Drawings
Children's drawings drawings may be interpreted in a variety of ways. Testssuch as the Bender-Gestalt and the House-Tree-Person provide informationabout perceptual-motor abilities and developmental level and can be usefulfor this purpose. But children's drawings are also used to assess possiblesexual abuse (Conte et al., 1991; Kendall-Tackett, 1992). This latter uselacks empirical support.
The assumption underlying this use is that, since emotionally disturbedchildren are believed to reflect their problems in their drawings (e.g.,Di Leo, 1973; 1996; Handler, 1996; Koppitz, 1968; Myers, 1978; Yates, Beutler,& Crago, 1985), the drawings of children who have been abused will differfrom those of nonabused children. Free drawings, as well as the as the House-Tree-Person,Draw-A-Person, and Kinetic Family Drawings are used and qualitative featuresof the drawings, such as the colors used, the size and detail of body parts,and the shape of the figures may be interpreted in terms of the presenceor absence of sexual abuse.
Burgess, McCausland and Wolbert (1981) claim that drawings in which a childexhibits a shift from age-appropriate figures to more disorganized objectsor drawings with repeated stylized, sexualized figures indicate suspectedsexual abuse. Sahd (1980) recommends using drawings as part of the evaluativeinterview of the sexual abuse victims and gives several examples of drawingsthat reflect abuse histories. Kelley (1984, 1985) believes that human figuredrawings can be analyzed for "emotional indicators" (signs) inyoung children who are unable to verbalize their trauma.
Cantlay (1996) claims that distress and trauma, including sexual abuse,is reflected in drawings that include such signs as large heads, large,empty eyes, abundant hair, shaded clouds, knotholes in trees, large hands,large heads, large pointed teeth, abnormally tiny eyes, eyes without pupils,crossed eyes, excessive details, box-shaped bodies, poorly integrated bodyparts, lack of gender differentiation, hair that is long at the sides orthinning at the crown, wedge-shaped windows, extraneous circles, and largesmoke trails coming out of the chimney. She cautions, however, that traumacan only be determined from a series of drawings which contain a numberof these signs and that a single characteristic is not enough to indicateabuse.
The presence of genitalia is often considered a sign of sexual abuse becauseit is considered rare for normal, nonabused children to include genitalsin their drawings (Di Leo, 1973, 1996). Cantlay (1996), Hibbard, Roghmann,and Hoekelman (1987), and Kelley (1984, 1985) claim that the presence ofgenitalia in drawings means possible sexual abuse, Yates et al. (1985) believethat incest victims either exaggerate or minimize sexual features in theirdrawings and Miller, Veltkamp, and Janson (1987) state that sexualized drawingsindicate sexual knowledge beyond a child's years.
Empirical support for all these claims is extremely weak. In addition, amajor difficulty with these assumptions is that sexually abused childrenare likely to have been interviewed about sexual abuse, have perhaps undergonea distressing genital examination, and/or have been placed into sexual abusetherapy. They are likely to have been shown undressed anatomical dolls wheretheir attention is focused on the genitals. They may have been asked repeatedlyto describe the details of the abuse. Therefore, genitalia may well becomesalient and it is not surprising that some of these children will includegenitals in their drawings. In addition, other factors, such as family nudity,the birth of a sibling, or viewing an X-rated video may affect the tendencyof a child to include sexual details in a drawing.
We have seen many examples of drawings by children that are erroneouslyinterpreted as bolstering a conclusion of sexual abuse: For instance:
· A 4-year-old girl drew nothing but circles which shecalled "caves." One of the drawings looked to the psychologistlike male genitalia-when asked what it was, the child said it was "aball rolling into a lion's cave." The psychologist said this meantthe child has been subjected to some type of traumatic experience. But whenwe saw evaluated the child, now age 5, we found that she was of borderlineintelligence and could not do any kind of drawing task. All she could dowas make scribbled circles.
· The child, when asked to draw a tree, also drew a cactus (Figure2). This was interpreted in terms of "unconscious expression of dangerand fearfulness." However, the child was not asked if she had a cactusin her yard (this was in Texas).
· The 7-year-old girl drew a picture of herself and her sister withtheir hands up in the air with the father standing next to them and smiling(Figure 3). She told the psychologist that she and her sister were "cheeringat a show." But the psychologist claimed that this really signifieda "helpless posture." She saw it as significant that there wereno fingers drawn on the hands and that the hands were large on the father sheclaimed that abused children put large hands on the drawings of their perpetrators.She also said that the thick lines in the crotch in the picture of the fathermeant an emphasis on genitals, was probably a penis, and showed anxietyabout the father. She concluded that the girl, who continued to deny allegationsof sexual abuse by the father, had, in fact, been sexually abused by thehim.
· Hundreds of drawings over two years were interpreted by a psychologistwho saw two girls in a day care case with allegations of ritualistic satanicabuse complete with costumes, masks, dead animals, sacrificed babies, blood,feces, skeletons, and monsters. These allegations only surfaced during therapy.The psychologist depended heavily upon the children's drawings in formingconclusions about satanic ritual abuse. But all of the drawings were typicalof the types of scribbles and rudimentary figures drawn by 3- and 4-year-olds.In her deposition the psychologist said that what she believed was significantincluded practically every characteristic she believed she saw in the drawings:
Shapes that are untypical for 3- and 4-year-old children
Shapes that are phallic symbols.
Jiggly lines that indicate anxiety
Straight mouths that mean people can't say anything.
Jagged mouths that mean anxiety.
A mouth that is open and oval shaped
Darkened eyes
Eyeballs that are scribbled around
Eyes that are two different colors
Drawing something and then covering it up
Drawings something and not talking about it
Colors are very important and significant:
Black means the child is frightened or distressed; black is a morbid downcolor
Red means angry, unless the child is drawing a pretty red flower, when itis healthy
If everything is the picture is red or red and black, this is very suspicious.
Blue, brown, and orange mean fear, anger, and depression
Pink, red, and green are healthy colors
There are no empirical data to support these types of interpretations.Despite their frequent use in child abuse investigations, drawings are subjectto the same criticisms as the anatomical dolls (Underwager & Wakefield,1990; Wakefield & Underwager, 1988, 1989, 1994). Interpretations ofdrawings lack validity and reliability as projective assessment devices.In a review of the Draw-A-Person test in the Seventh Mental MeasurementsYearbook, Harris (1972) states that there is little evidence for theuse of "signs" as valid indicators of personality characteristics.In fact, there is so much variability from drawing to drawing that particularfeatures of any one drawing are too unreliable to say anything about them.Reviews by Cundick (1989) and Weinberg (1989) in the Tenth Mental MeasurementsYearbook note that there are no normative data establishing reliabilityand validity of the Kinetic Drawing System. Smith and Dumont (1995) statethat four decades of research have failed to support the validity of humanfigure drawings in assessing personality, behavior, or intelligence. Theyobserve that the confirmatory biases expressed in anchoring errors predisposeclinicians to find support for their initial opinions in whatever materialthe client provides.
There are serious methodological problems with the few studies that claimto find differences between sexually abused and nonabused children. As withthe anatomical dolls, studies with drawings with children suspected of beingabused would have to take place before children underwent physical examinations,interviews, or therapy since these could affect their drawings. The personswho rated the drawings would have to be blind concerning the child's statusregarding abuse. Ideally, a study would involve children who were all suspectedof being abused who, based on subsequent evidence, could be divided intothose who have and have not been abused. None of the studies meet thesecriteria.
Another common drawing technique is an outline of the back and the frontof a naked male or a female. These cards are ostensibly used to enable theinterviewer to learn what terms the child uses for body parts. However,this suggests that the purpose of the interview is to talk about sexualmatters. The interviewer also may also tell the child to put an X wherehe or she was touched, which gives the message, "You were touched,now show me where." A recent New Zealand research report questionswhether this constitutes a prompt or priming technique and states that drawingsincreased errors and confabulation in children's accounts (Rawls, 1996).
Nevertheless, drawings may be useful evaluation aids. They can provide informationabout possible perceptual-motor difficulties and developmental delays. Theycan help build rapport and encourage narrative accounts. Goodwin (1982)had children complete the Draw-A-Person task and the Kinetic Family Drawingand also asked them to draw whatever they wanted, to draw the whole familydoing something together, and then to draw a picture of the alleged perpetrator.She reports that drawings were helpful in understanding the child's fearsand anxieties, her view of the family, and her self-image, and in openingup a workable line of communication between the evaluator and the child.She cautions, however, that by themselves drawings are not sufficient toform diagnostic conclusions. Miller et al. (1987) report that, once a childhas drawn a picture, he or she becomes highly verbal regarding the contentsof the drawing. They believe that drawings are less threatening to a childwho is hesitant to talk.
But drawings must not be used suggestively or the child's description ofthe drawing selectively reinforced. It inappropriate to tell a child whohas not mentioned anything about abuse to "draw me a picture of whatdaddy did to you." Any useful information about possible abuse willcome from the child's explanations of the drawing and spontaneous narrativesthat this elicits. Details and signs in the drawings itself cannot be projectivelyinterpreted. Drawings may be valuable in building rapport and in facilitatingcommunication but they cannot be used in the absence of a description fromthe child to draw conclusions about abuse.
