors and Youth in the Great Outdoors programs. First Lady Michelle Obama's Let's Move campaign also encourages outdoor activities for counteracting NDD. The National Environmental Education Foundation promotes outdoor education.


Research demonstrates that children are happier and healthier when they spend time outdoors. It appears that being out in nature may cause the brain to produce more beneficial chemicals. Research indicates that children who play outside are less likely to get sick, to suffer stress, or to be aggressive. They tend to be more adaptable and resilient. According to a 2010 NWF survey, a majority of educators report that children with regular unstructured outdoor playtime concentrate better, are more creative, and are better problem solvers. Studies have found that outdoor education improves attentiveness, focus, performance, and test scores.

Outdoor activities and play and exposure to nature may not cure ADHD, but they do appear to reduce symptoms. Unfortunately, children with ADHD may get less time outside than their peers, because they are more likely to be kept in during recess or after school because of behavior problems. Research indicates that schoolwork, ADHD, and depressive symptoms improve when children move to neighborhoods with more green space.


Nature therapy can be important for adult healing as well. Studies have shown that patients with a view of trees heal faster than those in windowless rooms or with views of city buildings. Even workers in windowless offices were healthier, happier, and more efficient with virtual windows—flat screens with nature views—although not as healthy, happy, or creative as workers with real windows with natural views.


Although there is nothing new about recommending that children—especially overweight and obese children—get more physical exercise, the American Academy of Pediatrics and other organizations recommend that as much of that activity as possible be in the outdoors. In societies in which children are bombarded with electronic media, it is the responsibility of parents, schools, youth organizations, and society at large to combat NDD by getting youngsters outside in nature. Parents can organize walk-to-school groups. Schools can institute more environmental education. Combating NDD may contribute to better adjusted, smarter, and more creative children. Without a doubt, it will contribute to physically healthier children and adults. Ultimately however, children will play outside, not to reduce their stress or do better in school but because it is fun.

See also National parks.



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Louv, Richard. The Nature Principle: Human Restoration and the End of Nature-Deficit Disorder. Chapel Hill, NC: Algonquin, 2011.

Louv, Richard. The Nature Principle: Reconnecting with Life in a Virtual Age. Chapel Hill, NC: Algonquin, 2012.

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Children & Nature Network, 7 Avenida Vista Grande B-7, no. 502, Santa Fe, NM, 87508,, .

National Environmental Education Foundation, 4301 Connecticut Ave., Ste. 160, Washington, DC, 20008, (202) 833-2933, Fax: (202) 261-6464, .

National Wildlife Federation, PO Box 1583, Merrifield, VA, 22116-1583, 1(703) 438-6000, (800) 822-9919, .

The Nature Conservancy, 4245 North Fairfax Dr., Ste. 100, Arlington, VA, 22203-1606, (703) 841-5300, (800) 628-6860,, .

Outdoor Foundation, 1776 Massachusetts Ave. NW, Ste. 450, Washington, DC, 20036, (202) 271-3252,, .

Margaret Alic, PhD

  This information is not a tool for self-diagnosis or a substitute for professional care.