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Short-Term Effects of an Outdoor Activities Intervention on Children's Stress, Socio Emotional, Behavioral, and Cognitive Regulation Skills

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Title: Short-Term Effects of an Outdoor Activities Intervention on Children's Stress, Socio Emotional, Behavioral, and Cognitive Regulation Skills
Language: English
Authors: Tamara Bastianello (ORCID 0000-0002-9052-8102), Fabiola Silletti, Rosalinda Cassibba, Gabrielle Coppola, Pasquale Musso, Valeria Rossini, Chiara Zusi, Ilaria Unali, Elena Florit, Marinella Majorano, Claudio Maffeis, Manuela Lavelli
Source: Early Education and Development. 2025 36(3):724-743.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 20
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Program Effectiveness, Stress Management, Self Control, Child Behavior, Toddlers, Infants, Child Care Centers, Physiology, Emotional Response, Recreational Activities, Environmental Influences, Playgrounds, Foreign Countries
Geographic Terms: Italy
DOI: 10.1080/10409289.2024.2423387
ISSN: 1040-9289
1556-6935
Abstract: Research Findings: In recent years, interest has grown in the potential benefits of outdoor activities (OA) for children's development, particularly in promoting socioemotional, behavioral, and cognitive regulation skills and reducing stress. However, empirical evidence on the effects of OA programs for children in the first three years of life on these outcomes still needs to be provided. To address this gap, our study involved 95 infants and toddlers (girls = 48, M[subscript age] = 23.3 months) attending child care centers in north and south Italy and their teachers. Participants were divided into two groups: the Outdoor group (n = 55), actively involved in the OA program for four months, and the Control group (n = 40), who followed the standard curriculum. We assessed the children's cortisol levels and emotional, behavioral, and cognitive regulation skills before (T1) and after (T2) the implementation of the OA intervention. After the 4-month intervention, improvements in the children's adaptive behavior (particularly in social interaction) and cognitive-behavioral regulation skills were observed only in the Outdoor group. Children's stress levels remained stable. Practice or Policy: Our findings show the benefits of daily OA on young children's self-regulation, suggesting to schools and families that increasing OA from the first years of life may support cognitive and social growth.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1499565
Database: ERIC
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  Value: <anid>AN0183685182;h4j01apr.25;2025Mar18.05:11;v2.2.500</anid> <title id="AN0183685182-1">Short-Term Effects of an Outdoor Activities Intervention on Children's Stress, Socio emotional, Behavioral, and Cognitive Regulation Skills </title> <p>Research Findings: In recent years, interest has grown in the potential benefits of outdoor activities (OA) for children's development, particularly in promoting socioemotional, behavioral, and cognitive regulation skills and reducing stress. However, empirical evidence on the effects of OA programs for children in the first three years of life on these outcomes still needs to be provided. To address this gap, our study involved 95 infants and toddlers (girls = 48, M<sub>age</sub> = 23.3 months) attending child care centers in north and south Italy and their teachers. Participants were divided into two groups: the Outdoor group (n = 55), actively involved in the OA program for four months, and the Control group (n = 40), who followed the standard curriculum. We assessed the children's cortisol levels and emotional, behavioral, and cognitive regulation skills before (T1) and after (T2) the implementation of the OA intervention. After the 4-month intervention, improvements in the children's adaptive behavior (particularly in social interaction) and cognitive-behavioral regulation skills were observed only in the Outdoor group. Children's stress levels remained stable. Practice or Policy: Our findings show the benefits of daily OA on young children's self-regulation, suggesting to schools and families that increasing OA from the first years of life may support cognitive and social growth.</p> <p>The prolonged health emergency posed by the outbreak of the COVID-19 pandemic generated conditions of risk for children's psychological well-being. First, the widespread pandemic that prevented all people from leaving their homes increased the stress perceived by both children and their parents (Dillmann et al., [<reflink idref="bib17" id="ref1">17</reflink>]; Spinelli et al., [<reflink idref="bib60" id="ref2">60</reflink>], [<reflink idref="bib61" id="ref3">61</reflink>]). Moreover, the sanitary emergency imposed restrictions on all educational services, such as using masks, maintaining physical distance, and limiting peer interactions by confining activities to the small group "bubble." These conditions also increased the stress perceived by caregivers, educators, and teachers (Bigras et al., [<reflink idref="bib5" id="ref4">5</reflink>]; Quinn et al., [<reflink idref="bib55" id="ref5">55</reflink>]), particularly those working with infants, with whom physical closeness is essential to the relationship. Recent studies have shown that the restrictions relating to the pandemic and the limitation of outdoor experience can increase children's hyperactivity and weaken their emotional, behavioral, and cognitive regulatory skills (Di Giorgio et al., [<reflink idref="bib16" id="ref6">16</reflink>]; Ulset et al., [<reflink idref="bib67" id="ref7">67</reflink>]).</p> <p>In light of these critical issues, around mid-2020, the Italian Ministry of University and Research (MUR) published a call for pilot projects to support the reorganization of the activities in educational services during the pandemic and improve the quality of the interactions in a safe environment. The study presented here – part of a project funded by MUR (FISR2020IP_05065) – has two aims. Firstly, to implement a program of daily Outdoor Activities (hereafter, OA) in the green yards (see Supplementary materials) of a group of child care centers in north and south Italy by involving teachers and parents. Secondly, to investigate the effects of the OA program on children's stress levels, and their socioemotional, behavioral, and cognitive regulation skills. Knowing more about the OA effects on infants' and toddlers' self-regulation skills can be relevant not only for the pandemic and post-pandemic periods but for a longer term in terms of applicability to enhance these early skills, as they are linked to later academic success and general well-being (Schmitt et al., [<reflink idref="bib57" id="ref8">57</reflink>]).</p> <p>OA refers to all types of learning activities in which children can be involved within the outdoor environment. In our study, we refer to the outdoor green spaces of the child care centers, which in Italy are usually open spaces with some greenery (e.g., grass with trees and shrubs) and some playground-like equipment. Thus, a variety of experiences "invited" by the features of the natural environment, such as exploration, motor activities, nature observation, manipulation experiences, free play with peers and natural elements, and other activities, are included in OA. Daily, and thus routinized, OA in the green yards of the child care centers could be important for several reasons. First, OA offers infants, toddlers and their teachers safer conditions to interact in physical proximity than indoor activities. Indeed, in outdoor spaces, the transmission of viruses is less plausible than the chance of contracting a virus indoors (see Bulfone et al., [<reflink idref="bib7" id="ref9">7</reflink>], for a review; Qian et al., [<reflink idref="bib54" id="ref10">54</reflink>]). This advantage appears particularly important during the pandemic and post-pandemic period, given that in infancy, closeness is vital for developing early relationships of trust and well-being. Second, because of the features of natural environments, OA in contact with nature offers a wide variety of "affordances<sups>"</sups> or "incentives to action" (Gibson, [<reflink idref="bib29" id="ref11">29</reflink>]; Greeno, [<reflink idref="bib32" id="ref12">32</reflink>]) that differ from those available indoors. These "incentives to action" offered by specific features of a given element are perceived by children based on their individual possibilities (size, skills, experience, psychological resources). For example, a tree can "invite" learning for a one-year-old, hiding for a 2-year-old, and climbing for an older child (Gibson, [<reflink idref="bib29" id="ref13">29</reflink>]; Heft, [<reflink idref="bib35" id="ref14">35</reflink>]). These different possibilities or "incentives to action" can encourage various play actions (i.e., learning, Golinkoff et al., [<reflink idref="bib31" id="ref15">31</reflink>]) and meet the infants'/toddlers' need for exploration and movement. Third, there is empirical evidence that OA in contact with nature is a favorable setting for promoting children's well-being/stress reduction and the development of socio emotional, behavioral, and cognitive regulation skills from as early as the first years of life (Carrus et al., [<reflink idref="bib8" id="ref16">8</reflink>]; Mårtensson et al., [<reflink idref="bib45" id="ref17">45</reflink>]; Monti et al., [<reflink idref="bib49" id="ref18">49</reflink>]; Ulset et al., [<reflink idref="bib67" id="ref19">67</reflink>]). Furthermore, studies suggest that the higher the frequency and time spent in OA in green schoolyards by preschool children, the greater the gains in self-regulation skills (Faber Taylor & Butts-Wilmsmeyer, [<reflink idref="bib19" id="ref20">19</reflink>]; Ulset et al., [<reflink idref="bib67" id="ref21">67</reflink>]).</p> <p>Below, we review the extant literature on empirical evidence and the most referred theories that elucidate the potential mechanisms of OA influence. We also highlight a gap in the unexplored possible effects of OA on infants' and toddlers' socioemotional and cognitive functioning; then, we conclude by presenting how our study aims to address this gap.</p> <hd id="AN0183685182-2">Effects of OA in Natural Environments on Children's Physical and Psychological Stress</hd> <p>It is well-established that OA in natural environments improve psychological health, reducing stress levels, in both young people and adults (e.g., Chang et al., [<reflink idref="bib9" id="ref22">9</reflink>]; Ewert et al., [<reflink idref="bib18" id="ref23">18</reflink>]; Gidlow et al., [<reflink idref="bib30" id="ref24">30</reflink>]). However, there have been few studies involving infants and toddlers. Söderström et al. ([<reflink idref="bib59" id="ref25">59</reflink>]) found that Swedish preschool children with more opportunities for OA in child care centers with high-quality outdoor environments (high quality evaluated in terms of total open area, amount of trees and green areas, and integration between vegetation, open areas, and play structures) had healthier body shape, longer night sleep and higher well-being than children attending child care centers with less green areas or open spaces. The authors found a strong positive correlation between outdoor environment quality and outdoor stay, indicating that quality affects the time spent outdoors, which in turn affects children's health. Consistent results were shown by studies indicating that preschool and school children with green around or close to their home exhibited less psychological distress and a greater sense of self-worth (Wells & Evans, [<reflink idref="bib70" id="ref26">70</reflink>]), although the effect was sometimes limited to preschool children in low-income families (Flouri et al., [<reflink idref="bib27" id="ref27">27</reflink>]). To explain the way OA in natural environments can facilitate children's stress reduction, Fiskum and Jacobsen ([<reflink idref="bib25" id="ref28">25</reflink>]) highlight that, during OA, children are not under the same demands for regulating their tendency to action as in indoor educational settings. Therefore, considering that behavioral regulation for some children might be stressful, they hypothesize that the outside environment with the great possibilities for movement and fewer demands for action regulation may help to reduce stress and recover concentration and motivation for learning. The idea that nature can help people restore their adaptive resources is also shared by the Stress Reduction Theory (SRT, Ulrich et al., [<reflink idref="bib66" id="ref29">66</reflink>]) and the Attention Restoration Theory (ART, R. Kaplan & Kaplan, [<reflink idref="bib38" id="ref30">38</reflink>], [<reflink idref="bib40" id="ref31">40</reflink>], see below). The SRT postulates that exposure to natural environments that were evolutionarily beneficial for well-being and survival can quite rapidly elicit positive affect, which in turn blocks negative feelings and fosters the reduction of stress and physiological activation (Hartig et al., [<reflink idref="bib34" id="ref32">34</reflink>]; Ulrich et al., [<reflink idref="bib66" id="ref33">66</reflink>]). All these hypotheses are consistent with kindergarten and school children's preference for natural environments rather than built environments (Titman, [<reflink idref="bib62" id="ref34">62</reflink>]) and with children's descriptions of the natural areas in the schoolyards as more peaceful and relaxing than classrooms indoors (Bagot et al., [<reflink idref="bib3" id="ref35">3</reflink>]; Chawla et al., [<reflink idref="bib10" id="ref36">10</reflink>]). However, very little is known about the impact of outdoor activities on infants' and toddlers' well-being.</p> <hd id="AN0183685182-3">Effects of OA in Natural Environments on Children's Socioemotional, Behavioral, and Cognitive...</hd> <p>In addition to providing safe proximity, promoting good health conditions, and reducing stress levels, outdoor activities in natural environments may promote socioemotional and cognitive functioning (Adhemar, [<reflink idref="bib1" id="ref37">1</reflink>]; Maynard et al., [<reflink idref="bib46" id="ref38">46</reflink>]; McClain & Vandermaas-Peeler, [<reflink idref="bib48" id="ref39">48</reflink>]; Monti et al., [<reflink idref="bib49" id="ref40">49</reflink>]). Although these issues have been largely studied in childhood and adulthood, less is known about the effects of OA in infancy and toddlerhood. Outdoor Activities can influence children's adaptive behavior, humor, and cooperative play (Ouvry, [<reflink idref="bib53" id="ref41">53</reflink>]), but also language, communication, and socioemotional functioning (Scott et al., [<reflink idref="bib58" id="ref42">58</reflink>]; Tovey, [<reflink idref="bib64" id="ref43">64</reflink>]; Waller, [<reflink idref="bib69" id="ref44">69</reflink>]). For instance, Fiskum and Jacobsen ([<reflink idref="bib25" id="ref45">25</reflink>]) investigated the effects of OA on primary school children's behaviors and emotional states by observing children during different indoor and outdoor activities and rating their emotional states. Children obtained fewer neutral and more positive scores when observed in outdoor activities, and more neutral and negative scores when assessed in indoor activities. McClain and Vandermaas-Peeler ([<reflink idref="bib48" id="ref46">48</reflink>]) examined the influence of OA on preschoolers' physical and socioemotional development, looking at their interactions with various environmental affordances and their peers. While outdoors, children participated in active and complex pretend play and exhibited far more social collaboration and helping than competition and fighting. Agostini et al. ([<reflink idref="bib2" id="ref47">2</reflink>]) investigated teachers' perception of the effects of OA on 3- to 5-year-old children. They found that children attending a program based on OA received higher scores in, cognitive, and motor development than children in the control group, though only in the short term.</p> <p>Other studies conducted with preschool and primary school children show that OA in green environments can affect the child's attention and behavioral regulation skills. van Dijk-Wesselius and colleagues ([<reflink idref="bib68" id="ref48">68</reflink>]) investigated the impact of greening schoolyards on 7-to 11-year-olds, showing that children who could easily access green schoolyards reported higher results in attention tasks than students who couldn't access green spaces. Interestingly, greening schoolyards was especially beneficial for younger children. However, very few studies have focused on the relationship between cognitive regulation skills and time spent outdoors. Recently, Faber Taylor and Butts-Wilmsmeyer ([<reflink idref="bib19" id="ref49">19</reflink>]) examined the relationships between the frequency and duration of OA in green schoolyards of kindergartens and children's self-regulation abilities; these authors' findings showed that children who spent more time in green schoolyards scored better results when assessed in behavioral and cognitive regulation processes through ad-hoc tests. Ulset et al. ([<reflink idref="bib67" id="ref50">67</reflink>]) examined the relationships between the amount of time children spent outdoors during preschool and their cognitive and behavioral development throughout preschool and first grade; they found that the daily outdoor hours were positively related to children's attention skills and inversely related with children's inattention-hyperactivity symptoms. Also, Mårtensson et al. ([<reflink idref="bib45" id="ref51">45</reflink>]) showed that attention skills in preschool children are correlated with OA in green outdoor environments. They found that children spending more time outside, in spacious and well-integrated green spaces, showed fewer behaviors of inattention measured with the Early Childhood Attention Deficit Disorders Evaluation Scale (McCarney, [<reflink idref="bib47" id="ref52">47</reflink>]). Further studies confirmed such a pattern, especially for children presenting with ADHD. Faber Taylor and Kuo ([<reflink idref="bib20" id="ref53">20</reflink>]) demonstrated that OA, such as a 20 min-walk in a park (<emph>vs</emph> a built setting), has a direct effect on the attention of children with ADHD. They also showed that playing regularly in outdoor green play settings can mitigate ADHD symptoms, suggesting that OA in green places is a protective factor for preventing neurodevelopmental disorders (Faber Taylor & Kuo, [<reflink idref="bib21" id="ref54">21</reflink>]). Finally, to our knowledge, only three studies have directly investigated the effects of OA on infants and toddlers in child care centers. Monti et al. ([<reflink idref="bib49" id="ref55">49</reflink>]) investigated the impact of an OA program on multiple domains of child development in a group of 1- to 3-year-old children. After attending the program, children in the experimental group showed significant improvements in cognitive and social-emotional development and better fine motor abilities than children in the control group. Carrus et al. ([<reflink idref="bib8" id="ref56">8</reflink>]) compared the performance of 16 toddlers (18–36 months) in a structured task requiring focused attention and their social behavior after indoor free play and outdoor free play in green spaces to investigate any effect of OA on children's skills. Their results showed that outdoor play was associated with better performances in directed (focused) attention and more positive social behaviors, suggesting that OA in contact with nature can promote psychological restoration and recovery of directed attention, even in toddlers. More recently, Florit et al. ([<reflink idref="bib26" id="ref57">26</reflink>]) conducted a motor intervention study, examining the impact of both the setting (indoor vs outdoor) and the program itself (I-MovE) on the motor, behavioral, and cognitive regulation skills of infants and young children (6–43 months). They found that the I-MovE program significantly improved children's motor skills both in the outdoor and in the indoor group. However, only children in the outdoor group benefited from the program in terms of their socioemotional and cognitive regulation skills.</p> <p>To explain these findings, one of the most accepted theories is the Attention Restoration Theory (ART, Kaplan, [<reflink idref="bib39" id="ref58">39</reflink>]; Kaplan & Kaplan, [<reflink idref="bib40" id="ref59">40</reflink>]). This theory distinguishes two types of attention: (<reflink idref="bib1" id="ref60">1</reflink>) directed attention, which is the ability to maintain focus on a task inhibiting distracting stimuli in the environment and other impulses, and (<reflink idref="bib2" id="ref61">2</reflink>) involuntary attention, or "soft fascination," which is effortless. Directed attention is foundational for executive functions, but it is also a limited cognitive resource that becomes fatigued after extended use; thus, when directed attention is depleted, a typical state of distractibility, restlessness, increased susceptibility to stress, and temporary worsening of cognitive performance appears. Situations in which a person can rest by relying on involuntary effortless attention are then crucial. ART holds that natural environments contain many intrinsically fascinating elements that effortlessly engage involuntary attention and facilitate the recovery of directed attention. OA in natural environments seems particularly restorative also because nature supports human informational needs, firstly the need for exploration (Kaplan & Kaplan, [<reflink idref="bib40" id="ref62">40</reflink>]), which is particularly strong in children (Liquin & Gopnik, [<reflink idref="bib42" id="ref63">42</reflink>]).</p> <p>On the whole, the reviewed findings highlight the potentially important role of OA in green spaces of educational settings in enhancing cognitive and socioemotional development, particularly self-regulation skills and well-being. Indeed, the body of empirical evidence shows that what counts in OA to potentially improving children's cognitive functioning and self-control, as well as stress reduction, is not a specific kind of activity children can do outdoors, but the presence of green areas (i.e., contact with nature), and how much time children spend outside. However, empirical evidence of links between OA and well-being and self-regulation skills in infants and toddlers is still scant. Promising clues come from the studies reviewed above. Still, Monti et al. ([<reflink idref="bib49" id="ref64">49</reflink>]) did not investigate the impact of OA on children's specific abilities; Carrus and colleagues' results ([<reflink idref="bib8" id="ref65">8</reflink>]) are based on a small sample size. Finally, Florit et al. ([<reflink idref="bib26" id="ref66">26</reflink>]) did not distinguish the effects of OA in the natural environment from those of the motor program itself. The current study aims to address and contribute to filling this gap.</p> <hd id="AN0183685182-4">The Present Study</hd> <p>This study aims to assess the following research questions (RQs):</p> <hd id="AN0183685182-5">RQ1.</hd> <p>Does the daily experience of OA in the green spaces of childcare centers impact children's stress levels?</p> <hd id="AN0183685182-6">RQ2.</hd> <p>Does the daily experience of OA in the green spaces of childcare centers impact a) children's socio emotional regulation skills, b) behavioral regulation skills, and c) cognitive regulation skills?</p> <p>After checking the actual implementation of the intervention program on the part of the teachers in the OA group (i.e., actual changes in frequency, duration, and variety of OA), we assessed any possible impacts of the OA program on (RQ1) children's stress levels, and (RQ2) children's socioemotional skills, adaptive behavior, and early executive functioning (including attentional and impulse control, and emergent working memory), as reported by parents and teachers. Although the intervention lasted only four months (because of the limited time given by the MUR call for projects), some positive short-term effects were expected on the considered variables. Concerning the stress factors, based on the empirical evidence reviewed and the theoretical foundation offered by the theories presented above, it would be possible to hypothesize a reduction in children's stress. However, considering that stress is a hard-to-change factor in a short time (Cicchetti et al., [<reflink idref="bib11" id="ref67">11</reflink>]) and that any important change in daily routines (such as that proposed with the OA program) can initially cause stress, especially in younger children, we could not formulate a clear hypothesis. On the contrary, regarding children's regulation skills, based on the empirical evidence reviewed and theoretical foundation offered by the theories presented above, we expected an interaction effect between Time (T1 vs T2) and Group (Outdoor vs Control), with the Outdoor group significantly improving their socioemotional, behavioral, and cognitive regulation skills between pre-intervention (T1) and post-intervention (T2). Lastly, we compared child care teachers' thoughts and practices about OA before and after the intervention to detect any possible perception of changes.</p> <hd id="AN0183685182-7">Method</hd> <p></p> <hd id="AN0183685182-8">Participants</hd> <p>Eight child care centers with 62 teachers and more than 250 children participated in the research project. Four centers were in Verona and four in Bari, two cities in north and south Italy, respectively, because the prototype required by the MUR calls for projects to be usable all over Italy. Despite the large number of children attending the centers, the number of children with data collected at T1 and T2 was considerably smaller at the end of the study. Indeed, only 55% of the families consented to data collection (see more details in the Procedure section). Moreover, many children absent from child care for extended periods because of the COVID-19 pandemic were excluded from the sample. We excluded children who did not attend child care for more than 30 days, including not consecutive, because there was only a short time (4 months) between data collection pre- and post-intervention. Thus, we did not expect any change in children who did not regularly attend the educational service (Mulvey et al., [<reflink idref="bib50" id="ref68">50</reflink>]). In addition, several parents were unwilling to collect salivary cortisol (see the Measures section). The final sample with data at T1 and T2 comprised 95 children, 55 children in the Outdoor group (<emph>M</emph><subs><emph>age</emph></subs> = 24.1, <emph>SD</emph> = 7.75, girls = 27) − 24 children in two child care centers in Bari and 31 in two child care centers in Verona participating in the OA intervention – and 40 children in the Control group (<emph>M</emph><subs><emph>age</emph></subs> = 22.7, <emph>SD</emph> = 8.97, girls = 21) − 18 children in two child care centers in Bari and 22 in two child care in Verona following the standard curriculum. It should be noted here that in Italy, the "standard" curriculum for education in child care does not include any specific program of OA, so few outdoor activities are usually carried out. The teachers were all Italian women. All children were born in Italy, 97% from Italian families, and around 3% from immigrant families from different countries (Spain, Nigeria, France).</p> <p>Children were not randomly assigned to the Outdoor or Control groups because the structural conditions of the Italian child care did not allow the differentiation of activities (i.e., the OA program with half of the children and the standard curriculum with the other half of the children) within same child care (sections organized in small groups of up to 5–6 children per teacher, depending on the children's age). Indeed, Italian child care centers ― aimed at children aged from 3 months (but usually attended by infants aged 9 months onwards) to 3 years ― are organized in sections based on infants' age: the younger ones (up to 12 months), the middle ones (second year), and the older ones (third year). Each section is organized in small groups of up to 5 (if younger) or 6 children, with a teacher responsible for each group and often a support teacher for the section. To address this issue, we controlled the most relevant intervening variables by comparing the children's, parents,' and teachers' characteristics and the quality of the child care centers (rated through the SVANI scales, see Procedure below) to identify any significant differences between the Outdoor and Control groups. Considering potential differences between child care centers in north and south Italy, we first performed these analyses separately for the north and south samples. Concerning children's, parents,' and teachers' characteristics, except for the age of entering the child care in the south sample (OA group <emph>M</emph> = 11.04, Control group <emph>M</emph> = 18.67, <emph>p</emph> =.003), and the teachers' age in the north sample (OA group <emph>M</emph> = 48.63, Control group <emph>M</emph> = 42.25, <emph>p</emph> =.014), no other statistically significant differences emerged between the Outdoor and Control groups in both north and south samples (all <emph>p</emph> >.05). Also, in relation to the quality of the child care centers, no statistically significant differences emerged between the SVANI average scores in the Outdoor and Control groups in both north and south Italy (north: OA group <emph>M</emph> = 4.82, Control group <emph>M</emph> = 4.59 <emph>p</emph> =.151; south: OA group <emph>M</emph> = 4.85, Control group <emph>M</emph> = 4.54 <emph>p</emph> =.305). Then, we compared the characteristics of the children, parents and teachers, and the quality of the child care centers (rated through the SVANI) between the north and south samples to detect any significant differences between participants of the two different geographical areas. Except for the age of entering the child care (north Italy <emph>M</emph> = 11.95, south Italy <emph>M</emph> = 14.03, <emph>p</emph> =.026), no differences emerged (all <emph>ps</emph> >.05) between the north and south samples. For this reason, we kept the participants in north and south Italy together as one sample. The children's, parents,' and teachers' characteristics, and the child care centers' SVANI scores are reported in Table 1.</p> <p>Table 1. Children's, parents,' teachers' and child care centers characteristics.</p> <p> <ephtml> <table><thead><tr><td /><td>Outdoor group</td><td>Control group</td><td /><td /></tr></thead><tbody><tr><td>Children</td><td><italic>M</italic> (SD)</td><td><italic>M</italic> (SD)</td><td><italic>t</italic> (94)</td><td><italic>p</italic></td></tr><tr><td>(<italic>n</italic> = 55)</td><td>(<italic>n</italic> = 40)</td></tr><tr><td> Age (months)</td><td>22.7 (8.97)</td><td>24.1 (7.75)</td><td>− 0.793</td><td>.430</td></tr><tr><td> Boys (<italic>n</italic>)</td><td>28</td><td>19</td><td><italic>χ<sup>2</sup></italic> =.171</td><td>.679</td></tr><tr><td> Girls (<italic>n</italic>)</td><td>27</td><td>21</td></tr><tr><td> Age of entering child care (months)</td><td>10.7 (5.37)</td><td>14.8 (7.61)</td><td>− 3.028</td><td>.003</td></tr><tr><td> Daily attendance at child care (hours)</td><td>6.82 (1.69)</td><td>6.66 (1.42)</td><td>0.687</td><td>.494</td></tr><tr><td>Parents and family</td></tr><tr><td> Mothers' age</td><td>36 (4.39)</td><td>35.9 (4.06)</td><td>0.020</td><td>.984</td></tr><tr><td> Fathers' age</td><td>38.5 (4.92)</td><td>39.0 (6.07)</td><td>− 0.910</td><td>.363</td></tr><tr><td> Mothers' education<sup>a</sup></td><td>3.60 (1.25)</td><td>3.56 (1.27)</td><td><italic>χ<sup>2</sup></italic> = 2.21</td><td>.694</td></tr><tr><td> Fathers' education<sup>a</sup></td><td>2.97 (1.30)</td><td>3.12 (1.38)</td><td><italic>χ<sup>2</sup></italic> = 2.04</td><td>.728</td></tr><tr><td> Number of children in the family</td><td>1.61 (0.62)</td><td>1.54 (0.55)</td><td>0.677</td><td>.500</td></tr><tr><td>Teachers</td><td><italic>M</italic> (SD)</td><td><italic>M</italic> (SD)</td><td><italic>t</italic> (57)</td><td><italic>p</italic></td></tr><tr><td>(<italic>n</italic> = 33)</td><td>(<italic>n</italic> = 26)</td></tr><tr><td> Age</td><td>47.21 (7.84)</td><td>42.50 (5.11)</td><td>2.650</td><td>.01</td></tr><tr><td> Education <sup>a</sup></td><td>2.61 (0.86)</td><td>2.88 (0.95)</td><td><italic>χ<sup>2</sup></italic> = 1.870</td><td>.76</td></tr><tr><td> Experience in child care centers (years)</td><td>18.82 (9.17)</td><td>15.19 (6.95)</td><td>1.671</td><td>.101</td></tr><tr><td><italic>Child care centers- sections</italic></td><td>M (SD)</td><td>M (SD)</td><td><italic>t</italic> (32)</td><td><italic>p</italic></td></tr><tr><td>(<italic>n</italic> = 17)</td><td>(<italic>n</italic> = 17)</td></tr><tr><td>SVANI (average score)</td><td>4.84 (0.46)</td><td>4.56 (0.51)</td><td>1.688</td><td>.101</td></tr></tbody></table> </ephtml> </p> <p>1 <sups>a</sups>Level of education was analyzed as a categorical variable, where 1 = 0–8 school years; 2 = 9–13 school years; 3 = 14–16 school years; 4 = 17–18 school years; 5 = more than 18 school years.</p> <hd id="AN0183685182-9">Procedure</hd> <p>The project was conducted over six months (October 2021-April 2022) as prescribed by the MUR call for projects. First, in each of the two cities, the child care centers of the Outdoor group were selected by the principal coordinator of the city's child care centers (i.e., the pedagogist who oversees the ECE programs). Then, the child care centers of the Control group were chosen by the principal coordinator and the coordinators of the different centers using a matching procedure (one-by-one) to the centers of the Outdoor group. The centers were chosen based on similarities in the numbers of children attending the service, children/teachers ratio, breadth and features of the outdoor space, indoor features (number of rooms and shared spaces), families' socioeconomic status, and presence <emph>vs</emph> absence of green spaces in the district. At the beginning of the project, two trained researchers (one in north and one in south Italy) administered the SVANI (Scala per la Valutazione dell'Asilo NIdo, the Italian version of the ITER, Infant/Toddler Environment Rating Scale;Harms et al., [<reflink idref="bib33" id="ref69">33</reflink>]; Italian vers. by; Ferrari & Livraghi, [<reflink idref="bib23" id="ref70">23</reflink>]). This rating scale was completed for each section of each child care center involved in the project; then, the SVANI average scores were considered to compare child care centers in the Outdoor and Control groups.</p> <p>The project was developed in three main phases, plus a preparation phase and a results return phase.</p> <p> <emph>Preparation phase (October 2021)</emph>. For both the Outdoor and the Control groups, teachers and families were invited to participate in the project through ad hoc meetings where the research coordinator presented the project. For the Outdoor group, a meeting with a pediatrician was organized before the study began to illustrate the benefits of OA. The Control group started their activities, which included access to the meeting with the pediatrician and the implementation of OA, immediately after the intervention with the Outdoor group concluded. After the presentation meeting, informed consent forms were distributed to teachers and families of the Outdoor and the Control groups. In the following week, the research group collected the signed consent forms. All teachers, 70% of families in the Outdoor group (<emph>N</emph> = 148) and 45% in the Control group (<emph>N</emph> = 142), gave their consent to participating also in data collection.</p> <p>Teachers of the Outdoor group were invited to participate in a Focus Group lasting 1.5–2 hours to share their beliefs, habits, and ideas/wishes about Outdoor Education. Focus groups were mediated by the research project coordinator and structured into three parts. Teachers were invited to (<reflink idref="bib1" id="ref71">1</reflink>) present themselves/their experience as child care teachers and their idea of Outdoor Education; (<reflink idref="bib2" id="ref72">2</reflink>) explain what kinds of OA they are used to doing with children (if applicable); and (<reflink idref="bib3" id="ref73">3</reflink>) start reflecting upon Outdoor Activities as part of their daily educational program. This last action was included in order to allow teachers to share their reflections on the kinds of child-guided and teacher-guided activities that could be developed in the new daily OA program and how to organize times and modalities. Focus groups allowed us to actively involve teachers and make them responsible for the OA program from the beginning. In addition, these events allowed us to collect data to compare what teachers knew or thought about OA before the intervention and what they learned while participating in the OA program.</p> <p> <emph>Phase 1 (November 2021- T1): Pre-intervention</emph>. The OA program and the monitoring diary were built with the teachers' collaboration (see the "<emph>OA Implementation: the OA Diary</emph>" section). Parents were asked to complete a short questionnaire on socio demographic data and the family's OA habits, and two rating scales about their child's socioemotional and adaptive behavior. They were also given a kit to collect a sample of their child's salivary cortisol in the early morning and bring it to the child care the same day. Then, the saliva samples were taken to the medical laboratory. Teachers were asked to complete a rating scale for each child's behavioral and cognitive regulation skills. Throughout the data collection, researchers were available to parents and teachers for clarification and support.</p> <p> <emph>Phase 2 (December 2021-March 2022): OA intervention</emph>. At the end of the first data collection, child care centers in the Outdoor group started implementing the OA four-month program. Teachers were asked to take daily informal notes on time spent outdoors with children and types of activities carried out and, at the end of each week, fill in the weekly OA diary to monitor the implementation of the OA program. To the same end, at the end of each month, OA data were reported in a summary grid (the monthly summary of the weekly OA diary) based on the items/questions of the diary and shared between teachers of the same section and researchers. Teachers in the Control group were also asked to take informal notes on time spent outdoors with children and the types of OA carried out each day they spent some time outside. Afterward, they were asked to complete the OA monthly summary diary. We avoided submitting the weekly diary to them because we did not want to influence them toward spending more time/days in OA than usual. However, the data allowed us to check the frequency and the types of OA teachers in the control group habitually did, and to compare data from the two groups. Parents of children in the Outdoor group attended the meeting with a pediatrician. The event was aimed to sensitize parents on the importance of OA for their children's physical and psychological health. Then, every two weeks, one micro-video about good OA habits was shared with parents of this group through social channels (for a total of 6 different videos). Throughout the OA intervention, the researchers visited the involved child care centers to observe activities and listen to the teachers' thoughts and feelings related to the intervention. Their presence was fundamental to being aware of the changes and feelings experienced by the teachers.</p> <p> <emph>Phase 3 (April 2022- T2): Post-intervention</emph>. Again, all parents and teachers were asked to complete the same questionnaires and rating scales as in the pre-intervention phase. Parents were asked again to collect their child's saliva samples. Then, the OA program implemented by the Outdoor group was extended to the Control group, and teachers were provided with tools useful to implement the program. Lastly, teachers in the Outdoor group were invited to a final meeting, where they were asked to comment on and evaluate the implementation of the OA program. The meeting was guided by the project coordinator at the beginning in the form of free comments and then in the form of a semi-structured interview to deepen the teachers' perceptions and thoughts about OA, the difficulties, changes, and benefits perceived, and any plans for the future.</p> <p> <emph>Results return phase</emph> (<emph>May 2022)</emph>. The results were communicated and discussed with all teachers and parents of the Outdoor group.</p> <hd id="AN0183685182-10">Measures</hd> <p></p> <hd id="AN0183685182-11">OA Implementation: The OA Diary</hd> <p>A weekly diary for monitoring the OA activities was shared at the beginning of the project. The OA program and diary were constructed with teachers and their referents. From the transcripts of the focus groups' recordings, a first picture emerged of what needed to be implemented. Then, ad hoc meetings were held with child care coordinators and experienced teachers from the Outdoor group, who volunteered to identify the necessary materials and knowledge for implementing the OA. They were aligned with the teacher's goals and educational objectives. The weekly diary and the monthly summary diary were organized into three sections: Section 1 aims at monitoring the OA quantitatively (number of days spent weekly outside, number of daily hours children spent outside in the child care yard). Section 2 aims at monitoring the types of activities conducted outdoors in terms of the frequency of different types of OA, such as exploration (e.g., free exploration in the green, teacher-guided exploration), motor activities (e.g., running, balancing, swinging, avoiding obstacles), manipulation experiences (e.g., digging, sand manipulation), observation and learning about nature (e.g., color changes and birth, growth and decay, insects, vegetable garden), and creative and narrative experiences (e.g., constructions and/or creation of stories with natural elements such as sticks, stones, leaves). Section 3 aims at monitoring any continuity of OA experiences at school and with family, based on parents' communication with teachers. In the monthly summary diary, sections 2 and 3 were assessed in frequency on a 1–5 point scale (where 1= never; 2 = at least once in the last month; 3 = at least twice in the last month; 4 = at least once a week; 5= every day). The first time the Outdoor group teachers filled in the monthly summary diary, they were also asked to reflect upon what kind of activities they wanted to implement in the next four months and to write a list of objects and materials they needed to implement these activities. These tools were all provided to them. For the present study, we considered the results from the monthly summary diary.</p> <hd id="AN0183685182-12">Children's Stress: Salivary Cortisol</hd> <p>Salivary cortisol, a biological marker of stress, was used to measure children's stress. The saliva samples were collected by parents in the early morning, when the child woke up, because, as in adults, that is when the circadian cortisol rhythm appears to be at its highest (Tryphonopoulos et al., [<reflink idref="bib65" id="ref74">65</reflink>]). The involvement of parents in such a daily duty afforded the measure a degree of ecological validity. All the saliva samples brought by families to the child's child care center were frozen and taken to the medical laboratory, where they were analyzed by one researcher with the Cortisol Competitive ELISA (LDN, Nordhorn, Germany). Not all the families were willing to collect the salivary cortisol at both T1 and T2 (<emph>n</emph> = 38 in the Outdoor group; <emph>n</emph> = 21 in the Control group). Most of the families who decided not to participate in this part of the project reported having trouble collecting saliva samples with the materials we provided them.</p> <hd id="AN0183685182-13">Socioemotional Skills and Adaptive Behavior: The Bailey Scales</hd> <p>The children's socioemotional skills and adaptive behavior were measured with the Socioemotional and Adaptive Behavior caregiver-report questionnaire of the Bayley Scales III (Bayley Scales of Infant and Toddler Development – Third Edition; It. Vers. (Ferri et al., [<reflink idref="bib24" id="ref75">24</reflink>]). It comprises 39 items referring to the main socioemotional milestones, such as the ability to comprehend emotional signals, the use of emotional expressions, and the elaboration of a range of feelings through words and other symbols. Children's behaviors are rated on a 1 to 5-point Likert scale. Scaled scores (1–19) were used. The Adaptive Behavior scale comprises various skill domains. For the present study, the "Communication" (25 items), "Self-control" (25 items), "Play" (22 items), and "Social interactions"' (24 items) subscales were used. Children's behaviors are rated on a 0 to 3-point Likert scale, where 0 stands for "unable," 1 stands for "never," and 3 stands for "always." A further column allows parents to indicate the items for which they were not sure of the frequency of their child's behavior. Scaled scores (1–19) were used.</p> <hd id="AN0183685182-14">Behavioral and Cognitive Regulation Skills: The Early Executive Function (EEF) Scales</hd> <p>The scales for evaluating early behavioral and cognitive regulation skills (i.e., the Early Executive Function Rating Scales; Authors, in preparation) were built ad hoc for the current project, because no easy-to-use tool was available for measuring EEF skills in early educational settings. EEF skills indicate a series of early behavioral and cognitive regulation skills, such as focused attention and response inhibition, that are foundational to Executive Functions (Devine et al., [<reflink idref="bib15" id="ref76">15</reflink>]; Garon et al., [<reflink idref="bib28" id="ref77">28</reflink>]). The item construction was shared with child care teachers, who requested an assessment tool that was informative but quick and easy to use. For this reason, we decided to use items corresponding to simple descriptions of infants' and toddlers' behaviors which are easily observable during daily activities at child care. Within the Hendry et al. ([<reflink idref="bib36" id="ref78">36</reflink>]) theoretical framework, the EEF Scales refer to three domains of EFF skills: attentional control (orienting and focused attention; e.g., "The infant turns toward and gazes at the teacher who is speaking to her nearby, ignoring potential distractors"), self-regulation (motor and impulse control; e.g., "The child wants a play object another child is playing with at all costs and does not wait his turn to get it, but reaches and grabs it forcefully"), and cognitive flexibility (maintaining and updating skills related to the infant's emergent working memory; e.g., "The child can accomplish a task requiring a sequence of actions (e.g., taking the cubes from a basket and putting them on top of each other to build a tower) even when something goes wrong (e.g., a cube falls and ends up far away) and a new action is needed"). The Scales differ according to the child's age: Scale 1 for infants from 6 to 12 months, Scale 2 for infants in their second year, and Scale 3 for toddlers in their third year; each scale contains ten age range-specific items in a 0–4 rating scale, where 0 stands for "never" and 4 for "always." The convergent validity of the EEF Rating Scales with the Adaptive Behavior-Self-control subscale of the Bayley Scales (for Scale 1) (Ferri et al., [<reflink idref="bib24" id="ref79">24</reflink>]), the ECBQ-SF (Cozzi et al., [<reflink idref="bib14" id="ref80">14</reflink>]) (for Scales 2 and 3), and the BRIEF-P (Marano et al., [<reflink idref="bib44" id="ref81">44</reflink>]) (for Scale 3) were demonstrated (all <emph>ps</emph> <.05). All the EEF Scales have adequate internal consistency values (on average <emph>α</emph> =.81) and good test-retest reliability (<emph>Pearson's coefficients</emph> range =.536–.772, with all <emph>ps</emph> <.01).</p> <hd id="AN0183685182-15">Data Analysis</hd> <p>First, in order to check the actual implementation of the OA program by the teachers of the Outdoor group and examine differences in OA between the Outdoor and Control groups, descriptive statistics and paired <emph>t</emph>-tests were conducted on indicators reported in the OA monthly summary diary at the beginning and the end of the program. All p-values associated with these comparisons were adjusted to mitigate the risk of type-I errors. These statistics were run using Jamovi version 1.2.9 ([<reflink idref="bib37" id="ref82">37</reflink>]).</p> <p>The measures of children's physiological stress, and children's socioemotional skills, adaptive behavior, and early executive functioning before (T1) and after (T2) the OA intervention were investigated in the Outdoor and Control groups using Linear Mixed-Effects Models (LMMs) in R-Studio (R Development Core Team, [<reflink idref="bib56" id="ref83">56</reflink>]; "lmer" function in the "lme4" package, Bates et al., [<reflink idref="bib4" id="ref84">4</reflink>]). Mixed models were used to consider the nested structure of the data since observations are nested in individuals (i.e., repeated measures of relevant DVs), who are nested in child care centers. Each base model included Time (T1 vs T2) and Group (Outdoor vs Control) as fixed effects, and subjects (children) and child care centers as random effects. Considering the significant initial difference between the intervention and the control groups (see Participants section) regarding the age at which children entered child care, we incorporated this variable as a covariate in our model to account for its potential confounding effect. Finally, post-hoc tests were run with the Bonferroni correction ("emmeans" function in package "sjstats," Lüdecke, [<reflink idref="bib43" id="ref85">43</reflink>]). Effect sizes were interpreted following Cohen's cutoff criteria (Cohen, [<reflink idref="bib12" id="ref86">12</reflink>]), where <.01 is negligible, 0.02–0.06 is small, 0.07–0.14 is medium, and > 0.14 is large.</p> <p>To test whether the sample sizes of the participants in the present study play a role in limiting the significance of each Linear Mixed-Effects Model, a series of post-hoc power analyses were conducted. These analyses were performed using G*power (Faul et al., [<reflink idref="bib22" id="ref87">22</reflink>]), with an α = 0.05, an effect size (f) derived from the <emph>η<sups>2</sups></emph><subs><emph>p</emph></subs> of the interaction Group*Time of each model, and the exact number of participants.</p> <p>Lastly, we used the first steps of a thematic analysis (Braun & Clarke, [<reflink idref="bib6" id="ref88">6</reflink>]; see also Lavelli et al., [<reflink idref="bib41" id="ref89">41</reflink>]) to analyze the transcripts from the focus groups (conducted before starting the intervention) and the final meetings with the teachers. First, two independent researchers read and re-read all transcripts from focus groups to identify recurrent themes across participants; then, themes that were recurrent in all focus groups and mentioned at least twice in each group were selected and organized in thematic areas, along with verbatim quotes that illustrated each of them. The same was done with transcripts from final meetings. Lastly, we compared the themes that emerged from focus groups and final meetings to detect any possible differences in teachers' thoughts and practices about OA after the intervention.</p> <hd id="AN0183685182-16">Results</hd> <p></p> <hd id="AN0183685182-17">Implementation of the OA Program</hd> <p>The OA monthly summary diary was completed carefully by the participating teachers of both groups; thus, all indicators of OA were available for comparison. Paired sample <emph>t</emph>-tests with the Bonferroni correction (significant <emph>ps</emph> are below 0.0056) showed that the Outdoor group significantly improved OA in all indicators: frequency, duration, type of activities, and OA-related activities at home (see Table 2). Differently, in the Control group only manipulation activities increased, and neither the frequency nor the duration of OA increased.</p> <p>Table 2. Descriptive statistics and paired T-tests for indicators of outdoor activities at T1 and T2.</p> <p> <ephtml> <table><thead><tr><td /><td>T1</td><td>T2</td><td>T1-T2</td><td>T1-T2</td></tr><tr><td>Outdoor group</td><td>Control group</td><td>Outdoor group</td><td>Control group</td><td>Outdoor group</td><td>Control group</td></tr></thead><tbody><tr><td>M (SD)</td><td>M (SD)</td><td>M (SD)</td><td>M (SD)</td><td>t-test, p</td><td>t-test, p</td></tr><tr><td>Days per week</td><td>2.2 (1.15)</td><td>1.29 (1.1)</td><td>4.47 (.915)</td><td>1.59 (1.12)</td><td>t = -6.58, <.001</td><td>t = -1.319, <italic>p</italic> =.206</td></tr><tr><td>Hours per week</td><td>2.47 (1.17)</td><td>1.24 (1.35)</td><td>6.63 (3.71)</td><td>2.00 (1.97)</td><td>t = -4.23, <italic>p</italic> <.001</td><td>t = -2.425, <italic>p</italic> =.028</td></tr><tr><td><italic>Type of activities</italic></td><td /><td /><td /><td /><td /></tr><tr><td>Exploration</td><td>3.32 (.784)</td><td>2.72 (1.42)</td><td>4.35 (.697)</td><td>3.14 (1.39)</td><td>t = -5.71, <italic>p</italic> <.001</td><td>t = -2.282, <italic>p</italic> =.038</td></tr><tr><td>Manipulation</td><td>2.43 (1.43)</td><td>1.69 (.661)</td><td>3.47 (1.01)</td><td>2.19 (1.05)</td><td>t = -3.42, <italic>p</italic> =.004</td><td>t = -3.297, <italic>p</italic> =.005</td></tr><tr><td>Movement</td><td>2.72 (1.28)</td><td>2.34 (1.12)</td><td>3.51 (1.25)</td><td>2.72 (1.28)</td><td>t = -3.48, <italic>p</italic> =.004</td><td>t = -1.637, <italic>p</italic> =.122</td></tr><tr><td>Narration</td><td>1.57 (.904)</td><td>1.74 (.986)</td><td>2.90 (1.07)</td><td>2.10 (.890)</td><td>t = -3.96, <italic>p</italic> =.001</td><td>t = -0.835, <italic>p</italic> =.418</td></tr><tr><td>Observation</td><td>2.18 (1.10)</td><td>1.87 (.841)</td><td>2.97 (1.15)</td><td>2.34 (.974)</td><td>t = -5.71, <italic>p</italic> <.001</td><td>t = -2.744, <italic>p</italic> =.015</td></tr><tr><td>Creation</td><td>2.02 (1.29)</td><td>1.53 (.850)</td><td>2.90 (1.24)</td><td>1.92 (.893)</td><td>t = -4.51, <italic>p</italic> <.001</td><td>t = -1.776, <italic>p</italic> =.098</td></tr><tr><td><italic>OA Continuity</italic> School-home</td><td>1.39 (.513)</td><td>1.94 (.921)</td><td>2.34 (.871)</td><td>2.25 (.872)</td><td>t = 4.62, <italic>p</italic> <.001</td><td>t = -1.439, <italic>p</italic> =.172</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 For Types of activities, the averages are based on categorical variables that indicate that the activities have never been done (<reflink idref="bib1" id="ref90">1</reflink>), or done at least once in the last month (<reflink idref="bib2" id="ref91">2</reflink>), at least twice in the last month (<reflink idref="bib3" id="ref92">3</reflink>), at least once a week (<reflink idref="bib4" id="ref93">4</reflink>), or every day (<reflink idref="bib5" id="ref94">5</reflink>).</item> <item>3 All p-values are adjusted using the Bonferroni correction to control for multiple comparisons (significant <emph>ps</emph> are 0.05/9 ≈ 0.0056).</item> </ulist> <hd id="AN0183685182-18">Children's Stress</hd> <p>Descriptive statistics are reported in Table 3. When the children's salivary cortisol level was considered as the dependent variable, the LMM showed no interaction effect between Time and Group [<emph>F</emph>(<reflink idref="bib1" id="ref95">1</reflink>, 57) = 0.336, <emph>p</emph> =.563, <emph>η<sups>2</sups> p</emph> =.003, <emph>1 – β</emph> =.13], indicating that the OA program did not affect this physiological measure of stress in children. Main effect was found for neither Time [<emph>F</emph>(<reflink idref="bib1" id="ref96">1</reflink>, 57) = 0.042, <emph>p</emph> =.837, <emph>η<sups>2</sups> p</emph> =.000] nor Group [<emph>F</emph>(<reflink idref="bib1" id="ref97">1</reflink>, 57) =.509, <emph>p</emph> =.477, <emph>η<sups>2</sups> p</emph> =.004]. The age at which children enter child care did not affect the results (<emph>p</emph> >.10).</p> <p>Table 3. Descriptive statistics for all measures.</p> <p> <ephtml> <table><thead><tr><td /><td>Pre</td><td>Post</td></tr><tr><td>Outdoor group</td><td>Control group</td><td>Outdoor group</td><td>Control group</td><td /></tr></thead><tbody><tr><td /><td>M(SD)</td><td>M(SD)</td><td>M(SD)</td><td>M(SD)</td></tr><tr><td><italic>Children</italic></td><td /><td /><td /><td /></tr><tr><td>Salivary Cortisol (ng/mL)</td><td>8.12 (6.08)</td><td>5.08 (3.35)</td><td>8.15 (5.37)</td><td>6.70 (6.37)</td></tr><tr><td>Socioemotional Bailey Scale</td><td>10.00 (4.42)</td><td>9.35 (4.42)</td><td>11.1 (5.03)</td><td>8.82 (4.34)</td></tr><tr><td>Adaptive Behavior – Communication</td><td>9.02 (3.23)</td><td>8.72 (3.05)</td><td>9.98 (3.28)</td><td>8.85 (2.97)</td></tr><tr><td>Adaptive Behavior – Self-Control</td><td>9.87 (2.27)</td><td>9.97 (2.70)</td><td>10.5 (2.54)</td><td>10.2 (2.56)</td></tr><tr><td>Adaptive Behavior – Play</td><td>9.89 (2.66)</td><td>9.5 (2.38)</td><td>10.4 (2.73)</td><td>9.88 (2.61)</td></tr><tr><td>Adaptive Behavior – Social</td><td>9.27 (2.75)</td><td>10 (3.29)</td><td>10.3 (2.65)</td><td>10.1 (3.32)</td></tr><tr><td>Early Executive Function Scales</td><td>27.7 (5.2)</td><td>25.6 (6.64)</td><td>29.9 (5.02)</td><td>25.1 (7.14)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0183685182-19">Children's Socioemotional Skills and Adaptive Behavior</hd> <p>Results from the LMM showed no effect for Time [<emph>F</emph>(<reflink idref="bib1" id="ref98">1</reflink>, 93) = 3.878, <emph>p</emph> =.051, <emph>η<sups>2</sups> p</emph> =.032], for Group [<emph>F</emph>(<reflink idref="bib1" id="ref99">1</reflink>, 93) = 0.303, <emph>p</emph> =.585, <emph>η<sups>2</sups> p</emph> =.003], and interaction between Time and Group [<emph>F</emph>(<reflink idref="bib1" id="ref100">1</reflink>, 93) = 3.180, <emph>p</emph> =.078, <emph>η<sups>2</sups> p</emph> =.026, <emph>1 – β</emph> =.88] for children's socioemotional skills (Figure 1).</p> <p>Graph: Figure 1. Children's socioemotional skills before (T1) and after (T2) the OA intervention, in the two groups.</p> <p>With regard to the children's adaptive behavior (scaled scores for each of the four selected areas of the Adaptive Behavior Scale), four LMMs (on "Communication," "Play," "Self-control," and "Social interaction" scores) were run (see Figure 2a–d). For children's adaptive behavior in communication, results from the LMM showed a significant main effect of Time [<emph>F</emph>(<reflink idref="bib1" id="ref101">1</reflink>, 93) = 7.442, <emph>p</emph> =.007, <emph>η<sups>2</sups> p</emph> =.066], but neither of Group [<emph>F</emph>(<reflink idref="bib1" id="ref102">1</reflink>, 93) = 0.359, <emph>p</emph> =.553, <emph>η<sups>2</sups> p</emph> =.003] nor of the interaction effect between Time and Group [<emph>F</emph>(<reflink idref="bib1" id="ref103">1</reflink>, 93) = 3.679, <emph>p</emph> =.058, <emph>η<sups>2</sups> p</emph> =.034, <emph>1 – β</emph> >.99]. For children's adaptive behavior in social interactions, results from the LMM showed a significant main effect of Time [<emph>F</emph>(<reflink idref="bib1" id="ref104">1</reflink>, 93) = 9.171, <emph>p</emph> =.003, <emph>η<sups>2</sups> p</emph> =.079], and an interaction effect between Time and Group [<emph>F</emph>(<reflink idref="bib1" id="ref105">1</reflink>, 93) = 4.863, <emph>p</emph> =.029, <emph>η<sups>2</sups> p</emph> =.044, <emph>1 – β</emph> >.99], but not of Group only [<emph>F</emph>(<reflink idref="bib1" id="ref106">1</reflink>, 93) = 2.635, <emph>p</emph> =.118, <emph>η<sups>2</sups> p</emph> =.024]. Post-hoc tests with Bonferroni corrections showed a significant difference between children's adaptive behavior in social interaction between Time 1 and 2 for the Outdoor group only [<emph>t</emph>(<reflink idref="bib93" id="ref107">93</reflink>)= −3.619, <emph>p</emph><subs>Bonf</subs> =.002], indicating that children's adaptive behavior in social interactions only demonstrated significant increases in the intervention group. Significant effects emerged neither for children's adaptive behavior during play nor for self-control (all <emph>ps</emph> >.05, <emph>η<sups>2</sups> p</emph> = for the interaction term is respectively.001 and.010, all <emph>1 – β</emph> >.99). The age at which children enter child care did not affect the results of the models (all <emph>ps</emph> >.10).</p> <p>Graph: Figure 2. Children's adaptive behavior in communication, play, self-control, and social interaction before (T1) and after (T2) the OA intervention, in the two groups.</p> <hd id="AN0183685182-20">Children's Behavioral and Cognitive Regulation Skills</hd> <p>Finally, the LMM computed on children's scores at the Early Executive Function Scales showed an interaction effect between Time and Group [<emph>F</emph>(<reflink idref="bib1" id="ref108">1</reflink>, 93) = 7.081, <emph>p</emph> =.009, <emph>η<sups>2</sups> p</emph> =.058, <emph>1 – β</emph> >.99]. Post hoc tests showed a significant increase from T1 to T2 for the Outdoor group [<emph>t</emph>(<reflink idref="bib93" id="ref109">93</reflink>) = −3.102, <emph>p</emph><subs>Bonf</subs> =.015] but not for the Control group [<emph>p ></emph>.05] (see Figure 3), indicating that the OA program improved the children's behavioral and cognitive regulation skills. The LMM also showed a main effect of Time [<emph>F</emph>(<reflink idref="bib1" id="ref110">1</reflink>, 93) = 9.681, <emph>p</emph> =.002, <emph>η<sups>2</sups> p</emph> =.078]. No effect of Group was found [<emph>F</emph>(<reflink idref="bib1" id="ref111">1</reflink>, 93) = 0.255, <emph>p</emph> =.618, <emph>η<sups>2</sups> p</emph> =.002]. The effect of age at which children enter child care did not affect the results (<emph>p</emph> >.10).</p> <p>Graph: Figure 3. Children's cognitive regulation skills before (T1) and after (T2) the OA intervention, in the two groups.</p> <hd id="AN0183685182-21">Teachers' Perceptions of Their Experiences During the Study</hd> <p>The analysis of the transcripts from focus groups and final meetings highlighted the most recurring themes teachers talked about. These themes were grouped into thematic areas (OA representations and practice, educational aims, types of OA, difficulties/fears <emph>vs</emph> benefits with younger infants' groups, difficulties <emph>vs</emph> benefits with toddlers' groups, relationship with families) and then compared to detect any possible difference between teachers' thoughts and practice about OA before and after the intervention. The opportunity to implement OA impacted not only the organization and routines of the child care centers but also how the teachers thought of outdoor education. First, when asked to consider "outdoor activities" before participating in this project, they talked about OA mainly as free outdoor play and free exploration of nature. After being involved in the project, teachers reported new perceptions and thoughts about OA and that they started integrating OA into their educational programs by bringing part of the daily routines outdoors: <emph>"The project has changed the way we think about the outdoor green space, now we have a more aware view of the educational opportunities it offers ... ;" " ... now we do some of the usual – and also new – teacher(or child)-guided activities outside."</emph> Second, before starting this project, teachers considered involving infants who did not yet walk in OA very difficult. However, by the end of the OA intervention, they had completely changed their mind. They noticed, instead, a strong positive impact of the OA program on the group of the youngest infants. They felt much surer about involving young infants in OA: <emph>"The project helped us to overcome some fears related to logistical difficulties (the long time spent dressing and undressing the infants) and emotional issues... In the beginning, opening the center door and not finding any parents was hard for the youngest infants, but the new stimuli from the external environment immediately conquered them;" "... thanks to the waterproof overalls, the infants crawled and even slept in the garden."</emph> Third, some teachers of groups of older children confirmed what they had sometimes observed before starting the OA program, i.e., that outdoors, children were more likely to manage and resolve conflicts between peers autonomously than indoors. Fourth, before starting the project, the teachers said they would go outside only when the weather "<emph>permitted it"</emph>. Participation in the project provided them with support equipment and materials to carry out OA even in the case of moderate rain and humidity (e.g., waterproof overalls for infants and toddlers, tarps) or intense sun (gazebo), which contributed to an increase in the frequency of OA (see Supplemental Materials).</p> <hd id="AN0183685182-22">Discussion</hd> <p>The present study is one of the first considering the effects of Outdoor Activities on multiple domains of infants' and toddlers' development. After checking the implementation of an OA program in a group of child care centers in north and south Italy, the study aimed to assess any possible effects of the program on children's stress levels, and on children's socioemotional, behavioral, and cognitive regulation skills.</p> <hd id="AN0183685182-23">Changes in Frequency and Types of OA, and in Thinking About OA</hd> <p>Findings from data reported in the OA monthly summary diary allowed us to assess a significant increase in the number of days per week, hours per day spent in OA, and types/variety of activities in the Outdoor group only. These results indicate the feasibility of a daily OA program in child care centers with organization and external spaces similar to those of the centers involved. In addition, comparing teachers' representation of OA before and after being involved in the outdoor program revealed a turn in their thinking about OA toward considering OA an integral part of their educational programs. We think this turn is crucial because, to develop OA programs, teachers may need to change their habits and thoughts about the outdoors (Neville et al., [<reflink idref="bib52" id="ref112">52</reflink>]).</p> <hd id="AN0183685182-24">Impacts of the OA Program on Children's Stress Levels</hd> <p>Our findings show that the OA program did not impact the children's physiological stress. Based on empirical evidence (Cicchetti et al., [<reflink idref="bib11" id="ref113">11</reflink>]), stress is a hard-to-change factor, especially in a short time (as in our 4-month intervention). Moreover, intra-individual cortisol variability should be considered when interpreting the results because it is very high in infants, particularly during the first year of life (Tollenaar et al., [<reflink idref="bib63" id="ref114">63</reflink>]).</p> <p>In addition, methodological limitations could help to explain our findings. The children's stress levels were measured only for a small sub-group because many families reported difficulties obtaining the saliva sample, as documented by other researchers (Condon, [<reflink idref="bib13" id="ref115">13</reflink>]). Although the parents' difficulties in collecting the salivary cortisol should be addressed in future studies, and although the sample size is not sufficient to draw generalizable conclusions, it is worth noting that our study is the first to use a physiological measure to assess Italian children's stress levels.</p> <hd id="AN0183685182-25">Impacts of the OA Program on Children's Socioemotional, Behavioral, and Cognitive Regulation...</hd> <p>Our findings show that the OA program promoted the growth of children's behavioral and cognitive regulation skills. In particular, children in the Outdoor group significantly improved their adaptive behavior, especially when this was requested in social interactions. This finding suggests that supplying more chances to stay outdoors during school time reduces adaptation problems in social situations, including for young children. This is in line with other evidence (see Scott et al., [<reflink idref="bib58" id="ref116">58</reflink>], for a review) and consistent with the teachers' comment that children were more likely to manage conflicts outdoors than indoors. Also, findings reported in previous studies were based on teachers' reports and perceptions of the children's skills (e.g., Monti et al., [<reflink idref="bib49" id="ref117">49</reflink>]). Thus, the fact that our data come from parents' perceptions, that is, from another point of view on children's behavior, further confirms the beneficial effect of the OA conducted in child care centers. No direct effects of OA can be statistically confirmed on children's socioemotional skills.</p> <p>Our results show that positive effects of the OA program also emerged in the cognitive developmental domain. Children attending the OA program significantly improved their attentional control and other early executive function skills. The Attention Restoration Theory (Kaplan, [<reflink idref="bib39" id="ref118">39</reflink>]; Kaplan & Kaplan, [<reflink idref="bib40" id="ref119">40</reflink>]; see the Introduction section) can help to explain this result, suggesting that spending time in green natural spaces – in contact with many fascinating elements that effortlessly capture attention – can help individuals to restore their attention skills, particularly those used in activities that require effortful attention control. Attention restoration would also arise from nature's support of the human need for exploration. We think these motives can work well for infants and toddlers, too, because open spaces with natural loose and fixed elements (trees, vegetation, sand, sticks, stones ...) provide children with affordances for many activities that readily engage their attention. In addition, the need for exploration is particularly high in toddlers who have just started walking (Gibson, [<reflink idref="bib29" id="ref120">29</reflink>]). However, during OA, children also engaged in teacher-directed activities demanding focused attention. OA may thus offer a variety of opportunities for both effortless and effortful attention, allowing children to switch back and forth between the two states of attention, as also highlighted by Ulset et al. ([<reflink idref="bib67" id="ref121">67</reflink>]). The restoration theory would also support our findings on improving adaptive behavior (see also Faber Taylor & Butts-Wilmsmeyer, [<reflink idref="bib19" id="ref122">19</reflink>]; Florit et al., [<reflink idref="bib26" id="ref123">26</reflink>]; Mårtensson et al., [<reflink idref="bib45" id="ref124">45</reflink>]).</p> <p>Overall, our findings support the hypothesis that infants and toddlers who spend more time in OA may benefit from the natural resources offered by the external environment. These benefits would result in improvements in children's behavioral and cognitive regulation skills, similar to the benefits shown by a growing number of studies mainly conducted with preschool- and school-age children and adolescents (for systematic reviews, see Mygind et al., [<reflink idref="bib51" id="ref125">51</reflink>]; Scott et al., [<reflink idref="bib58" id="ref126">58</reflink>]).</p> <hd id="AN0183685182-26">Limitations</hd> <p>The current study has certain limitations. First, the intervention was too short to bring about significant changes or medium-long-term effects in all considered factors. Therefore, the study should be replicated with a longer intervention period to check for confirmation of our findings or any other effects of outdoor activities on children's regulation skills and children's stress levels. Second, there was a significant reduction in sample size between the beginning and the end of the study. In addition to the physiological dropout rate that characterizes longitudinal studies, this reduction was mainly due to the temporary closure of some child care centers involved in the project during the pandemic and the parents' unwillingness to collect cortisol measurements. Although for most measures the final sample size did not compromise the possibility of using robust statistical analyses, for children's stress levels the power of the sample size was not enough for the results to be generalized. Thus, future research should enlarge the sample size to draw more robust conclusions. Third, not all the tools we used for collecting data were already validated or used in other published studies. In particular, because of the absence of available easy-to-use tools for observing and assessing infants' attention and other cognitive regulation skills in educational contexts, the EEF Scales (Authors, in preparation) were created and used for the first time in this study. However, the validation process was accomplished six months later.</p> <p>Future studies should address the difficulty reported by many families in withdrawing the salivary sample by organizing the withdrawal in a play context at school, with the help of medical staff and teachers. In addition, separate analyses for sub-samples of children of different ages (e.g., first year, second year, third year) should be computed to get major details on possible effects of OA on their physiological stress levels, given the high intra-individual cortisol variability in early infancy. Lastly, although the child care centers involved in this study represent the majority of Italian child care services, the generalizability of our findings is limited to centers with similar outdoor space, structural and organizational features, and teachers' and children's characteristics. Future research involving child care centers with similar characteristics, but smaller outdoor spaces and/or without greenery, should be replicated to assess whether – with adequate teachers' training and support to implement OA in their educational programs – the type of outdoor space might impact outcomes. It would also be interesting to investigate whether this intervention model of OA in child care centers could be applied to diverse cultural settings.</p> <hd id="AN0183685182-27">Strengths and Implications</hd> <p>Despite its limitations, this study advances our knowledge of the benefits of regular outdoor activities with infants and toddlers in child care centers. In particular, it highlights the positive impact that even a short period of OA can have on developing early cognitive regulation skills and adaptive behavior in social interaction. These findings are particularly important, given that infancy has so far been relatively neglected by the emerging research area on the effects of outdoor activities. The use of a multimethod approach, including physiological measures, measures based on both parents' and teachers' perceptions, data from the OA diary, and transcripts of the teachers' meetings allowed us to get a complete view of the effects of the OA program and its feasibility, and avoid having a single source of data collection.</p> <p>The findings have educational and social implications. At an educational level, from the teachers' feedback during the final meetings emerged that integrating OA into their educational programs helped to increase the quality of the educational activities offered at the child care centers and fostered interactions between teachers and parents through sharing the OA project. In addition, the involvement of the families in the project allowed us to inform them and start raising awareness about the beneficial effects of OA (e.g., some parents provided positive feedback and stated they began to spend more time in OA with their children).</p> <p>Finally, at a social level, the project made it possible to develop and test a prototype of actions and conditions to improve the quality of the reorganization of educational activities in child care centers following the pandemic emergency, based on the daily experience of outdoor activities. The positive effects highlighted by the model proposed in child care centers in northern and southern Italy suggest that the results depend not on contextual characteristics but on the tools used and the psycho-pedagogical and social mechanisms activated, including sharing and collaboration among child care teachers on OA experiences. Therefore, replicating the same intervention model in other child care centers, with the necessary contextual adaptations and, possibly, a longer duration, could lead to similar or even better results, especially if teachers are adequately trained and families are adequately involved. Regarding the importance of training teachers, our findings suggest that it would be beneficial to introduce the topic of Outdoor Education into the University training course for child care teachers. Moreover, researchers and professionals working with infants and toddlers should continue to explore the educational opportunities offered by OA.</p> <hd id="AN0183685182-28">Acknowledgments</hd> <p>We want to acknowledge the help of the daycare administrators—Rosanna Zerbato, Giovanna D'Onchia, Teresa Schino, Valentina D'Elia, Anna Putzolu, and Roberta Lorusso—and all the coordinators and teachers who participated in the project. And thank you to Dr. Elena Fornari and Dr. Marco Rioda medical doctors of the "Centro Regionale di Diabetologia Pediatrica." And a special thank you to all the children and their families who were actively involved in the study.</p> <hd id="AN0183685182-29">Disclosure Statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0183685182-30">Supplementary Material</hd> <p>Supplemental data for this article can be accessed online at https://doi.org/10.1080/10409289.2024.2423387</p> <ref id="AN0183685182-31"> <title> References </title> <blist> <bibl id="bib1" idref="ref37" type="bt">1</bibl> <bibtext> Adhemar, A. (2000). Nature schools. Resurgence, 199 (4), 44.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref47" type="bt">2</bibl> <bibtext> Agostini, F., Minelli, M., & Mandolesi, R. (2018). Outdoor education in Italian kindergartens: How teachers perceive child developmental trajectories. 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  Data: <searchLink fieldCode="AR" term="%22Tamara+Bastianello%22">Tamara Bastianello</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9052-8102">0000-0002-9052-8102</externalLink>)<br /><searchLink fieldCode="AR" term="%22Fabiola+Silletti%22">Fabiola Silletti</searchLink><br /><searchLink fieldCode="AR" term="%22Rosalinda+Cassibba%22">Rosalinda Cassibba</searchLink><br /><searchLink fieldCode="AR" term="%22Gabrielle+Coppola%22">Gabrielle Coppola</searchLink><br /><searchLink fieldCode="AR" term="%22Pasquale+Musso%22">Pasquale Musso</searchLink><br /><searchLink fieldCode="AR" term="%22Valeria+Rossini%22">Valeria Rossini</searchLink><br /><searchLink fieldCode="AR" term="%22Chiara+Zusi%22">Chiara Zusi</searchLink><br /><searchLink fieldCode="AR" term="%22Ilaria+Unali%22">Ilaria Unali</searchLink><br /><searchLink fieldCode="AR" term="%22Elena+Florit%22">Elena Florit</searchLink><br /><searchLink fieldCode="AR" term="%22Marinella+Majorano%22">Marinella Majorano</searchLink><br /><searchLink fieldCode="AR" term="%22Claudio+Maffeis%22">Claudio Maffeis</searchLink><br /><searchLink fieldCode="AR" term="%22Manuela+Lavelli%22">Manuela Lavelli</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Early+Education+and+Development%22"><i>Early Education and Development</i></searchLink>. 2025 36(3):724-743.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 20
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Management%22">Stress Management</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Control%22">Self Control</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Behavior%22">Child Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Toddlers%22">Toddlers</searchLink><br /><searchLink fieldCode="DE" term="%22Infants%22">Infants</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Care+Centers%22">Child Care Centers</searchLink><br /><searchLink fieldCode="DE" term="%22Physiology%22">Physiology</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Response%22">Emotional Response</searchLink><br /><searchLink fieldCode="DE" term="%22Recreational+Activities%22">Recreational Activities</searchLink><br /><searchLink fieldCode="DE" term="%22Environmental+Influences%22">Environmental Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Playgrounds%22">Playgrounds</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Italy%22">Italy</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/10409289.2024.2423387
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1040-9289<br />1556-6935
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Research Findings: In recent years, interest has grown in the potential benefits of outdoor activities (OA) for children's development, particularly in promoting socioemotional, behavioral, and cognitive regulation skills and reducing stress. However, empirical evidence on the effects of OA programs for children in the first three years of life on these outcomes still needs to be provided. To address this gap, our study involved 95 infants and toddlers (girls = 48, M[subscript age] = 23.3 months) attending child care centers in north and south Italy and their teachers. Participants were divided into two groups: the Outdoor group (n = 55), actively involved in the OA program for four months, and the Control group (n = 40), who followed the standard curriculum. We assessed the children's cortisol levels and emotional, behavioral, and cognitive regulation skills before (T1) and after (T2) the implementation of the OA intervention. After the 4-month intervention, improvements in the children's adaptive behavior (particularly in social interaction) and cognitive-behavioral regulation skills were observed only in the Outdoor group. Children's stress levels remained stable. Practice or Policy: Our findings show the benefits of daily OA on young children's self-regulation, suggesting to schools and families that increasing OA from the first years of life may support cognitive and social growth.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1499565
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1499565
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  BibEntity:
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      – Type: doi
        Value: 10.1080/10409289.2024.2423387
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 20
        StartPage: 724
    Subjects:
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Stress Management
        Type: general
      – SubjectFull: Self Control
        Type: general
      – SubjectFull: Child Behavior
        Type: general
      – SubjectFull: Toddlers
        Type: general
      – SubjectFull: Infants
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      – SubjectFull: Child Care Centers
        Type: general
      – SubjectFull: Physiology
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      – SubjectFull: Emotional Response
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      – SubjectFull: Recreational Activities
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      – SubjectFull: Environmental Influences
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      – SubjectFull: Playgrounds
        Type: general
      – SubjectFull: Foreign Countries
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      – SubjectFull: Italy
        Type: general
    Titles:
      – TitleFull: Short-Term Effects of an Outdoor Activities Intervention on Children's Stress, Socio Emotional, Behavioral, and Cognitive Regulation Skills
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