Çocuk Dergisi 1308-8491 Istanbul University 10.26650/jchild.2024.1352499 Clinical Sciences (Other) Allied Health and Rehabilitation Science (Other) Klinik Tıp Bilimleri (Diğer) Yardımcı Sağlık ve Rehabilitasyon Bilimi (Diğer) Examining Children’s Perceptions of Covid-19 Through Drawings: A Case Control Study https://orcid.org/0000-0003-4311-2670 Uzun Mehmet Erdem University of Health Sciences, Bursa Yüksek İhtisas Education and Research Hospital, Department of Child and Adolescent Pscyhiatry https://orcid.org/0000-0002-2596-9091 Beyazıt Utku Akdeniz University, Kumluca Health Sciences Faculty, Child Development Department https://orcid.org/0000-0003-1155-8416 Erdem Atak İrem Istanbul University, Faculty of Literature, Psychology Department https://orcid.org/0000-0002-4073-5445 Yurdakul Yeşim Akdeniz University, Kumluca Health Sciences Faculty, Child Development Department https://orcid.org/0000-0002-2159-523X Şirin Hande University of Health Sciences, Bursa Yüksek İhtisas Education and Research Hospital, Department of Child and Adolescent Pscyhiatry https://orcid.org/0000-0002-1692-7447 Bostancı Muharrem University of Health Sciences, Yüksek İhtisas Training and Research Hospital, Department of Pediatry https://orcid.org/0000-0002-0813-7189 Ekici Arzu University of Health Sciences, Yüksek İhtisas Training and Research Hospital, Department of Pediatric Neurology https://orcid.org/0000-0003-3306-9672 Bütün Ayhan Aynur Ankara University, Faculty of Health Sciences, Child Development Department 08 15 2024 24 2 78 91 08 30 2023 07 29 2024 Copyright © 2000, Journal of Child 2000 Journal of Child

Objective: The objective of the present study was to examine the perceptions of children regarding the Covid-19 pandemic through their own drawings and to reveal the impact of the pandemic on children’s psychological dynamics through an examination of their perceptions related to the pandemic and draw-and-tell interviews.Methods: Participants were 60 children aged 6–10 years (30 children diagnosed with COVID-19 in the last six months and 30 healthy children not diagnosed with Covid-19) and their parents. Children diagnosed with COVID-19 were recruited from a state hospital, whereas children in the non-Covid-19 group were recruited from a kindergarten. The children’s experiences were examined using drawings, the Children’s Apperception Test (CAT), and draw-and-tell interviews. The study employed descriptive and content analysis approaches.Results: In the descriptive analyses, it was observed that the frequency of colour use was less in the Covid-19 group (p<.001) while emotional difficulties such as introversion, regression, and insecurity were higher in this group than in the non-Covid-19 group (p< .05). Content analysis revealed that the vital threats posed by the pandemic negatively affected the mental health of all children. Additionally, the external reality experienced by children during the pandemic prevented them from accurately reflecting their actual mental functionality in their responses. Upon comprehensive evaluation of the study results, it was determined that children in both groups exhibited signs of fear, anxiety, depression, aggression, insecurity, introversion, and regression.Conclusions: The findings of the present study may be beneficial for understanding the psychological effects of the Covid-19 pandemic on children from their own perspectives and may have implications for clinical practise regarding the support that should be offered to children. In psycho-social support interventions for children, it is of critical importance to address the anxiety that may arise from being intensely present and intertwined with their parents, as well as their sensitivity to separation and dependency.

 Children Covid-19 Drawing Anxiety Depression Psychosocial Influence Çalışma için herhangi bir destek alınmamıştır. Hui DS, Azhar E, Madani TA, Ntoumi F, Kock N, Dar O, Ippolito G, et al. The continuing 2019 novel coronavirus epidemic threat to global health—The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020; 91: 264-266. google scholar Centres for Disease Control and Prevention (CDC). Coronavirus disease 2019 (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19.html, 2023. google scholar Andrews HS, Herman JD, Gandhi RT. Treatments for COVID-19. Annu Rev Med. 2024; 75(1): 145-157. google scholar Qiu J, Shen B, Zhao M., Wang Z, Xie B, Yu Y. A nationwide survey of psychological distress among Chinese during the COVID-19 epidemic: Implications and policy recommendations. Gen Psychiatr. 2020; 33: 1-3. google scholar Hughes C. Some implications of COVID-19 and remote learning and the future of schooling. Current and Critical Issues in Curriculum, Learning and Assessment 2020; 36: 3-17. google scholar Saurabh K, Ranjan S. Compliance and psychological impact of quarantine in children and adolescents due to Covid-19 pandemic. Indian J Pediatr. 2020; 29: 1-5. google scholar Turkish Ministry of Health. COVID-19. The new coronavirus illness. https://cobi19bilgisaglik.gov.tr/tr/, 2020. google scholar Abukan B., Yıldırım F, Öztürk H. Being a Child in the Covid-19 pandemic: Social work requirements and recommendations according to developmental periods. Electronic Turkish Studies 2020; 15(6): 1-14. google scholar Phelps, C., Sperr, L. Children and the Covid-19 pandemic. Psychol Trauma. 2020; 12(S1): 73-75. google scholar Wolf K, Schmitz J. Scoping review: Longitudinal effects of COVID-19 on child and adolescent mental health. Eur Child Adolesc Psychiatry. 2024; 33(5): 1257-1312. google scholar Spinelli M, Lionetti F, Pastore M, Fasolo M. Parents’ stress and Children’s psychological problems in families facing the COVID-19 outbreak in Italy. Front Psychol. 2020; 11: 1713. google scholar Rothe J, Buse J, Uhlmann A, Bluschk A., Roessner V. Changes in emotions and worries during the Covid-19 pandemic: an online survey with children and adults with and without mental health conditions. Child Adolesc Psychiatry Ment Health. 2021; 15(1): 1-9. google scholar Tang S, Xiang M, Cheung T, Xiang YT. Mental health and its correlates with children and adolescents during COVID-19 school closure: The importance of parent-child discussion. J Affect Disord. 2021; 279: 353-360. google scholar Yang X, Chan KK. COVID-19 and stress related to schooling. In International and Life Course Aspects of COVID-19 (pp. 475-484). Academic Press, 2024. google scholar Jiao WY, Wang LN, Liu J, Fang SF, Jiao FY, Pettoello-Mantovani M, Somekh E. Behavioural and emotional disorders in children during the Covid-19 epidemic. J Pediatr 2020; 221: 264-266. google scholar Panda PK, Gupta J, Chowdhury SR, Kumar R, Meena AK, Madaan P, et al. Psychological and behavioural impact of lockdown and quarantine measures for COVID-19 on children, adolescents, and caregivers: a systematic review and meta-analysis. J Trop Pediatr. 2021; 67(1): 1-13. google scholar Raymond C, Provencher J, Bilodeau-Houle A, Leclerc J, Marin MF. A longitudinal investigation of psychological distress in children during Covid-19: the role of socio-emotional vulnerability. Eur J Psychotraumatol. 2022; 13(1): 2021048. google scholar Crescentini C, Feruglio S, Matiz A, Paschetto A, Vidal E, Cogo P, et al. Stuck outside and inside: an exploratory study of the effects of the COVİD-19-19 outbreak on Italian parents and Children’s internalising symptoms. Front. Psychol. 2020; 11: 1-14. google scholar Başaran M, Aksoy AB. Views of parents on their experiences during the Corona-Virus (Covid-19) pandemic. The Journal of International Social Research 2020; 13(71): 668-678. google scholar Chartier S, Delhalle M. Parental peritraumatic distress and feelings of parental competence in relation to Covid-19 lockdown measures: What is the impact on children’s peritraumatic distress?. Eur J Trauma Dissociation 2020; 5(2): 1-9. google scholar Lee SJ, Ward KP, Changg OD, Downing KM. Parenting activities and the transition to home-based education during the COVID-19 pandemic. Child Youth Serv Rev. 2021; 122: 1055-1085. google scholar Pfeerbaum B, North CS. Mental health and the COVID-19 pandemic. N Engl J Med. 2020; 383: 510-512. google scholar Winnicott DW. The maturation process and the facilitating environment. International University Press, 1962. google scholar Bion WR. Learning from experience. London: Karnac Books, 1962 google scholar Silverman MA. Capturing and comprehending Bion’s Ideas about the analyst’s container function: The need for containing states of mind. Psychoanal Q. 2011; 80(2): 475-491. google scholar Artut K. Art education in preschool. Ankara: Anı Publishing, 2007. google scholar Yavuzer H. Children’s drawings. Remzi Publishing, 2016. google scholar Yıldırım A, Şimşek H. Qualitative research methods in social sciences. Seçkin Publishing, 2021. google scholar Burns-Nader S. Examining children’s healthcare experiences through drawings. Early Child Dev Care 2017; 187(11): 1809-1818. google scholar Kim JK, & Suh JH. Children’s kinetic family drawings and their internalising problem behaviours. Arts Psychother. 2013; 40: 206-215. google scholar Bellak L, Sorel Bellak S. Children’s Apperception Test (C.A.T.). U.S.A.: C. P. S. Incorporated, 1980. google scholar Malchiodi CA. Understanding children’s drawings. New York: Guilford Publications; 1998. google scholar Köçkar Ç, Gürol A. Anxiety, aggression, and self-esteem analysis through pictures in children with cancer. Journal of F.N. Hem. 2013; 21(1): 33-39. google scholar Rollins JA. Tell me about it: drawing as a communication tool for children with cancer. J Pediatr Oncol Nurs. 2005; 22(4): 203-221. google scholar Erdem Atak İ, Beyazıt U, Taşçıoğlu G, Bütün Ayhan, A. A study on the psychological status of hospitalised children and their perceptions of hospital and sickness through drawings. Turkish Journal of Paediatric Disease 2019; 13(4): 283-291. google scholar Çelik FY. Examination of the relationship between the drawings of 9-12 years old children and variables of depression, anxiety, and self-respect. [Master’s thesis, University of Işık], 2018. google scholar Dolidze K, Smith E, Tchanturia K. A clinical tool for evaluating emotional well-being: Self-drawings of hospitalised children. J Pediatr Nurs. 2013; 28: 470-478. google scholar Savedra M, Gibbons P, Tesler M, Ward J, Wegner C. How do children describe pain? A tentative assessment. Pain 1982; 14(2): 95-104. google scholar Altan H, Çevik H, Doğru S, Coşgun A, Süren M, Okan İ. The pain colour of children with toothache in the Turkish population. BMC Oral Health 2019; 19(1): 1-8. google scholar Kortesluoma R, Punamaki R, Nikkonen M. Hospitalised children drawing their pain: contents and cognitive and emotional characteristics of pain drawings. J Child Health Care 2008; 12(4): 284-300. google scholar Beyazıt U, Bütün Ayhan A. Psychological characteristics of sick children and approach sick children. In The development and education of sick children (pp. 60-78). Eskişehir: Publications of Anadolu University, 2015. google scholar Tiryaki Ö, Zengin H, Çınar N. Reflection of Children’s Perceptions of the Covi-19 Pandemic on their Drawings. Ordu University Journal of Nursing Studies 2021; 4(3): 296-305. google scholar Stavridou A, Stergiopoulou AA, Panagouli E, Mesiris G, Thirios A, Mougiakos, T, et al. Psychosocial consequences of Covid-19 in children, adolescents and young adults: a systematic review. Psychiatry Clin Neurosci. 2020; 74(11): 615-616. google scholar Barnett B. You ought to: A psychoanalytic study of the superego and conscience. U.K.: Karnac Books, 2007. google scholar Rennison N. Freud and Psychoanalysis. U.S.A.: Trafalgar Square Publishing, 2015. google scholar Idoiaga Mondragon N, Eiguren Munitis A, Berasategi Sancho N, Picaza Gorrotxategi M, Dosil Santamaria M. How are children coping with the COVID-19 health crisis? Analysing their representations of lockdowns through drawings. Childhood 2022; 1-16. google scholar Duan L, Shao X, Wang Y, Huang Y, Miao J, Yang X, et al. An investigation of mental health status of children and adolescents in china during the outbreak of COVID-19. J Affect Disord. 2020; 275: 112-118. google scholar