Flu, AIDS, and the Development of Intuitive Thinking about Disease

Main Article Content

Carol K. Sigelman


Despite the importance for their health and well-being of children’s acquiring knowledge and understanding of disease, surprisingly little work has been done to compare children’s thinking about different diseases at different ages to determine whether and how thinking about familiar diseases shapes thinking about newly encountered diseases. The present study reports a new analysis of interviews with 156 children that were conducted in 1992, when AIDS represented a new and life-threatening but not well understood health threat.  The aim was to compare thinking about the causality of a familiar disease, influenza, and a then-unfamiliar disease, AIDS, among third, fifth, and seventh graders. Comparisons of the two diseases and three grade levels focused on: (a) level of understanding based on cognitive-developmental theory and (b) three features defining children’s intuitive theories of disease (a biological ontology or vocabulary, causal propositions featuring an invisible germ or virus, and logical coherence). Scores on all four resulting summary measures and on all but one of eight causal propositions collectively constituting a scientific explanation of each disease, increased with age, with growth especially pronounced from third grade to fifth and seventh grades. Summary scores were moderately intercorrelated, both within each disease and across the two diseases. Folk beliefs about cold weather causing flu and casual contact causing AIDS declined with age. Levels of knowledge and understanding of the two diseases were more often similar than different. However, children’s thinking about flu was ahead of their thinking about AIDS in some respects, especially among the youngest children and especially with respect to symptomology. At the same time, exposure to information during the AIDS epidemic appeared to enable children describing AIDS causality to replace the generic term germ used for flu with the more specific term virus and to better understand that a person must have a disease or its pathogen to transmit it, that the causal agent for a disease is disease-specific, and that the body resists germs and viruses. Implications for better understanding the development of disease concepts and filling gaps in children’s knowledge and understanding in the era of COVID-19 are discussed.

Keywords: child development, intuitive theories, influenza, AIDS, causal thinking, knowledge

Article Details

How to Cite
SIGELMAN, Carol K.. Flu, AIDS, and the Development of Intuitive Thinking about Disease. Medical Research Archives, [S.l.], v. 10, n. 12, dec. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3404>. Date accessed: 29 jan. 2023. doi: https://doi.org/10.18103/mra.v10i12.3404.
Research Articles


1. Au TK, Romo LF. Building a coherent conception of HIV transmission: A new approach to AIDS education. Medin DL, eds. The Psychology of Learning and Motivation: Advances in Research and Theory, Vol. 35. Academic Press; 1996:193-241.
doi: 10.1016/S0079-7421(08)60576-9
2. Au TK, Chan CKK, Chan T, Cheung MWL, Ho JYS, Ip GWM. Folkbiology meets microbiology: A study of conceptual and behavioral change. Cognit Psychol. 2008;57(1):1-19.
3. Blacker K, LoBue V. Behavioral avoidance of contagion in childhood. J Exp Child Psychol. 2016;143:162-170.
doi: 10.1016/j.jecp.2015.09.033
4. Conrad M, Kim E, Blacker K, Walden Z, LoBue V. Using Storybooks to Teach Children About Illness Transmission and Promote Adaptive Health Behavior – A Pilot Study. Front Psychol. 2020;11.
5. Weisman K, Markman EM. Theory-based explanation as intervention. Psychon Bull Rev. 2017;24(5):1555-1562. doi:10.3758/s13423-016-1207-2
6. Mann MJ, Lohrmann DK. Addressing challenges to the reliable, large-scale implementation of effective school health education. Health Promot Pract. 2019;20(6):834-844.
doi: 10.1177/1524839919870196
7. Carey S. Conceptual Change in Childhood. MIT Press; 1985
8. Wellman HM, Gelman SA. Cognitive development: foundational theories of core domains. Annu Rev Psychol. 1992;43(1):337-375. doi: 10.1146/annurev.ps.43.020192.002005
9. Piaget J. The Child’s Conception of the World. Harcourt, Brace; 1926
10. Bibace R, Walsh ME. Development of children's concepts of illness. Pediatrics. 1980;66(6):912-917.
doi: 10.1542/peds.66.6.912
11. Perrin EC, Gerrity PS. There's a demon in your belly: Children's understanding of illness. Pediatrics. 1981;67(6):841-849.
doi: 10.1542/peds.67.6.841
12. Burbach DJ, Peterson L. Children's concepts of physical illness: A review and critique of the cognitive-developmental literature. Health Psychol. 1986;5(3):307-325. doi: 10.1037/0278-6133.5.3.307
13. Hansdottir I, Malcarne VL. Concepts of illness in Icelandic children. J Pediatr Psychol. 1998;23(3):187-195. doi:10.1093/jpepsy/23.3.187
14. Schonfeld DJ, Johnson SR, Perrin EC, O'Hare LL, Cicchetti DV. Understanding of acquired immunodeficiency syndrome by elementary school children--a developmental survey. Pediatrics. 1993;92(3):389-395. doi: 10.1542/peds.92.3.389
15. Walsh M,E., Bibace R. Children's conceptions of AIDS: A developmental analysis. J Pediatr Psychol. 1991;16(3):273-285. doi:10.1093/jpepsy/16.3.273
16. Wellman HM, Gelman SA. Knowledge acquisition in foundational domains. Damon W, ed. Handbook of child psychology: Vol. 2. Cognition, perception, and language. John Wiley & Sons Inc; 1998:523-573.
17. Kalish CW. Preschoolers' understanding of germs as invisible mechanisms. Cogn Dev. 1996;11(1):83-106.
18. Solomon GEA, Cassimatis NL. On facts and conceptual systems: Young children's integration of their understandings of germs and contagion. Dev Psychol. 1999;35(1):113-126. doi: 10.1037/0012-1649.35.1.113
19. Hergenrather JR, Rabinowitz M. Age-related differences in the organization of children's knowledge of illness. Dev Psychol. 1991;27(6):952-959.
20. Nagy MH. The representation of “germs” by children. Pedagog Semin J Genet Psychol. 1953;83(2):227-240.
doi: 10.1080/08856559.1953.10534089
21. Sigelman CK, Glaser SE. Characterizing children’s intuitive theories of disease: The case of flu. Cogn Dev. 2019;52: 100809.
doi: 10.1016/j.cogdev.2019.100809
22. Legare CH, Gelman SA. South African children's understanding of AIDS and flu: Investigating conceptual understanding of cause, treatment and prevention. J Cogn Cult. 2009;9(3-4):333-346.
doi: 10.1163/156770909X12518536414457
23. Sigelman CK. Age and ethnic differences in cold weather and contagion theories of colds and flu. Health Educ Behav. 2012;39(1):67-76.
doi: 10.1177/1090198111407187
24. Flood EM, Block SL, Hall MC, et al. Children's perceptions of influenza illness and preferences for influenza vaccine. J Pediatr Health Care. 2011;25(3):171-179.
25. McCann-Sanford T, Spencer MJ, Hendrick A, Meyer EE. Knowledge of upper respiratory tract infection in elementary school children. J Sch Health. 1982;52(9):525-528.
doi: 10.1111/j.1746-1561.1982.tb04032.x
26. Jones MG, Rua MJ. Conceptual representations of flu and microbial illness held by students, teachers, and medical professionals. Sch Sci Math. 2008;108(6):263-278. doi: 10.1111/j.1949-8594.2008.tb17836.x
27. Sigelman CK, Alfeld-Liro C, Lewin CB, Derenowski EB, Woods T. The role of germs and viruses in children's theories of AIDS (or, AIDS are not band-aids). Health Educ Behav. 1997;24(2):191-200.
doi: 10.1177/109019819702400207
28. Kistner J, Eberstein IW, Balthazor M, et al. Assessing children's conceptions of AIDS. J Pediatr Psychol. 1996;21(2):269-281.
29. Sigelman, CK. Development and coherence of beliefs about disease causality and prevention. Appl Dev Sci. 2014;18(4):201-213. doi: 10.1080/10888691.2014.950734
30. Sigelman CK. Children’s thinking about HIV/AIDS causality, prevention, and social interaction. J Child Fam Stud. 2018;27(10):3288-3299. doi: 10.1007/s10826-018-1152-y
31. Legare CH, Shtulman A. Explanatory pluralism across cultures and development. Proust J, Fortier M, eds. Metacognitive Diversity: An Interdisciplinary Approach. Oxford University Press; 2018:415-432. doi: 10.1093/oso/9780198789710.003.0019
32. Raman L, Winer GA. Children's and adults' understanding of illness: Evidence in support of a coexistence model. Genet Soc Gen Psychol Monogr. 2002;128(4):325-355.
33. Legare CH, Gelman SA. Bewitchment, biology, or both: The co-existence of natural and supernatural explanatory frameworks across development. Cogn Sci. 2008;32(4): 607-642. doi:10.1080/03640210802066766
34. Labotka D, Gelman SA. Scientific and folk theories of viral transmission: a comparison of covid-19 and the common cold. Front Psychol. 2022;13. doi: 10.3389/fpsyg.2022.929120
35. Motta M, Callaghan T. The pervasiveness and policy consequences of medical folk wisdom in the US. Sci Rep. 2020;10(1):1-10. doi:10.1038/s41598-020-67744-6
36. Sigelman CK, Estrada AL, Derenowski EB, Woods TE. Intuitive theories of human immunodeficiency virus transmission: Their development and implications. J Pediatr Psychol. 1996;21(4):555-572.
37. Centers for Disease Control and Prevention. Flu symptoms & diagnosis. https://www.cdc.gov/flu/symptoms/index.html. Updated November 18, 2021. Accessed November 5, 2022.
38. Centers for Disease Control and Prevention. About HIV.
https://www.cdc.gov/hiv/basics/whatishiv.html. Updated June 30, 2022. Accessed November 5, 2022.
39. Wilkinson SR. The Child's World of Illness: The Development of Health and Illness Behaviour. Cambridge University Press; 1988
40. Toyama N. Development of integrated explanations for illness. Cogn Dev. 2019;51:1-13. doi: 10.1016/j.cogdev.2019.05.003
41. Myant KA, Williams JM. What do children learn about biology from factual information? A comparison of interventions to improve understanding of contagious illnesses. Br J Educ Psychol. 2008;78(2):223-244.
doi: 10.1348/000709907X205263
42. Sigelman C, Derenowski E, Woods T, Mukai T, Alfeld C, Durazo O, & Maddock A. Mexican‐American and Anglo‐American children's responsiveness to a theory‐centered AIDS education program. Child Dev. 1996;67(2):253-266. doi: 10.2307/1131812
43. Leotti L, Pochinki N, Reis D, Bonawitz E, LoBue V. Learning about germs in a global pandemic: Children’s knowledge and avoidance of contagious illness before and after COVID-19. Cogn Dev. 2021;59:101090. doi: 10.31234/osf.io/y6xhj