1. (#1) Has the story changed
(#1) Has the story changed?: Children’s picture books about illnesses and disability over the decades
Dr. Judith L. Newman, Darby McGurk, & Courtney Colkett-Harvey Psychological and Social Sciences, Penn State Abington, Abington, PA
Procedure
We conducted a conceptual content analysis of every edition and supplement (from 1982 to 2016) of the A to Zoo guide to children’s picture books. The books listed span about 5 decades of publication, are viewed as the most available and accessible as they are housed in most public libraries. They are all English language fiction or non-fiction picture books in which the illustrations occupy as much or more space than the text which is written for preschool to second grade children.
We tried to clearly classify books from areas of Illness/Disease and Handicaps/Disabilities into specific illness categories and then made a count of the books in each category in each edition.
Concerns
We are surprised that while we could classify 13 books as being about mental illness (e.g. depression, anxiety) in 2006, that number was down to just 2 almost a decade later. Since we also note that very few books are listed for highly occurring disorders like ADHD and Addiction, we are concerned that certain “psychological” illnesses may be underrepresented in children’s books.
In a similar vein, Sakai et al. (2012) in a study of storybooks about Alzheimer's disease, wonder if by protecting “children from the more grim images of …. disease, the consequence is that children may not learn about what truly happens …. until they witness it in their own family” (p. 588) .
It is our interest in the actual content of the storybooks, rather than just their topic, that led us to conduct research for Poster #2.
Introduction
This research (Posters #1 and #2) was conducted to enhance an academic book being written about how children develop an understanding of what causes various types of illnesses/disorders. Medical and mental health professionals often suggest that parents should explain an illness (e.g., autism or cancer) to a child in developmentally-appropriate ways but there is no clarity about how to do so.
Since picture books may be used by parents to introduce difficult topics and to bridge conversation, repeated reading of stories about illness could familiarize a child with an ill character and possibly enhance interactions between healthy and unhealthy peers/family members, or even help a diagnosed child to feel better about themselves.
We wondered what types of illnesses are represented in children’s picture books and whether those illnesses being written about have changed over the last several decades (Poster #1). We also wondered about what explanations and representations are offered in a sampling of children’s picture books about illnesses of various types (Poster #2) and whether we would consider such explanations as developmentally-appropriate.
We began by conducting interviews with librarians in various settings (e.g., community library, children’s hospital, college campus, elementary school). We interviewed a physically disabled children’s book author and his illustrator, as well as the author of the recent editions of A to Zoo: Subject Access to Children’s Picture Books. We also interviewed a child life specialist/ bibliotherapist, and two college faculty members who teach about children’s literature and/or literary images of illness.
Results
The most important findings are shown in Table 1. We have bolded three of the time periods (1989, 1998, 2014) to gain greater focus as to trends regarding which illnesses are being written about the most, the least, and what changes can be seen across the three decades.
We have highlighted and bolded the 12 specific illnesses/disorders for which more than 5 children’s picture books were listed in at least one of the three time periods. We are not including the Unspecified or the Doctor/Hospital category in our analyses. While they are highly populated, they are not about a particular illness or disorder.
If we focus only on the 12 bolded illnesses at those 3 time periods we note that disabilities such as Blindness, Deafness, and Physical Handicaps contain the greatest number of listed books. And these categories remain highly populated in spite of the fact that the recent editors of the A to Zoo guides have eliminated the listing of books that are out of print, difficult to access, or considered outdated in terminology or illustrations.
The other bolded illnesses/disorders have fewer books listed but those with more than 5 books in at least one of the three decades are Alzheimer’s, Asthma, Autism, Brain Damage, Cancer, Chicken Pox, Cold and Flu, Down Syndrome, and the Measles/Mumps category.
Conclusions
We assume that the notable increase in books about Autism and Cancer may parallel increases in occurrence and diagnoses of these conditions over the decades.
Not surprisingly, the number of books about Cold and Flu seem stable across the years as do books about Down Syndrome and Chicken Pox.
The decline that we note over the decades of books about Measles and Mumps is not so surprising as the incidence is lower now that the MMR vaccine is mandated for any child entering kindergarten.
Table 1: Number of available books listed for each illness in every edition of A to Zoo: Subject access to children’s picture books
ILLNESS
1982
1986
1989
1993
1998
2001
2006
2010
2014
ADD/ADHD
Addiction
AIDS 8 7
Alzheimer’s 9
Arthritis
Asperger’s
Asthma
Autism 6 13
Blindness 14 18 22 29 38 42 19 24
Brain damage 12
Cancer 11 15
Cerebral Palsy
Chicken Pox
Cold/Flu 10 21 16
Cystic Fibrosis
Deafness 5 17 34 26
Diabetes
Doc/Hosp. 28
Down Syndr
Dwarfism
Dyslexia
Epilepsy
Germ/Virus
Hiccoughs
Injury
Laryngitis
Measles/Mumps
Mental Illness
MuscularDystrophy
PhysHandicaps 30 44 20
Polio
Speech Impediment
Spina Bifida
Stroke
Tourette
Unspecified 63 76 96
117
151 75
Limitations
We used only one subject guide.
We may not have comprehensively and correctly classified books into their specific illness category.
Acknowledgements
We thank all of our interviewees as they provided us with important insights. For example, families may be more interested in the general books about visits to doctors and hospitals, but (biblio)therapists use the more specific illness books.
Sample References
Lima, C. W., & Lima, J. A. (2001). A to Zoo subject access to children’s picture books. New Providence, NJ: Bowker.
Sakai, E. Y., Carpenter, B. D., & Rieger, R. E. (2012). “What’s wrong with Grandma?”: Depictions of Alzheimer’s disease in children’s storybooks American Journal of Alzheimer’s Disease and Other Dementias, 27(8),  
= 1 to 5 books
= 6 or more books in years of our focus
= 6 or more books in years other than our focus