Children's Understanding of Biology and Health, edited by Michael Siegal and Candida C. Peterson, Cambridge, UK, Cambridge University Press, 1999, 291 pp, $59.95.
This book provides an overview of the development of children's cognitive understanding of various processes related to biology and health. This includes a wide variety of topics, such as children's concepts of the controllability of pain, the meaning of life and death, the function of food consumption, and the role of the physician. There is a strong emphasis on description of research methods to investigate these issues; however, the topics themselves are of interest to researchers and practitioners alike.
The first major section guides the reader through broad issues related to children's understanding of life and health. Although as readers, we may be tempted to ask simple questions, such as, "When do children understand that death is final?" the issues raised in these initial chapters impress on us that such an understanding is dependent on several layers of cognitive reasoning. Children first must have a vitalistic theory of "life" or "alive" as representing a biological phenomenon, not simply a behavioral state, to grasp the cessation of that state as "death." The chapters in this section guide us through research findings that elucidate children's preliminary understanding of mind-body relationships, naïve theories of biology, and a biological understanding of life and death.
The second section includes various chapters regarding health issues, including children's understanding of contamination and contagion, reasoning about pain, conceptions of food, and their moral connotations of body, self, and diet. This section, as a whole, is somewhat uneven. The chapter concerning the "Ethics of emaciation" is of interest, although it contains very little developmental theory or data. Conspicuously missing from this section is a chapter on children's understanding of various chronic and acute diseases, ignoring an established literature on children's concepts of illness. A chapter on "Children and pain," however, provides a useful overview of the limitations of current models of pain assessment in children given their level of cognitive development, as well as updated research regarding children's beliefs about the controllability of pain.
The final section, which is focused on applications of children's understanding of health in specific contexts, has strong appeal to clinicians, as well as theoreticians and researchers. The chapter entitled "Considering children's folk biology in health education" provides an excellent example of how understanding children's causal reasoning about specific illnesses, such as AIDS, can inform and improve a health education curriculum. Specifically, moving beyond conveying factual information regarding disease (e.g., you can get AIDS from infected needles) and instead emphasizing the causal connections between germ and disease (e.g., AIDS is a virus that can reproduce but can die) assists children in reasoning about AIDS risks in novel situations. Similarly thoughtful chapters address children's understanding of the physician's role and the medical hearsay exception, and the cognitive development of competence to consent to medical and psychotherapeutic treatment.
Overall, this volume is a useful resource. The careful specification of research protocols in some of the earlier chapters may seem quite detailed to some readers, although for those embarking on research in the field, they could serve as useful models. The real strengths to this book, however, are in the final chapters, which illustrate the implications of cognitive development for health education, patient-physician relationships, and medical decision making. The excellent coverage of these and other topics make this a useful reference for research, training, and practice.
Elizabeth L. McQuaid, Ph.D.
Child and Family Psychiatry; Rhode Island Hospital/Brown Medical School; Providence, Rhode Island