Children’s conceptions of coronavirus

Abstract

The present study aimed to examine children’s conceptions of coronavirus as denoted in their verbal descriptions and drawings and whether these vary as a function of children’s age and the mode of expression. Data were collected in Greece during spring 2020 and 344 children aged 4 to 10 years were first asked to verbally describe coronavirus and then to produce a drawing of it. Content analysis of data revealed the following main themes: (a) Coronavirus, (b) Medical, (c) Psychological, and (d) Social. Results showed that children from an early age present a remarkable level of understanding of coronavirus and the COVID-19 disease as a multidimensional construct, which can be designated not only through characteristics of the Sars-Cov-2 but also through its medical, social, and psychological consequences on people’s lives. Moreover, children were found to emphasize different aspects of this construct depending on their age and the mode of expression.

Keywords

children conceptions coronavirus COVID-19 drawings

1. Introduction

Public communication of COVID-19

Since the emergence of COVID-19 early in 2020, public communication worldwide has been inundated with messages about infection and transmission risks, as well as preventive measures like social distancing, handwashing, and sanitation, or wearing a face mask (Zou and Tang, 2021). Among the general public, children have also been receiving these messages (Kayemba et al., 2020; Mukherjee, 2020; Soma, 2020), which they are expected to handle both cognitively and emotionally (Valadez et al., 2020) and to commit to pertinent prevention practices. In this pandemic context non-experts – among them children – adopt social representations (Assante and Candel, 2020; Idoiaga et al., 2020), that is, shared ideas founded on direct experiences and information they receive through the media and their social interactions. Social representations serve the purpose of transforming scientific knowledge and rendering it familiar to non-experts, thus contributing to a common understanding of controversial, or risky issues (Moscovici, 1988). Inherent in social representations are the mechanisms of anchoring unfamiliar threats into pre-existing knowledge and objectifying abstract ideas by concretising them through images, symbols, or tangible objects (Höijer, 2010; Mayor et al., 2013; Smith and Joffe, 2013).

Visual images about the Sars-CoV-2 coronavirus¹ have been powerful objectification means in public communication and meaning-creation during the pandemic, as has been the case in previous crises or threatening circumstances (Alcibar, 2018; Höijer, 2010; Stark and Stones, 2019). Such images are especially useful in representing invisible entities. Therefore, due to the emergency caused by COVID-19, visualizations of coronavirus have dominated public discourse, with varying degrees of ‘realism’ and artistic processing. In fact, none of these visual representations is literally realistic, that is, photographic, but result from the application of sophisticated visualization techniques on microscopic imagery (Joubert and Wasserman, 2020).

Visual images addressing the general public convey meanings more easily than verbal communication, by rendering complex information accessible to non-experts (Joubert and Wasserman, 2020). Furthermore, public visual communication goes beyond the representation of scientific information, by addressing social, cultural, emotional, or other aspects of the pandemic crisis (Zou and Tang, 2021). Images are therefore socio-cultural mediating constructs that rely on specific visual rhetorics, thus shaping and echoing public emotions, attitudes, and understandings (Smith and Joffe, 2013).

Visual rhetorics in representations of coronavirus involve two prevalent characteristics. The first concerns the morphology of the virus, with popular imagery emphasizing its spherical shape and the spikes on its surface. These spikes are often depicted with exaggeration, which has been interpreted as a deliberate choice of image creators for drawing attention to the threat posed by the coronavirus (Joubert and Wasserman, 2020). The second prevalent characteristic in coronavirus images is anthropomorphism, that is, the tendency to attribute human abilities, behaviours, and features like a face with eyes, mouth, and facial expression, a body, or human-like limbs to the virus (McGellin et al., 2021). Anthropomorphic depictions are commonly used when representing entities entailing uncertainty and fear, as is the case with Sars-CoV-2, and they are considered as an accessibility aid for non-experts, since they relocate an invisible, unknown entity to a human framework, thus rendering it concrete and familiar (De Rosa and Mannarini, 2020).

Children’s conceptions of microorganisms and infectious diseases

Micro-organisms are interesting objects for studying lay conceptions. They have extraordinary impacts on human lives, since they cause diseases and have historically been responsible for a large variation in human mortality and morbidity (Jee et al., 2015). As COVID-19 is a new global situation, and related research on its public understanding is embryonic, existing studies with microorganisms and infectious diseases can assist in identifying similar or evolved ideas in understanding novel infectious diseases. In the earliest known study, Nagy (1953) exploring children’s graphic representations of and conceptions about germs, concluded that germs are either identified as animal-like worms or insects or depicted in geometric shapes (points, circles, squares, etc.), findings that were duplicated in subsequent studies (Byrne, 2011; Byrne et al., 2009; Byrne and Grace, 2010). In addition, participants believed that all germs were harmful to humans, an idea confirmed by subsequent studies with older students (Simonneaux, 2000; Vasquez, 1985), who additionally associated poor hygiene with germs. Prokop et al. (2016) also found that the typical shape of micro-organisms in 4- to 8-year-old children’s drawings was circle-like. Anthropomorphism has been also reported in several studies (Faccio et al., 2013; Jee et al., 2015; Prokop et al., 2016), as many children attributed both physical (two or more hands, and two legs) and mental human characteristics and intentionality to micro-organisms. Moreover, Byrne (2011) found anthropomorphic ideas about micro-organisms decline with age; 7-year-olds tended to have a highly anthropomorphic perspective, consistent with young children’s naïve biology (Carey, 1985), while anthropomorphic ideas persisted in a substantial minority of 11- and 14-year-olds (Byrne and Grace, 2010). Older students appeared to be aware that anthropomorphisms are 'ways' of explaining rather than literal expressions of reality, but continued to use them to explain particular concepts and ideas (Byrne, 2011; Byrne and Grace, 2010).

In addition, anthropocentric conceptions about micro-organisms were recorded in all age groups. Germs are discussed predominantly in terms of their harmful effects on humans, indicating a negative view of micro-organisms as essentially malevolent (Byrne, 2011; Byrne and Grace, 2010), conceptions possibly deriving from non-formal learning (Ruiz-Gallardo and Paños, 2018).

Furthermore, the distinction between viruses and bacteria seems to be a difficult task for young children, as knowledge concerning viruses, their biology, and their importance as causal agents for infectious diseases distinct from bacterial ones seems rather fragmentary even among university students (Simon et al., 2017). A progression towards more scientifically accurate knowledge has been suggested across different age groups and expertise levels (Jee et al., 2015), but this development does not always follow a predictable, linear developmental trajectory from novice to expert. Thus, participants with varying levels of expertise have been found most knowledgeable about symptoms of microbial illness, treatments of symptoms, and routes of transmission for respiratory illnesses, and this knowledge seems to be tightly linked to their prior experiences with colds and flu (Jones and Rua, 2008).

Children’s understanding of COVID-19

Children are particularly affected by COVID-19, in terms of their physical and mental health, well-being, and education (Garcia de Avila et al., 2020; Waller et al., 2021). Their daily lives have been vastly disrupted and imposed restrictions combined with changes in family routines and practices could have significant psychological repercussions on them (Mukherjee, 2020; Soma, 2020; Valadez et al., 2020).

Therefore, children need to be empowered and supported in understanding and responsibly participating in mitigating the pandemic, taking into account the implications for their everyday activities, such as going to school, playing with peers, or being in contact with elderly or vulnerable family members (Garcia de Avila et al., 2020; Li et al., 2020; Provenzi et al., 2020).

Awareness of public health issues, such as COVID-19, is crucial to instil appropriate hygienic and prevention practices that would help control the pandemic, while strengthening communication between groups of people and improving mental health (Li et al., 2020; Zou and Tang, 2021). To design and implement effective teaching or sustainable communication campaigns about COVID-19 addressing children, it is critical to gain an insight into how they understand this unprecedented condition and handle it emotionally (Assante and Candel, 2020; Garcia de Avila et al., 2020; Idoiaga et al., 2020; Kayemba et al., 2020; Majid et al., 2020).

As with any other conceptual domain, children form their understanding of COVID-19 by combining a large amount of information from different sources, including media (multimodal) messages, explanations, and emotional reactions of family members, or other social contacts (Provenzi et al., 2020). Thus, scaffolding children’s meaning-making of COVID-19 is essential to support them in handling this unpredictable situation and in avoiding traumatic effects (Assante and Candel, 2020; Idoiaga et al., 2020).

However, little is known to date on how and to what extent this abundance of information is understood by children, and thus far related studies reveal different – often contradictory – findings. On the one hand, it has been suggested that children lack an adequate understanding of infectious diseases and appropriate prevention practices (Jee et al., 2015; Li et al., 2020). On the other, children’s awareness of COVID-19 has proven significant by several studies. Thus, children have been found to (a) differentiate between coronavirus (cause) and COVID-19 (result); (b) be aware of symptoms of the disease like cough, or fever, but also of the possibility of asymptomatic infection; (c) recognize the value of COVID-19 prevention measures; and (d) have a preliminary understanding of the virus transmission through droplets (Kayemba et al., 2020) and its high contagiousness (Idoiaga et al., 2020). Despite these findings, none of the relative studies attempted to investigate systematically how children’s understanding of COVID-19 changes during their development.

Furthermore, the above-mentioned studies relied on language-based data collection instruments. However, having participants express their thinking about microorganisms through drawings has several advantages (Byrne et al., 2009; Byrne and Grace, 2010; Nagy, 1953; Prokop et al., 2016). In an earlier study on students’ understanding of the HIV/AIDS, Mutonyi and Kendrick (2011) found that the participants’ drawings reflected a broad understanding of the topic, in terms of causes, effects, ways of transmission, and prevention. Thus, asking students to express their understanding of a complex scientific issue through drawing facilitates them in combining sociocultural with scientific knowledge in their representations. This selection has two crucial advantages. It allows children to express their understanding of scientific knowledge without having to rely on specialized vocabulary, while it provides a more comprehensive picture of their thinking and emotions compared to verbal communication alone (Jolley, 2010; Kress and van Leeuwen, 1996; Mutonyi and Kendrick, 2011).

For the aforementioned reasons, drawings have proved an effective means for exploring children’s conceptions of illness (Mouratidi et al., 2016; Piko and Bak, 2006; Zaloudikova, 2010). Drawing-based studies have confirmed that children identify illness primarily as a biomedical situation (Myant and Williams, 2005; Schmidt and Frohling, 2000), but have also revealed an appreciation of its consequences on one’s social and emotional adjustment (Bonoti et al., 2019; Zaloudikova, 2010).

This is no surprise, since public reactions to illness and viruses are highly emotional, due to the danger and uncertainty they entail (Joubert and Wasserman, 2020; Provenzi et al., 2020). As a consequence of the COVID-19 pandemic and its resulting restrictions, children have been found to report negative emotions – mainly fear (Assante and Candel, 2020; Garcia de Avila et al., 2020; Li et al., 2020), but also sadness, anxiety, anger, boredom, fatigue, loneliness and concern (Idoiaga et al., 2020; Soma, 2020). At the same time, positive emotions, like happiness resulting from spending time with family linked with a sense of security prompted by confinement measures (Idoiaga et al., 2020) have been expressed.

Despite the growing body of research related to the COVID-19 crisis and its consequences on children’s well-being (e.g. Garcia de Avila et al., 2020; Mukherjee, 2020; Soma, 2020; Valadez et al., 2020; Waller et al., 2021), few studies so far have focused on children’s perspective about this phenomenon (Idoiaga et al., 2020; Kayemba et al., 2020). These pioneering studies, although enlightening, have only shed light on some aspects of children’s conceptions of coronavirus and COVID-19, while questions about the development of these conceptions have not been addressed. For example, it would be interesting to investigate whether children’s knowledge of coronavirus follows the major developmental changes occurring in their biological knowledge around the age of 7 years (Duschl et al., 2007). Moreover, none of the existing studies have investigated children’s drawing representations of coronavirus or COVID-19, although visual communication has been a powerful information channel for the general public internationally.

The present study explores children’s conceptions of coronavirus as denoted in their verbal descriptions and drawings.

Specifically, the study addressed the following research questions:

What are children’s conceptions of coronavirus as conveyed through their verbal descriptions and drawings?

Do these conceptions differ between younger and older children?

Do children’s conceptions conveyed through verbal descriptions and drawings differ?

2. Method

Participants

The sample consisted of 344 children (156 boys and 188 girls) ranging in age from 4 to 10 years who were recruited from different parts of Greece. Participants were distributed in two age groups: Group A, involving 69 boys and 95 girls aged from 4 years, 0 months to 6 years, 11 months (n = 164, M = 68.81 months, SD = 10.62); and Group B, involving 87 boys and 93 girls aged from 7 years, 0 months to 10 years, 11 months (n = 180, M = 103.42 months, SD = 13.05).

Given the lockdown restrictions, a snowball sampling was adopted. Researchers identified families through their social networks, who then nominated other participants to take part in the study. Parents were informed about the aims of the study and were advised not to prepare or orientate their children for the topic under investigation. The procedure of data collection was explained and parents provided their oral consent for their children’s participation, which was reflected in their presence and assistance during the data collection procedure described below. Furthermore, both parents and children were given the choice not to participate or to interrupt the procedure in case they wanted to. This research has obtained the approval of the Ethics Committee of the institution of the first author.

Tasks and procedure

Data were collected between April and May 2020, during lockdown restrictions imposed for COVID-19. Children were tested individually while being at home through video calls on online platforms. Initially, they were asked to answer to the following question: ‘Do you know what coronavirus is?’ and then to use a white page and a set of coloured pencils or crayons and they were prompted ‘Would you like to draw coronavirus?’. There was no time constraint and children were given as much time as needed to complete their drawings. Τhe researchers did not intervene and if there were signs that children felt uncomfortable the procedure was ended. These cases were not included to the final sample. After completion of the drawing, each child was prompted to describe his or her drawing and the researchers, when needed, simply encouraged the children to describe the elements of their drawing. Children’s verbal responses were transcribed verbatim during discussions. Individual communication with children was facilitated by their parents, who ensured their connection to video calls via the links sent to them and subsequently photographed and emailed children’s drawings to the researchers.

Coding of data

Children’s verbal descriptions and drawings were content analysed by adopting an emergent coding approach (Stemler, 2000) to detect the recurring themes they included. Initially, two coders independently inspected the transcripts and drawings to identify verbally described and depicted items, namely any verbal or graphic element denoting coronavirus-related meanings. Next, items identified by the independent coders were compared and differences were reconciled, resulting in a common list. This list was used for independent analysis of the data, and inter-coder agreement calculated as k coefficient (Cohen, 1960) was satisfactory [.85, p < .01 and .89, p < .01 for descriptions and drawings, respectively], signifying that the frequency with which coders agreed was much stronger than by chance alone. Subsequently, all identified items were aggregated to four themes, namely: (a) Coronavirus, (b) Medical, (c) Psychological, and (d) Social Theme. The themes and items that emerged formed the analysis framework presented in Figure 1. Using this framework, the coders reviewed the transcripts of children’s comments and drawings by giving a score of 1 for the presence and a score of 0 for the absence of each theme and each item.

Figure 1.

The analysis framework.

For the first theme, Coronavirus, analysis focused on whether children’s verbal depictions were Realistic, namely whether they described coronavirus as a virus or a germ or illustrated morphological characteristics of coronavirus as commonly depicted in the media, that is, its spherical scheme and/or spikes respectively. Alternatively, when participants verbally identified coronavirus with the resulting disease, or when they added a crown and/or anthropomorphic features to their – otherwise realistic – drawings of the virus, their responses were categorized as Hybrid. Last, when children’s verbal descriptions or graphic representations ascribed supernatural or animal-like characteristics to coronavirus, they were classified as Mythical/Symbolic. Children’s failure to provide any description of or depiction of coronavirus was categorized as No response.

The second theme, namely the Μedical dimension of COVID-19, involved children’s verbal and/or graphic items related to Illness, virus Transmission, Symptoms of the COVID-19 disease, Medical care (such as hospitals, medical staff and equipment, ambulances, medicines, and vaccines), and personal hygiene Preventive measures (e.g. wearing a mask and/or gloves, using sanitizer, handwashing, etc.).

The Psychological theme involved items referring to psychological functions such as emotions or abstract thoughts. Specifically, in this theme were aggregated verbal comments or graphic representations of Emotional expression, or references and graphic signifiers of Danger/Death. Furthermore, analysis of the psychological theme in children’s drawings examined if they included Captions, or depictions of natural or urban Landscapes, which metaphorically denoted mood (e.g. empty streets, deserted woods, etc.).

The last theme, indicating the Social dimensions of COVID-19 included items related to one’s social interactions with others. Therefore, it involved references or depictions of Lockdown conditions; recommended or imposed Restrictions (like avoiding crowded, indoor spaces, or physical distancing); the Globality of the pandemic; and children’s limited possibilities to meet Significant others, such as peers or vulnerable relatives (e.g. grandparents) to protect them from being infected.

To investigate whether the incidence of the Coronavirus, Medical, Psychological, and Social themes and pertinent items varied as a function of age, a series of chi-square tests were conducted using the IBM SPSS Statistics v. 25 package in all cases that the prerequisites of the test were not violated, excluding from further analysis those items whose distribution within cells exhibited frequencies less than 5. Moreover, in order to investigate whether the emergence of themes and items varied between the two data collection techniques, we used Cochran’s Q test since this nonparametric test is suggested (Siegel and Castellan, 1988) for dichotomous variables (presence or absence of themes/items) in repeated measures designs (descriptions and drawings).

3. Results

As already stated, content analysis revealed four themes in children’s (N = 344) descriptions and drawings. Results are presented through analyses related to (a) the Coronavirus theme, which was the main focus of the study, and (b) the Medical, Psychological, and Social themes, which children spontaneously included in their descriptions and drawings. Simultaneously, age-related trends are presented, while a comparison of results obtained through participants’ descriptions and drawings is attempted. Gender-related results are not reported, since preliminary analyses did not indicate relevant differences. Table 1 presents the distribution of participants using the identified items in their descriptions and depictions of each theme and item by age group.

Table 1.

Frequencies of themes and items in participants’ descriptions and drawings by age group (Group A: children aged from 4.0 to 6.11 years; Group B: children aged from 7.0 to 10.11 years).¹

Themes and items	Verbal description			Drawing
Themes and items	Group A (n = 164)	Group B (n = 180)	Total (n = 344)	Group A (n = 164)	Group B (n = 180)	Total (n = 344)
Coronavirus	147	176	323	156	172	328
Realistic	56	88	144	77	100	177
Hybrid	67	75	142	62	60	122
Mythical/symbolic	24	13	37	17	12	29
No response	17	4	21	8	8	16
Medical	129	130	259	32	39	71
Illness	98	109	207	10	5	15
Transmission	63	42	105	5	18	23
Symptoms	16	9	25	5	9	14
Medical care	10	9	19	9	8	17
Prevention measures	9	4	13	18	16	34
Psychological	48	76	124	75	87	162
Expression of emotion	13	14	27	67	67	134
Danger/death	39	74	113	3	8	11
Captions	0	0	-	17	36	53
Nature/landscapes	0	0	-	5	6	11
Social	51	64	115	30	31	61
Lockdown/stay home	23	12	35	20	17	37
Restrictions	27	16	43	5	5	10
Globality	10	34	44	5	13	18
Significant others	16	21	37	4	2	6

Overall frequencies of the Medical, Psychological and Social themes do not correspond to the sum of frequencies of the pertinent items for each theme, since a description, or a drawing could involve one or more items of the same theme. For instance, a drawing could involve both Expression of emotion and a Caption scored as incidence of the Psychological theme and as incidence of each corresponding item.

Coronavirus theme

Regarding the Coronavirus theme, analysis of participants’ verbal descriptions showed that most children either provided a Realistic description (Example 1), by referring to virus or germ (n = 144) or offered a Hybrid response (Example 2), by identifying the virus with illness (n = 142). Fewer children included Mythical items in their descriptions (n = 37), as in Example 3, or offered No response (n = 21). Quite frequently, though, children combined items from different themes in their responses (Example 4).

Example 1 (9-year-old girl):

I think coronavirus is a germ like other germs [. . .]. I think it’s bad because it kills.

Example 2 (5-year-old boy):

My dad told me that [coronavirus] is a flu, like when our throat aches, but we have to stay at home because the doctors have not yet found a medicine that we can take and stop getting sick and he told me that we are not going to suffer, but we have to be careful with grandmas and grandpas.

Example 3 (4-year-old boy):

I know what it is. It is a ball that you must not touch! It is like a bad snail because it won’t go away quickly. It’s bad because my mom won’t let me go out and she shouts at me whenever I cry because I want to go out.

Example 4 (4-year-old girl):

The bad germ wants to hang out with people but sees that everyone stays at home. [. . .] and this makes [the coronavirus] sad, he wants to cry.

Crosstabulation of these data showed significant differences between age groups [χ²(3, N = 344) = 18.17, p < .001], with younger children providing Mythical/Symbolic responses, or No response more frequently than expected and older ones indicating a preference to Realistic descriptions.

Regarding drawing representations of coronavirus, the majority of children produced Realistic images (n = 177), while a considerable number of drawings included Hybrid representations (n = 122). Few children drew coronavirus as a Mythical/Symbolic agent (n = 29), while 16 failed to depict coronavirus. It should be noted that 283 out of 344 children included spikes in their realistic or hybrid representations. Representative drawings scored as Realistic, Hybrid and Mythical/Symbolic are presented in Figure 2.

Figure 2.

Examples of (a) Realistic, (b), Hybrid, and (c) Mythical/Symbolic drawings of coronavirus produced by an 8-year-old boy, a 9-year-old girl, and a 5-year-old boy, respectively.

Participants’ age does not seem to differentiate drawing representations of coronavirus. This absence of age-related effects can be attributed to children’s tendency in both age groups to depict either a Realistic or a Hybrid coronavirus (see Table 1).

Medical, psychological and social themes

Analysis subsequently focused on the Medical, Psychological, and Social themes identified in children’s descriptions and drawings. The overall frequencies with which each theme and item was included in participants’ verbal descriptions and drawings (Table 1), indicates that in total, 259 participants referred to the Medical dimension of COVID-19 (Example 2), while 124 mentioned its Psychological (Examples 3 and 4) and 115 its Social aspects (Example 5). Prevalent items prompted verbally within these themes concerned Illness (n = 207), as in Example 6, Danger/Death (n = 113), Transmission (n = 105), Globality (n = 44), and Restrictions (n = 43). Children’s drawings primarily emphasized the Psychological theme (n = 162, Figure 3b), while depictions of the Medical (n = 71, Figure 3a) and the Social (n = 61, Figure 3c) themes were less frequent. Also, the items most frequently depicted involved Expression of emotions (n = 134), Captions (n = 53), Lockdown/Stay at home (n = 37), and personal hygiene Prevention measures (n = 34):

Example 5 (4-year-old boy):

I don’t know [what the coronavirus is], it just harms people and I can’t meet my friends, or hug my grandma.

Example 6 (5-year-old girl):

These little things [points at the coronavirus spikes he drew] get inside you . . . they can dig and go inside you. Then they multiply from 1 to 2, from 2 to 3, from 3 to 4 and so on.

Examining the frequencies of themes in children’s verbal responses, analysis indicated statistically significant age differences only for data corresponding to the Psychological theme [χ²(1, N = 344) = 6.25, p < .05], with Group B making relevant comments more frequently than Group A. No statistically significant differences were detected between age groups regarding the introduction of the Medical, Psychological, and Social themes in participants’ drawings.

Figure 3.

Examples of drawings involving items of the (a) Medical, (b) the Psychological, and the (c) Social theme produced by a 7-year-old girl, a 7-year-old boy, and a 10-year-old girl, respectively.

Accordingly, significant age differences were detected for particular items within themes. Specifically, (a) Transmission [χ²(1, N = 344) = 9.20, p < .05] was invoked more frequently by the younger group than by the older one; (b) Signifiers of Danger/Death [χ²(1, N = 344) = 11.68, p < .001], were more frequently alluded to by younger participants than by their older counterparts; (c) Lockdown/Stay at home [χ²(1, Ν = 344) = 5.08, p < .05] was more frequently mentioned by Group A than by Group B; and (d) Restrictions [χ²(1, N = 344) = 4.50, p < .05] were mentioned significantly more frequently within younger children than within older ones; and (e) references to COVID-19 Globality [χ²(1, N = 344) = 12.59, p < .001] were more frequently identified in older than younger participants’ responses. Children’s drawings did not reveal extensive differences concerning the items preferred, with the exemption of Transmission [χ²(1, N = 344) = 6.65, p < .05] and Captions [χ²(1, N = 344) = 6.11, p < .05] which were more frequently introduced in older than in younger children’s depictions.

Ιn a next step, data presented in Table 1 were analysed in order to investigate whether the emergence of themes and items varied between the two data collection techniques. Thus, children indicated more Medical [Cochran’s Q(1, N = 344) = 157.78, p < .001] and Social themes [Cochran’s Q(1, N = 344) = 22.09, p < .001] in their verbal responses than in their drawings, while Psychological themes [Cochran’s Q(1, N = 344) = 8.80, p < .05] were displayed more frequently in drawings than in children’s verbal responses.

Analyses related to specific items showed that children employed more often in their descriptions than in their drawings items of Illness [Cochran’s Q(1, N = 344) = 182.49, p < .001], Transmission [Cochran’s Q(1, N = 344) = 56.98, p < .001], Signifiers of Danger/Death [Cochran’s Q(1, N = 344) = 91.26, p < .001], Restrictions [Cochran’s Q(1, N = 344) = 22.22, p < .001], Globality [Cochran’s Q(1, N = 344) = 13.52, p < .001] and Significant Others [Cochran’s Q(1, N = 344) = 25.97, p < .001]. On the other hand, children displayed more often in their drawings than in their descriptions items of Preventive measures [Cochran’s Q(1, N = 344) = 9.80, p < .05] and Emotional Expression [Cochran’s Q(1, N = 344) = 81.67, p < .001]. The frequencies of items denoting Symptoms, Medical Care and Lockdown/Stay at home did not differ across the two data collection techniques, while Captions and Nature/Landscape items emerged only in children’s drawings.

A separate note should be added for the specific emotions mentioned or depicted by participants. Interestingly, different emotions emerged between descriptions and drawings. Analytically, children mostly referred to fear (n = 12) or sadness (n = 8) while describing coronavirus, whereas they mentioned less frequently anger (n = 3) and happiness (n = 2). Contrarily, anger was the predominant emotion (n = 39) in children’s drawings, followed by happiness (n = 38), sadness (n = 32) and fear (n = 22). Other emotions, like hope, boredom, or hatred were sporadically observed in both descriptions (n = 2) and drawings (n = 3).

4. Discussion

This study explored children’s conceptions of coronavirus as denoted through their descriptions and depictions, and whether these vary as a function of their age. Our results revealed that children conceive coronavirus as embedded in a multidimensional COVID-19 construct, which can be designated not only through characteristics of the Sars-CoV-2 per se but also through its medical, social, and emotional consequences on people’s lives. This holistic understanding of coronavirus seems to be in accordance with studies suggesting a similar trend in children’s conceptions of illness (Bonoti et al., 2019; Zaloudikova, 2010).

Participants in this study exhibit a remarkable level of understanding of coronavirus and COVID-19, further supporting the rapid spread of knowledge (Majid et al., 2020) and the flexibility of meaning-making based on social representations during pandemics (Mayor et al., 2013). Specifically, children primarily described coronavirus either realistically as a ‘virus’ or a ‘germ’ or identified it with the resulting disease. Similarly, their drawings were mostly realistic, or hybrid, that is, they included anthropomorphic items like a face or a crown in their otherwise realistic depictions. Realistic drawings could resonate the objectification of the coronavirus through abounding visual representations in the media, while hybrids could be interpreted as indications of anchoring an unfamiliar virus into the well-known representation of human beings (Höijer, 2010; Smith and Joffe, 2013). These findings are in line with research on conceptions of microorganisms before the COVID-19 pandemic (Byrne, 2011; Byrne et al., 2009; Prokop et al., 2016), where microorganisms were typically depicted as cyclical, occasionally with human limbs, possibly revealing children’s attempt to place an unknown entity in a familiar context (Byrne et al., 2009; Byrne and Grace, 2010). What may be remarkable is that many participants in our study do not interpret the component ‘corona’ of the coronavirus term as a metaphor related to the characteristic crown-like halo apparent in electronic microscopy images of Sars-CoV-2 (Joubert and Wasserman, 2020). Their misunderstanding, expressed again metaphorically, relates ‘corona’ – which means ‘crown’ in Greek – to the supremacy of coronavirus or the high risk it entails compared to other microorganisms, hence the inclusion of crowns in some hybrid descriptions and drawings. This metaphor could again be seen as indicative of children’s attempt to objectify coronavirus. For instance, a 10-year-old girl commented on her drawing (Figure 3c), as follows: ‘I have drawn the coronavirus that has imprisoned the earth and is watching over us. I put a crown because he is the king of the viruses since no antidote has been found yet’.

As expected from previous studies (Byrne, 2011; Byrne et al., 2009; Faccio et al., 2013), findings suggest that children’s ability to verbally describe coronavirus changes with age, since children older than 7 years old seem to abandon mythical or anthropomorphic explanations and provide more scientifically oriented descriptions. These findings are also in line with developmental data, suggesting major changes in children’s biological knowledge at the age of 7 years or later (Duschl et al., 2007). Although children develop biological knowledge much earlier (Carey, 1985; Hatano and Inagaki, 1994), early years’ naïve biology is acquired based on the general mechanism of personification or the person analogy (Hatano and Inagaki, 1997). Αs children get older, these ideas gradually change towards more scientifically appropriate conceptions; however, adults and older children may still rely on anthropomorphism regarding biology topics, which indicates that resorting to personification may be used as a lifelong fallback strategy (Hatano and Inagaki, 1994).

Whether children’s descriptions of coronavirus indicate development of an adequate understanding of the term remains uncertain, since this study did not include an in-depth interview to allow a detailed investigation of their conceptualizations of coronavirus or COVID-19. However, a similar age-related trend was not observed in children’s drawings. Participants, irrespective of age, produced representations that shared common characteristics with images dominating the public sphere since the beginning of the pandemic. These characteristics involve the virus’ shape and spikes, the latter being often oversized. The remarkable uniformity in participants’ depictions of coronavirus offers additional evidence regarding the popularity and communicative effectiveness of such public visual representations (Joubert and Wasserman, 2020; Stark and Stones, 2019).

It is of particular interest that although children were prompted to simply describe and draw coronavirus, they spontaneously brought up other themes related to the pandemic crisis. A similar trend was observed in Idoiaga et al.’s (2020) study, in which children were asked to report their thoughts and feelings about coronavirus. Their lexical analysis classified children’s mentions into two main categories: one related to the virus per se, and another to the lockdown imposed during the pandemic. These findings support the assumption that meaning-making in the case of coronavirus involves assessing not only scientific but also social, cultural, and emotional information (Joubert and Wasserman, 2020). In other words, children do not merely receive information related to the virus, but directly experience several aspects of the health crisis, attributing to it both emotional and social dimensions. Furthermore, our results imply the power of social representations of coronavirus and COVID-19 at the time of their emergence. In the midst of the pandemic, non-experts, even very young children have swiftly responded to the threat, by conceptualizing coronavirus and their conceptions are indicative of the resonance between internal (i.e. personal conceptions) and external (i.e. social) representations, as earlier studies have suggested (Smith and Joffe, 2013).

In our study different dimensions of the COVID-19 pandemic emerged indicating that even young children have developed a broad understanding of the phenomenon that includes medical, psychological, and social dimensions. When children were asked to describe or to depict coronavirus they not only relied on their biological knowledge about the virus, but they also assumed that it could be defined through closely-related meanings, namely in medical terms, such as personal hygiene prevention measures or medical care, but also through the changes that the pandemic imposed on their psychological and social world. In other words, children spontaneously brought up a variety of medical, psychological, and social items with specific references to illness, transmission, danger and death caused by coronavirus infection, the social restrictions imposed, and the globality of the pandemic.

In addition, data suggest that children conceptualize COVID-19 as a highly emotional phenomenon. Negative emotions expressed by participants, like fear, anger, or sadness, indicate that children share similar emotional reactions to the pandemic with adults (Wang et al., 2021) that are in accordance with the negative connotations attributed to all microorganisms (Byrne, 2011; Byrne and Grace, 2010). Apart from these negative emotions, several children expressed happiness – especially through their drawings. It is unclear, however, whether the depiction of happiness in participants’ representations can be attributed to children’s tendency to more often produce happy drawings (Cox, 2005), or to their intentional desire to associate the aforementioned emotion with coronavirus (Idoiaga et al., 2020). Some indications for the latter interpretation were found in participants’ quotes. For instance, a 6-year-old boy mentioned that ‘coronavirus is happy because it achieved its goal.’ and a 7-year-old girl said, ‘I feel happy staying safe at home’. However, this issue requires further investigation.

Analysis of data collected through two different tools revealed that children tend to emphasize different aspects of the topic under investigation depending on the mode of expression. In the present study, participants tended to focus verbally on the medical and social dimensions of the COVID-19 crisis, and graphically on the psychological ones. Thus, as previously indicated (Driessnack and Gallo, 2013), verbal and drawing communication can prompt different facets of participants’ understanding of a phenomenon. In addition, drawings seem to facilitate the representation of psychologically laden situations (Gross and Hayne, 1998) and emotional expression, since children from an early age possess numerous strategies for denoting emotions in their pictorial representations (Brechet et al., 2009; Cox, 2005).

Similar differentiations in the responses elicited by the two tools were reflected between age groups. In their verbal responses, older participants invoked the psychological theme – particularly danger and death – more frequently than younger ones. As far as the medical theme was concerned, younger children referred to coronavirus transmission significantly more than older ones. Last, in terms of the social dimension of COVID-19, younger participants tended to emphasize the imposed lockdown and its resulting restrictions, while older ones preferred to highlight the globality of COVID-19. Despite these differences in verbal responses, participants addressed the topic rather homogenously in their drawings, with the exemption of differences in including signs of transmission and captions between younger and older children, which may be attributed to older children’s familiarity with the conventions of drawing and writing, respectively.

The outcomes of the present study have several implications on raising children’s awareness of COVID-19 and supporting them in addressing similar risks they may face in the future. Scaffolding children in coping with such crises involves providing simple and clear information and explanations to support understanding, along with emotional expression and awareness (Provenzi et al., 2020; Soma, 2020).

Furthermore, as the results in the present and previous studies (Joubert and Wasserman, 2020; Mutonyi and Kendrick, 2011) suggest, the visual mode can be a powerful and valuable meaning-making tool in the case of coronavirus, COVID-19, and other viruses and infectious diseases. Inadequate understanding of such concepts might lead children – and the general public – to inappropriate and risky behaviours. Having students read and produce visual representations of coronavirus, might assist them in constructing more scientifically-sound conceptions (Britsch, 2013; Jewitt, 2008) and engage in meaningful and effective health promotion and disease prevention practices (Mutonyi and Kendrick, 2011).

The procedure followed for data collection poses several limitations. First, although parents were asked not to intervene in their children’s responses, their intermediating role for data delivery might have affected the reported findings. Second, given that children were tested at home, variability regarding the quality of web communication and the materials used for drawing was observed. Third, the structured procedure followed did not permit an in-depth exploration of children’s conceptions. For instance, describing coronavirus as ‘a virus’, or ‘a germ’, does not say much about the participants’ understanding of these biological concepts. After all, the ideas conveyed through their verbal responses and drawings are only indicative of how they internalized the wealth of information about COVID-19 and the relevant social representations the public was exposed to at the beginning of the pandemic, not a result of formal or systematic teaching.

Appreciating children’s conceptions of coronavirus is crucial for helping them cope with the implications of COVID-19. However, identification of factors that intervene and affect the development of these conceptions should be attempted. For instance, what source of information children use and assess to understand coronavirus, remains a question to be answered. Future research should also examine whether children’s conceptualization of coronavirus and COVID-19 relates to other variables, such as their socio-cultural background, their personal direct or indirect experiences (Williams and Binnie, 2002), and their parents’ views and practices (Waller et al., 2021).

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Fotini Bonoti

Vasilia Christidou

Penelope Papadopoulou

Notes

Author biographies

Fotini Bonoti is a Professor in Developmental Psychology at the Department of Early Childhood Education of the University of Thessaly, Greece. Her current research activity focuses on children’s drawing development and children’s understanding of pictures.

Vasilia Christidou is an Associate Professor at the Faculty of Early Education, Aristotle University of Thessaloniki, Greece. Her research interests include teaching and learning in science, public understanding of science, and the recontextualization of scientific texts addressed to non-experts.

Penelope Papadopoulou is a Professor in Biological Education at the Department of Early Childhood Education of the University of Western Macedonia, Greece. Her research interests include preschool children’s understanding of biological concepts as well preschool and primary teachers learning in Biology.

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