Tag Archives: ADHD

Accessing Developmental Testing

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child working with blocks

Note: This post is tailored to families in Washington State, but the general process is similar elsewhere.

Monitoring

I encourage all parents and teachers to do developmental monitoring: from time to time check out a developmental checklist to be sure your child is on track. And read developmental newsletters for ideas on how to support well-rounded development. Or, you can check out the Washington Early Learning and Development Guidelines which are an amazing resource for children birth through grade 3, where each developmental level includes ways to support your child’s development, differences in development and guidelines for when/how to seek intervention services.

Screening

About 1 in 6 children has a developmental or behavioral issue, such as autism, ADHD, dyslexia, and developmental delays. Only 30% of those concerns would be detected just through the monitoring process. Early intervention from birth to age 3 can help children learn important skills, and getting support and services for children age 3 and up can have a huge benefit for their schooling.

If you are wondering if your child might have autism or ADHD or developmental delays, start with a screening tool. The results might help to reassure you that your child is actually developing normally or they could validate that seeking further assessment and testing would be beneficial. The ASQ – Ages and Stages questionnaire is one of the best available tools for overall development, and you can complete it yourself in about 15 minutes. The ASQ-SE screens for social-emotional development, and can help to identify possible autism signs. (Learn more about using the ASQ and ASQ-SE and understanding your child’s ASQ results.)

For Washington state residents: you can complete the ASQ and ASQ-SE online and a child development specialist from Within Reach will contact you with the results within a week and discuss those results with you. Oregon offers an online ASQ and ASQ-SE here that appear to be open to anyone – you will see the results when you complete the screening.

Talk with a Professional

A helpful second step is to talk to your child’s doctor or their teacher or childcare provider about your concerns, and share the results of the screening. Here is a tip sheet for talking with a doctor about your concerns.

Your child’s doctor may offer a referral to a specialist, such as a child neurologist or a child psychologist. You could also ask for a written referral for testing, using this form.

You can also directly contact your state’s early childhood system to request a free Child Find Evaluation to find out if your child qualifies for intervention services. You do not need a doctor’s referral to make this call.

Evaluation – for Children under 3

The Individuals with Disabilities Education Act, or IDEA (specifically in Part C) guarantees your child a right to a free developmental evaluation. Some people call it “birth to three services,” “early intervention,” or “Part C services”. If your child qualifies for intervention, services can be billed to insurance, or offered on a sliding scale. You will not be denied services if you can’t pay for them.

In Washington, evaluations are provided through ESIT – Early Support for Infants and Toddlers. (Info for Outside Washington.) Each county has a lead agency that processes referrals and schedules evaluations. All the agencies are listed here. To learn which agency serves your location, you can call the Help Me Grow Washington Hotline at 1-800-322-2588.This statewide, toll-free number offers help in English, Spanish and other languages.

The evaluation process uses standardized tools and observations to evaluate a child’s development in 5 areas: physical, cognitive, social-emotional, communication, adaptive / self-care, and sensory processing skills. The evaluator uses natural situations to look at these skills as a child plays, stacks blocks, draws, etc.

If the evaluation shows your child is eligible for services (eligibility criteria here), they may develop an IFSP – Individualized Family Service Plan – and you will be referred for early intervention services, such as physical therapy, occupational therapy, speech therapy, hearing or vision services. In most cases, services are provided in the home or in a child-care setting.

Learn more about IFSP and Early Intervention, and even more about IFSP.

Evaluations for Children age 3 – 5

In Washington, “Child Find” evaluations are offered through your school district. They are free but you must request them.

You can call your school district coordinator* and say: “I have concerns about my child’s development and I would like to have my child evaluated through the school system for preschool special education services. Can you help me or let me speak with someone who can?” Write down who you speak to, the date, and what was said; you might need this information later.

At some point, you will need to submit a written request for evaluation. Some parents start with that. A sample letter to request evaluation is available on PAVE’s website, or the state offers a referral form. (Learn more about how to make the request for an evaluation.)

From the time of request the school has 25 school days to decide whether to evaluate, then 35 school days to complete the evaluation. Make sure you keep a record of when you started the process. (Learn more about the referral and evaluation process.)

The evaluation might look like academic tests, questionnaires, informal observations of the child and parent interviews. They may measure: communication skills, hearing and vision, motor skills, social skills, academic skills, thinking and reasoning. (Learn more about evaluation.)

IDEA describes 14 disability categories. If your child meets the criteria under one of those categories, they are eligible for an Individualized Education Program (IEP). Learn more about developing an initial IEP. (Tips for preparing for your IEP meeting.)

If they don’t meet IDEA eligibility, but they have a disability that impacts a “major life activity” they can have a section 504 plan for accommodations which enable equitable access. (If they are found not eligible, learn what to do.)

Children with identified disabilities can receive free special education and related services at preschools run by the local public-school district or through Head Start or ECEAP. (Learn more about preschool placement.) Related services might include speech therapy, occupational therapy, mental health counseling or special transportation, etc.

If your child is older than 5:

Contact the public school that your child attends or that they would assigned to (if they are homeschooled or attending private school). From there, the process is much as described above.

Most specialized education is provided by special educators who “push in” with support in the general education classroom. (The IDEA requires education in the Least Restrictive Environment (LRE) to the greatest extent possible with typically developing peers.) Some children do not thrive in typical classrooms, and may receive “pull out” instruction in a specialized setting.

Families that homeschool or attend private school, have the option to receive some services from the public school system, even if they are not attending full-time. Learn more about private school Equitable Services plan.

Private Evaluations

In order to access publicly funded early intervention services and special education, you will only need to complete the free evaluations described above.

It is also possible to have a formal evaluation by a child psychologist or psychiatrist, a occupational therapist or speech/language pathologist, clinic specializing in autism, ADHD, etc. This may lead to a more detailed report about your child’s diagnosis and how you can support them, or it may make you eligible for additional services that could be covered by insurance, or may make your child eligible for medications. These diagnostic evaluations may be covered by your insurance or might require paying out of pocket, and can be expensive, so be sure you check about costs and coverage.

If you’re looking for a provider for a diagnosis, seek recommendations of knowledgeable professionals in your area from:

  • Support groups (for example, Autism Speaks has a national directory of providers;
  • People who have children or other family members with the condition
  • Governmental resources (for example, the Autism Guidebook for WA)
  • Your primary care provider or other health care professionals
  • Early intervention or special education providers

More Resources

*How to Contact Your School District

For children age 3 to 5, you’ll reach out to the special ed team in your child’s school district. Here’s info for all the districts in the state. k12.wa.us/sites/default/files/public/specialed/resourcelibrary/SpEdDirectory.pdf

Here are contacts for district’s on Seattle’s Eastside. (I teach for the Bellevue College Parent Education Program so these are the resources I refer to.) If their websites said what agency provides evaluations for ages birth to 3, I list that after the website URL. (If the Early Intervention provider is not listed, call Help Me Grow Washington Hotline at 1-800-322-2588.)

To refer your child for Kindering services, call (425) 653-4300 or submit an online referral form here.  Kindering provides helpful information about their telehealth evaluations.

The Race Car Brain

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There are some children whose brains and bodies always seem to be racing. The parent may feel like they start playing with blocks with the child and then the child runs off to paint and while the parent is still putting blocks away and cleaning up paint, the child has already flipped through a few pages of five different books and is climbing the bookshelf. Or while doing one activity the child is looking around the room at other activities.

Talking to them may also feel like this – they ask a question, and as you start to answer it, they ask another question, and before you can answer that one, they interrupt to tell you what they had for breakfast. Parents (or teachers) may feel like they can never quite catch up.

It’s easy to fall into patterns of continuously scolding them to “stop!” or “pay attention!” It’s easy to see them as problem kids. However, they have a lot of important strengths, like curiosity, enthusiasm and energy.

Dr. Ned Hallowell* would say to these kids: “Your brain is very powerful.  Your brain is like a Ferrari, a race car.  You have the power to win races and become a champion. However, you do have one problem.  You have bicycle brakes.  Your brakes just aren’t strong enough to control the powerful brain you’ve got.  So, you can’t slow down or stop when you need to.  Your mind goes off wherever it wants to go, instead of staying on track.  But not to worry… we can strengthen your brakes.”

Strengthening their Brakes

We can do several things to help them slow down and learn new skills like a longer attention span, persistence, and impulse control:

  • Routines: having predictable schedules, where they know what to expect and know what is expected of them. Visual schedules may help.
  • Break it down: they may have a very hard time doing a big task, but find it easier if you break it down into small specific tasks. So instead of saying “clean up this mess”, say “we have four steps – the first step is to put the Legos in the basket – when you’re done with that, let me know and I’ll tell you step two.”
  • Practice sticking with a task: try setting a timer and say “we’re going to do this activity together for at least five minutes. When we give persistence muscles a workout, they get stronger.” (Before you do this, try to get a baseline of how long they typically stick to a task. If they typically can do 3 minutes, you don’t want to set a timer for fifteen… that would be too much of a stretch.)
    • Use a timer they can read and see the progress on (for example, an hourglass where they can see that their time is halfway up, or a kitchen timer, where they can see that the dial is halfway toward zero are both easier to understand than a digital countdown timer on a phone)
  • Tell them what to focus on. Instead of just saying “focus” or “pay attention” tell them exactly what to pay attention to: “I’m going to tell you the three things we need to do today, so I want you to listen till you hear all three things.” Or “right now the priority is eating breakfast – can you focus on counting each bite you take till you get to ten?”
  • Physical supports: Some children focus better in a class when they sit on a ball where their body can wiggle or they spin a fidget spinner while their brain pays attention. My child could focus better when he wore a weighted vest because the pressure gave his brain some tactile stimulation. Some children focus better if there’s some white noise or quiet background music. (It’s over-stimulating for others who do best when they wear noise canceling headphones.) Experiment to see what helps your child.
  • De-clutter! Too much stimuli can over-activate these kids. If they’re in a room with just a few toys, they do fine. If they’re in a room full of toys and decorations, they flit from one to the next non-stop and never settle down. (Read about “How Many Toys is Enough.”)
    • These kids LOVE novelty! But instead of buying more toys, keeping a quiet home environment that helps to settle them with familiar items to explore in depth. Then once a day provide new experiences outside the home – taking classes or going on field trips (even just a trip to the store) gives their brain the novelty it craves while also giving them somewhere to settle their energy.
    • You can also add novel experiences with existing toys without having to add new – like putting the toy dinosaurs with the blocks, or using toy cars with the paint.
  • Connect to their interests. If there’s something they have to do, but it doesn’t capture their attention, find a way to make it more engaging. For example, if they need to practice writing their letters and they are dinosaur fans, you don’t have to practice writing the words a teacher assigns – they could practice writing pachycephalosaurus.
  • Brain and body breaks: Make sure they do have plenty of opportunities to play and burn off lots of energy.
  • Spend more time outdoors. Nature can be very calming to people whose brains are always racing.

Discipline and Race Car Brains

It’s important to know that some discipline techniques that work well with other kids might not work well with these kids. Parenting advice is not one size fits all.

Check out: 8 practical tips for parents of children with challenging behaviors. For my racecar kid, I found the book Incredible Years by Stratton had the most helpful discipline tools. I wrote several posts on discipline based on these techniques. Find links to them here.

I also find neuropsychiatrist Daniel Siegel’s writing on brain development to be very helpful. He says the “downstairs brain” is responsible for survival and emotions. It’s fully developed in a toddler. The upstairs brain is responsible for advanced functions like language, decision-making, impulse control and empathy. These take years to develop. When a child is very upset, extreme emotions block their ability to use their upstairs brain. They “flip their lid” and regress back to the downstairs brain. When they’re in this state, you can’t reason with them, you can’t ask them to make choices, you can’t expect them to “use their words.” Learn more: http://msue.anr.msu.edu/news/understanding_the_upstairs_and_downstairs_brain.

So, if you have a racecar kid in the middle of a meltdown, you’re not going to be able to reason with them or have long discussions about the implications of their choices. They can’t pay attention to a deep discussion when they’re at their best, and especially not if they’ve flipped their lid. They’ll do better with clear rules, concrete statements of what behavior you want to see, and quick consequences for misbehavior. See more tips in the Discipline Toolbox.

Is it ADHD?

*Note: Hallowell, who coined this race car metaphor, specializes in ADHD, so he is using race car brain to describe the ADHD brain. I am using it more broadly.

Many toddlers or preschoolers (2 – 4 year olds) may seem like racecar kids. If you help them learn skills to slow themselves down and calm themselves, most of those kids slow down as they get older and develop better brakes and would never be considered ADHD.

However, if you’ve got a child about to start kindergarten who you have been working on brake-building skills with for a year or so and you’re still seeing this race car brain, it may be a good idea to check in with their teacher or doctor. About 9% of children do have ADHD. Learn about criteria for an ADHD diagnosis and deciding whether to have your child assessed for ADHD, and how to access testing.

Autistic? ADHD? SPD? Or Just “Quirky”?

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As a parent educator, and as a parent of autistic children with ADHD, I’ve had multiple discussions with parents who are wondering whether their child is autistic or has ADHD or “just” sensory issues or whether there are developmental delays. Parents who are wondering whether they should have their child tested. Parents who received testing results of “well, we can’t say it’s autism, but we also can’t rule out autism.”

I’ve also had conversations with colleagues about children in their classes, where they’ll wonder about a child’s unusual behavior, but also say things like “I see some symptoms, but I don’t think they’re autistic, because they don’t ______.”  [fill in the blank of a stereotyped assumption about how “all” autistic people behave].

It’s tricky to figure out what to do about these “maybe?” cases, and trickier still when parents see that their child has challenges, and think they would benefit from support (like occupational therapy or social groups) but their insurance won’t cover it unless they have a diagnosis.

The Spectrum / Gray Areas

When I was a kid, we tended to think of autistic people as ones who showed significant impairment in multiple domains: non-verbal, developmentally delayed, frequently stimming (e.g. rocking). Then there were a bunch of other kids who were skilled in many areas, but had some unusual behaviors. We called them “quirky.” I don’t remember anyone being called ADHD when I was a kid, but there were absolutely “hyper” kids, and “head in a cloud” kids.

We understand far more now, and have clear diagnostic criteria for ADHD, a better understanding of autism and sensory processing disorders, and solid research-based developmental milestones which help us more accurately diagnose delays.

But within these criteria, there’s still a spectrum…. a range of behaviors from subtle to blatant, and from minimal impact to major impacts on school and home. Some children present very obvious symptoms very early and get a quick referral for services. Many take longer to figure out.

When you look at any behavior scoring, there’s the “typical” kids. In this bell curve, the kids in the green zone of scoring are considered normal. The kids in the red zone are two standard deviations off of “normal” and typically qualify for things like IEP’s (or gifted services) or SSI disability payments. The kids in the yellow zone – one standard deviation off – would often benefit from some services / accommodations, but may not get diagnosed early or ever.

deviations

To Test or Not to Test

I have been a childbirth educator for over 20 years. In that field, we often say – before you get a test, think what you will do with the results and whether it will be helpful to you to have the results.

If you are a parent deciding whether to test, or an early childhood professional deciding whether to refer for testing, it’s worth asking that same question.

If there are services that you believe that a child would benefit from that they can only access if they have a diagnosis, then they should be tested. If you believe they are being labeled as lazy, or spoiled, or whatever judgmental label, and you are wondering if there may be an underlying cause, they could be tested. If it would be helpful to you as a parent to have a “label” that helps you better understand your child and learn more about what they need, then it’s worth getting them tested to learn more from a professional, whether that’s a diagnosis or just resources for more ideas and support.

I’ve talked to parents who worry that having a diagnosis will harm the child’s self-esteem, and wonder if it would be better to try to “pass” and get by without the diagnosis. I have talked to multiple adults who received diagnoses as adults (whether it’s a diagnosis of autism, of ADHD, of dyslexia, of auto-immune diseases…), and they pretty much all said that receiving a diagnosis was a relief. They’d always thought, or been told, that there was something wrong with them, and if they just “tried harder” or “quit whining” they would be successful. When they had a diagnosis, they were better able to understand their needs and felt more able to ask for the accommodations they need to be successful. And they’ve also discovered more about what their unique strengths are now that they’re not trying to be just like everybody else. They wonder how much further they could have gone in life if they had the diagnosis and the correct accommodations earlier in life.

There is a meme (I saw it posted on Twitter by “OMG I’m autistic AF” that says “why do you need a label? Because there is comfort in knowing you are a normal zebra, not a strange horse.” Once you know you’re a zebra, you can find a community of zebras and learn what helps them be the very best zebras they can be… so much better than feeling like a failure at being a horse!

To refer or not to refer

As a parent educator, I observe the kids in my class. I had one toddler where I had no doubt she was on the autism spectrum and would benefit from early and intensive services. I spoke to that parent early in the year, encouraged her to seek testing, and got her connected to services.

I’ve had lots of other students who were “quirky” or have asymmetrical development issues.

I do developmental screenings in my classes, and this can start the conversation with parents about developmental issues. If there’s a minor delay in one area at one time stamp, I just talk about ways to enhance learning in that area, but if I see more delays or persistent delays in that one area, we have a broader conversation about what might be going on there. Sometimes, I have shared “here are some things about your child that are a little different than what we see in other kids their age. It could just be a temperament thing or just where they are in their development, but it does make me wonder a bit, so it’s something you could keep an eye on, and check in with me again if it becomes a concern.”

If I suspect a specific condition, I use the word, because I’ve spoken to parents of 7 year olds who have said things like “I can’t believe no professional we worked with ever mentioned the word autism to us before last  month or told us that those behaviors might be signs of autism. If anyone had the courage to have that conversation with us, we wouldn’t feel blindsided now, and we could have learned more about accommodations that would have helped us parent him more successfully and access services earlier.”

Re-Framing A Diagnosis

I also talk about autism, ADHD, and SPD differently than the common dialogue. Autism is often treated as a tragic thing. ADHD is often viewed as bad behavior which would be fixed if the parents only ______. Kids with sensory processing issues are viewed as over sensitive and told they just need to get over it.

I think it’s better to just think about these as a developmental difference which creates some challenges but can also be accommodated. If a child is blind, or deaf, we don’t expect them to be able to change that, just by “choosing to behave better.” We don’t assume that “learning to act normal” will “cure” them. We try not to let their label limit them and try to maximize their access to a full life. We figure out what accommodations they need to move through the world, and to maximize their potential for a successful life. It’s an accessibility issue. The same is true for all accommodations.

And many of the “challenges” of these conditions actually come from societal attitudes or lack of understanding. If the neurotypical community understood more about neurodiverse people, it would greatly reduce the challenges of each condition. It turns out that some of the things we do to accommodate them also benefit all the other people in the room.

Screening

If you’re wondering about your child, or a child you know, start with a list of symptoms, or red flags to watch for. Or with a screening test. Here are some resources to try:

  • Milestones Checklists from the CDC. (And here’s info about other developmental resources)
  • Overall Developmental Screening: the Ages and Stages Questionnaire assesses fine and large motor skills, communication, problem-solving and social emotional development. Here’s how you can do your own ASQ screening and the ASQ-SE which focuses on social-emotional development.
  • Autism screening: For children under 2, check out Baby Navigator. If your child is 16 – 30 months old, try the Modified Checklist for Autism in Toddlers, available at www.autismspeaks.org/screen-your-child
  • For ADHD, consider the checklist of symptoms. Think about other children the same age as your child. Compared to them does your child have several of these challenges? Do they have these challenges only at home? Only outside the home? Only when doing things they don’t enjoy (like cleaning) or that don’t interest them (sitting still at a restaurant table)? If they have these challenges in all circumstances it is more likely to be ADHD. If you only occasionally see the symptoms, there may be another cause.

Diagnostic Testing

  • If you’re still concerned after completing a screening, talk to your child’s health care provider, and/or contact your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. If your child is under three years old, look at the ECTA website. If your child is 3 years old or older, contact your local public school system.

I have a full post here on: Accessing Testing for Developmental Concerns.

What if they’re NOT diagnosed with a condition?

Sometimes you go through the steps of testing to be told your child is fine. Or that they’ll outgrow the challenges. Or they’re a quirky kid but only one standard deviation off, and thus don’t qualify for services.

If you feel strongly that your child needs services now and you can only access them if you have a diagnosis, you may have to do a fair amount of advocacy and may need to seek second opinions. Know that some clinics will refuse families who have already had an evaluation elsewhere – they worry that some parents may just be shopping around for someone who will give them the diagnosis they want. That wouldn’t be in the best interest of the child.

If it is possible for you to wait to pursue a diagnosis, that may work out better. A few months or a few years down the road, you may discover that they did outgrow it. They moved through a phase, and are now doing well in school and social occasions. Or, you may discover that things have gotten more challenging for them, and more professionals are on board with a diagnosis, given more evidence.

In the meantime, try not to be overly focused on finding a label – an answer to “WHY is my kid different than other kids.” Or on how to “fix” them.

Instead, you may find it more helpful to think: “given that my kid is who they are, what can I do to support them?” Learn more about how other people have accommodated kids with similar challenges, and try those those things. Figure out simple things that help them be more successful. Adjust some things so they’re not under continuous stress and pressure, while still giving them appropriate challenges so they learn and grow and reach their potential. Don’t let the possible label limit them more than necessary.

More resources

  • To learn about autism, read my overview of autism which includes a lot more info on signs and symptoms, and also on supportive tools that help make it more manageable.
  • For possible ADHD: If you’ve got one of those kids whose brain and body are always moving super fast, leaping from one thing to the next, make sure to check out my post on “the race car brain.”
  • If you have a very “shy” kid who holds back, hovers on the edge, and observes, check out my post on the Slow to Warm Up Child.
  • Read about Accessing Developmental Testing.

A sample decision-making process

I can share my own experiences about developmental testing for my youngest. I’m not saying it’s the ideal story or the only approach, just one example.

As a parent, I suspected something was unusual about him from when he was about six months old – signs like when he got overstimulated, he’d purposely bump his head into things. If the usual routines were disrupted, he’d have big meltdowns. When he was a toddler, he would perseverate – like during one gymnastics class where he told his coach “I am an ankylosaurus” at least 20 times. He had singular obsessions – like the month where he wanted nothing but Cat in the Hat, or the periods where he only wanted to talk about the planets and could easily be calmed out of a meltdown by just handing him 8 objects and asking him to decide which one was Mercury and putting them all in order.

However, he didn’t fit some key stereotypes of autism: he’s very verbal, OK at eye contact, and seeks out social connections. So no professional ever told us that we should seek an autism diagnosis, but I suspected that was where we’d be someday.

I learned  about autism and sensory processing disorders, and what accommodations help kids with those challenges, and I just did all those things for him. We chose preschools and activities that were a good fit for him, not ones that we knew would push his buttons. We didn’t have him tested yet, because having results wouldn’t have changed anything about what we were doing.

However, when he started kindergarten, things got more challenging. Luckily his kindergarten teacher was fabulous with him and just naturally did the accommodations he needed. But all of school didn’t accommodate as well. So, at that point, we had the testing done, and received an autism diagnosis, and that has made it easier for us to access the services he needs. For school, he has an IEP which ensures he gets extra support. And now our insurance will cover OT treatment and therapeutic social groups for him. Having access to therapies and supports are the upsides of having the official diagnosis. (There is a downside… some summer camps and other programs say they can’t take children with autism or can only take a limited number, so there are some programs that are no longer an option for him.)

In second and third grade, when kids are expected to sit still and pay attention for longer periods, he was having challenges with that, so we then learned more and had him evaluated for ADHD. That diagnosis allowed us to adjust his IEP for more accommodations which has helped him be more successful in school. And when he was 10, he was assessed to determine whether ADHD meds would be helpful for him, and they have, in fact, been very helpful. So, doing each of those evaluations when we did worked out for us. Your needs may be different.

We were hesitant to choose ADHD medication for my son, but again talked to adults we know with ADHD, and they universally recommended them, saying “on days without my meds, my brain just spins and spins and I can’t get the things done I need to get done and then I feel bad about myself and then I get less done… having my meds helps me be more the person I want to be.”

He will start middle school next year, and is far more focused and more organized than he used to be. We know that’s partially due to his meds, partially due to the extra supports he’s gotten from us and from school in learning organizational skills and executive function skills that might come naturally to others. He has far fewer emotional regulation issues and meltdowns than he had in the past. We know some of that is developmental, but most of it is due to the additional supports we have sought out (like pyramid model tools, Floor Time, ideas from Ross Greene and the Zones of Regulation) and the extra supports he has gotten from school due to his IEP.

Why you should let your child play in the mud: Benefits of Outdoor Play

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Not spending time outdoors – the modern epidemic of Nature Deficit Disorder – carries risks for our children. They include: vitamin D deficiency and nearsightedness. May include: obesity (and related diseases), asthma, allergies, ADHD, and depression.

There are so many benefits to spending outdoors in nature! Most parents have seen those benefits in action – times outdoors where their child seemed calmer, more settled, and happier than they usually seem indoors. There’s plenty of research to back up our observations.

Cognitive Benefits of Outdoor Play:

  • Exploring and Investigating: There are always new things to find outside (if you slow down and look closely.) This helps keep the spark of curiosity burning in a child, and creates a passion for learning more that can carry over into school work as well.
  • Creativity and Imagination: “Studies in several nations show children’s games are more creative in green places than in concrete playgrounds. Natural spaces encourage fantasy and role-play, reasoning and observation.” (Guardian)
  • Symbolic play: If you hand a child a manufactured toy (like the current top seller at Toys R Us for Pre-schoolers: the Peppa Pig Playhouse), it is usually obvious to the child at first glance what the object is supposed to be and how they are supposed to play with it. If you take that child outdoors, he may soon start looking for the perfect stick – then the stick becomes: a sword, or a magic wand, or a walking staff, or a fishing pole, or whatever he needs it to be in the moment. (The Stick made Wired magazine’s list of 5 best toys of all time, and sticks are in the Toy Hall of Fame.)
  • Building: Children love to build sand castles on the beach, build dams in a stream, build fairy houses in the woods, weave daisy chains, build houses of driftwood, dig holes and more. Manipulating these loose parts builds large and small motor skills, balancing all those uneven items teaches some of the basic laws of physics in a hands-on way. They also develop persistence, remaining dedicated to a task as they fail again and again, and then get it right, only to have the waves sweep away their hard work so they need to start again.
  • Self-direction: The outdoors don’t come with instructions. There’s not a right and wrong way to play outdoors, and parents tend not to have any agenda for what “must be done”, so children are free to create their own ways to play. They continue a game for as long as it pleases them, then evolve a new game when they’re ready.
  • Control and mastery: This ability to move independently, explore, and create gives kids a huge sense of empowerment and competence, which will serve them well in other challenges.

Mood and Concentration Benefits of Outdoor Time:

Most people find spending time outdoors relaxes and calms them. To understand these benefits, it helps to understand a little about how the nervous system works. The sympathetic nervous system is triggered in response to stressors and allows us to focus on what actions we need to take right now. (A full scale response would be if someone senses a predator, and they get the adrenaline rush which guides them to choose between fight and flight and freeze.) This targeted focus on tasks is very helpful in most jobs in the modern world, but always operating in this mode also is stressful in the long run. The parasympathetic nervous system is about conserving energy while the body is at rest, so the body (and mind?) can heal itself. Rather than “fight or flight”, this is called “rest and digest” or “feed and breed.”

Cities and built environments are full of intense stimuli that capture attention dramatically – honking horns, flashing lights, traffic to navigate. These trigger the sympathetic nervous system. Outdoor environments are filled with interesting stimuli – there’s plenty to look at and explore, but it’s much less dramatic – someone walking outside can relax and gaze around them without needing tight focus on anything. This triggers the parasympathetic system. One study showed that after spending 14 minutes seated in nature, and 16 minutes walking in nature, participants had lower cortisol levels, lower pulse rates, lower blood pressure, greater parasympathetic nerve activity, and lower sympathetic nerve activity than they did after spending 30 minutes in a city environment.

Spending time outside is restorative – studies show that being outdoors, exercising outdoors, and viewing nature all increase participant’s sense of vitality (physical and mental energy). And when people (adults or children) return indoors, they are better able to focus on tasks that require directed attention. Research shows:

  • Children’s classroom behavior is better if they have recess.
  • Children with ADHD concentrate better after spending just 20 minutes in nature.
  • Schools with environmental education programs score higher on standardized tests in math, reading, writing and listening.

Another benefit that parents often appreciate about outdoor time is that it allows kids to “burn off some energy.” When kids are indoors, we’re often saying “quiet voice” and “don’t make a mess” and “don’t throw that” and “would you just calm down a little!!” Outdoors they can be loud, they can be big, they have freedom, and can push boundaries and take risks. This helps them settle down, and regulate their mood and emotions better when they return inside.

Physical Benefits of Outdoor Play:

  • More ways of moving. In a dance class, gymnastics class, or soccer class, children are using specific muscle groups to accomplish specific tasks. There is certainly benefit to doing that. But there’s also benefit to moving freely during play in the outdoors and discovering all the ways their bodies can move, as they scramble under low branches, climb rocks, step carefully over brambles…
  • More ability to customize experience to ability  They can choose how high up the tree to climb, choose fatter or skinnier logs to balance on, choose the steeper or less steep parts of the hill.
  • More variability in surfaces requires kids to adapt their movement. In most playgrounds, the movements are standardized. For example, on a playground ladder, all the rungs are the same size and the same distance apart, but on a tree there’s a variety of sizes of branches and a range in the distance between them.
  • Challenges grow with a child: Modern playgrounds are much safer for younger children than older playgrounds, but modern playground design often means kids over age 8 find them limiting and boring. Nature always offers new challenges.

One occupational therapist argues that children would be better served by sessions in the woods than in O.T. clinics filled with specially designed tools. She describes the outdoors as the ultimate sensory experience. “In the clinic, we often have children go barefoot on plastic balance beams, which have been engineered to be “sensory” with little plastic bumps. If we take children outside, we could let them go barefoot on fallen trees… experiencing different textures… [and] sensations of moist versus dry, crunchy versus soft, noisy versus quiet, and changes in temperature”

Health Benefits of Outdoor Time:

  • More exercise: children who play outside are more physically active than those who play inside. Kids who make up their own play activities are more active than those who are told what to do by adults. (i.e. their free play may be better exercise than their sports classes)
  • Lower obesity rates
  • Better vision: For every hour per week a child spends outdoors while growing up, chance of myopia drops 2%
  • Even just seeing nature benefits our health: studies of hospital patients have shown decreased need for pain medications and shorter post-operative stays for those who can see nature.
  • Living near natural settings leads to: lower stress levels, lower rates of many diseases, less asthma, reduction in circulatory disease, and lower childhood obesity rates.
  • Playing in the sun provides essential Vitamin D, which protect children from future bone problems, heart disease, diabetes and other health issues

Social Benefits of Outdoor Time:

  • Social interaction: Parents tend to sit back and observe more outdoors rather than get as involved as they do in indoor settings. That allows children to explore social dynamics. Many parents observe that their children seem to make friendships quickly in outdoor settings.
  • Multi-age: Outdoor settings that encourage free play (like playgrounds) often attract a wide range of ages, unlike structured recreational activities that are usually limited to kids within a one-year age span. This encourages multi-age interaction.
  • Different basis for popularity: “The social standing of children [outdoors] depends less on physical dominance, more on inventiveness and language skills.” (Guardian)
  • Concern for the Environment: You can only care about what you know about. Kyle MacDonald of Bay Area Wilderness Training says “Connecting kids to the out of doors in a way that makes them realize, ‘this is fun, this is a place I want to be’ — that’s going to create a generation of environmental stewards.”
  • In coronavirus times, it’s easier to be socially distanced outdoors, and there’s much less risk of viral transmission than in an indoor setting, which may allow us to socialize more with others.

Given all these benefits, why do modern children spend so little time outside? Parents and kids describe all sorts of barriers to outside time. Here are tips for overcoming the barriers and getting outside to play.

If you’re in the Bellevue / Kirkland / Redmond area of Washington State, be sure to check out my post on lots of great lesser-known parks on the Eastside. If you’re in the Pacific Northwest, you might like my Guide to Northwest Native Plants.