PEDIATRICS Vol. 92 No. 3 September 1993, pp. 389-395
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Understanding of Acquired Immunodeficiency Syndrome by Elementary School Children—A Developmental Survey

David J. Schonfeld MD1, Susan R. Johnson MD2, Ellen C. Perrin MD3, Linda L. O'Hare MS4, and Domenic V. Cicchetti PhD5

1 From the Department of Pediatrics and the Yale Child Study Center, Yale University School of Medicine, New Haven, CT
2 From the Department of Pediatrics, University of California San Francisco, San Francisco, CA
3 From the Department of Pediatrics, University of Massachusetts, Worcester, MA
4 From the Department of Pediatrics, Yale University School of Medicine, New Haven, CT
5 From the the Yale Child Study Center, the Department of Psychiatry, Yale University School of Medicine, New Haven, CT; and the West Haven VA Medical Center, New Haven, CT.

Objectives. The developmental process by which young children acquire an understanding of the concepts of causality, treatment, and prevention of illness as related to acquired immunodeficiency syndrome (AIDS) is poorly understood. Previous studies have focused on adolescent populations and have meaured the facts that children seem to know rather than their understanding of relevant concepts. Such approaches are likely to overestimate the child's true level of understanding and obscure significant misconceptions. The aims of this project are to measure directly the level of understanding of the concepts of causality, treatment, and prevention of AIDS in healthy, elementary school children and to assess the sociodemographic variables associated with their conceptual understanding.

Methods. Using a new, developmentally based, semistructured interview protocol (ASK, AIDS Survey for Kids), 361 children (57% black, 24% Hispanic, 19% white) in kindergarten through sixth grade at four public schools in New Haven, CT were interviewed. Responses to questions about causality, treatment, and prevention were scored for each of three illnesses (AIDS, and for comparison, colds and cancer) based on the level of conceptual sophistication of the response, irrespective of its factual accuracy.

Results. Scores for each of the concepts were highly intercorrelated and were correlated most strongly with grade level (R = .31 to .50, P < .0001 for each of these correlations, with the exception of the treatment of AIDS). Gender, race, and socioeconomic status did not contribute significantly to the variance observed for any of the concept scores in a linear regression model. Overall, children's level of understanding of causality was significantly less sophisticated for AIDS than for colds (P < .0001); their level of conceptual understanding for the causality of AIDS was not significantly different from that of cancer (P = .9).

Conclusions. Children's understanding of causality, treatment, and prevention of AIDS, as measured by the ASK, follows the same developmental sequence reported for children's understanding of general physical illness. Sociodemographic variables, such as race, gender, and socioeconomic status do not affect children's level of sophistication of these developmental concepts. These results have implications for the creation of developmentally appropriate and effective AIDS education curricula for primary and elementary grades. They also offer guidance to health care providers in their efforts to educate parents and young children about this important topic.

Key Words: AIDS • HIV infection • AIDS education • health education • school health • conceptual development • cognitive development • health concept • illness concept

Submitted on November 25, 1992
Accepted on March 4, 1993




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[Abstract] [PDF]