KUO AND FABER TAYLOR RESPOND

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There is much that we agree with in Canu and Gordon’s assessment. We agree that our text might easily be interpreted as dismissing the value of psychosocial treatments. This is unfortunate and we regret it. In stating that “among . . . children for whom medication is not an option, a regular regime of . . . green time outdoors might offer the only relief from symptoms available,” our focus was on treatments that reduce symptoms. While to our knowledge psychosocial treatments do not actually reduce attention-deficit/hyperactivity disorder (ADHD) symptoms, their value in helping ADHD sufferers function despite their symptoms is undisputed. We agree regarding many of the limitations Canu and Gordon discuss. The effects of exposure to nature on impulsivity need to be addressed. And, as we acknowledged in the article, parent report is fallible, verbal descriptions of activities are insufficiently specific, and it is not clear how large any effects are or how long they last. Our purpose in this study was to test for the generality of the nature–ADHD connection; in other research we have begun to quantify the effects under carefully specified conditions, using objective measures. We disagree with Canu and Gordon in some respects. The heterogeneity of our sample was deliberate, and we regard the consistency of the findings across such a large and diverse sample as a hopeful sign. Similarly, we did not include non-ADHD children because our question was not whether ADHD children benefit more from nature than other children but whether they benefit at all. We did not hope for readers to be persuaded by unpublished data, nor did we rely on statistical significance to draw conclusions about effect sizes. The unpublished data are clearly indicated as such, to be taken with a liberal helping of salt, and we drew no conclusions about effect sizes. We strongly object to Canu and Gordon’s depiction of our conclusions. It would indeed be premature to conclude that nature is widely effective in reducing ADHD symptoms, or to portray nature as a well-established treatment. We made no such claims. Suggesting that nature may be widely effective is a far cry from claiming that it is widely effective, and referring to nature as a potential treatment falls well short of portraying it as well established. In a study of 452 parents nationwide, we found that activities conducted in relatively natural outdoor settings were reported to reduce ADHD symptoms more than activities conducted in other settings. This finding held across a wide variety of activities, environments, children, and case characteristics. These findings raise the possibility of a new tool for managing ADHD; we call for this exciting possibility to be investigated.