Kids’ Drawings—a different type of lab data 10/18/2021

Scientific psychological investigations of children’s drawing have been reported for well over 100 years and the extensive literature describes the utility of children’s graphic productions as tools in assessing general developmental parameters and in evaluating for various neurologic, cognitive and emotional issues.

While interpretation of the significance of such drawings, particularly in the arena of psychosocial or psychodynamic issues, can be subject to significant reviewer bias and needs to be done with a degree of caution, the relative ease of obtaining a drawing from a child or youth, even in a busy pediatric setting, can make it a useful tool to engage with them and, at times, to obtain clues regarding both their strengths and vulnerabilities.

Human figure drawings, elicited by a request to “Draw-a-Person/Man/Woman/Yourself” were first rigorously studied by Goodenough in the 1920’s who developed a scoring system that was reliable in assessing a young child’s intellectual development, with the number of features and the complexity of the drawing being closely aligned with the child’s developmental age.   Later investigators expanded on the use of these drawings to screen for other more focal neurological and/or cognitive handicaps.

Human figure drawings have also received attention as tools for assessing psychological and emotional issues.  Though less amenable to quantification and statistical verification, such projective evaluations across the lifespan have garnered recognition as adjunctive tools in both diagnostic and therapeutic endeavors.  Assessed within the context of other relevant clinical data, children’s figure drawings can provide an indication of the youth’s emotional status, self-concept, coping style, anxieties and wishes.

Various other techniques—e.g., a request for a drawing of the family and spontaneous drawings may be revealing of a child/adolescent’s experience of their family dynamics and of their emotional conflicts and/or trauma experience.

Beyond their potential value in screening and in contributing to a diagnostic understanding, drawings can be use therapeutically with youth and with their parents to demonstrate areas of concern that may need more formal intervention.  Just as laboratory findings of concern may be shared with the family, drawings can also be shown and discussed with both the youth and with their parents to highlight the presence of potential problems.

Three examples associated with the following clinical vignettes are accessible at the following link:  http://www.smartcarebhcs.org/wp-content/uploads/2021/10/Kids-Drawing-a-different-kind-of-lab-data.pdf

  • Maurice: 10 yo lad with recent diagnosis of a seizure disorder, academic difficulties and behavioral problems.   The mother and the pediatric resident were concerned that recently prescribed seizure meds may have triggered behavior problems.  Maurice’s drawings were developmentally immature, with minimal detailing and form, disproportionality of body parts and demonstrates his difficulty in drawing a hat.   When shown to the mother, she became aware of his underlying developmental, cognitive and visual-motor learning disability status and was able to shift her focus from seeing him as “bad” and was able to shift her focus to seeking needed services from his school and the regional disability agency.
  • Stephanie: This 8 yo, who had recently been medically hospitalized for abdominal pains, vomiting and headaches, drew a poignant family picture of a “little girl crying” because the “man who used to love her had found another girlfriend”.  The picture is filled with various indicators of distress in the young girl (tears, upraised helpless arms, genital shading), the father (stub like hands, he is turned away from the girl and declares his love of the woman) and the adult female (no arms)— all of this, not surprisingly, suggestive of extreme family conflict (not previously revealed to the pediatrician) which, in fact, was the case, as both abuse by the father and periods of maternal abandonment were subsequently revealed.
  • Anthony: Age 12, Anthony had been medically hospitalized three times in the past 18 months with recurrent leg pains which had engendered extensive and intrusive, but negative, work ups.  His multiple drawings showed pictures of himself in positions of imbalance and/or with obvious distortion of his body (no legs and with a malformed upper torso with an unformed left arm).  A referral for psychotherapy was suggested.

While most children will draw age-appropriate and normative pictures when offered the opportunity, and even youth with major traumas or significant biopsychosocial challenges may do likewise, but creating opportunities for non-verbal communication during a health care visit can be a vehicle to obtain “lab data of a different sort” that may prove of value as a screening tool for areas of concern.

References:

Goodenough & Harris (1950) “Studies in the Psychology of Children’s Drawings”, Psychol. Bull., #47: 369-433.

DiLeo (1973), “Children’s Drawings as Diagnostic Aids”, Brunner & Mazel

Silver (1950), “Diagnostic Value of Three Drawing Tests for Children”, J. Pediat., 37, 129-143

Chenven (1978), “Diagnostic, Therapeutic and Teaching Potentials of Children’s Drawing Techniques in Child Psychiatric Consultation”, Presentation AACAP Annual Meeting, 1978

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