The Draw-A-Person Test: An Indicator of Children's Cognitive and Socioemotional Adaptation?

Juvenile Delinquency in Kashmir: A Retrospective Analysis of Psychosocial Profiles

Background

India has a large population of children under 18, one-third of the total population. Jammu and Kashmir (J&K) has experienced an increase in juveniles in conflict with the law compared to the rest of the country. This study aimed to assess the socio-demographic profiles, psychosocial factors, and psychopathology of juveniles in conflict with the law in Kashmir who were referred to our institute for assessment.

Methods

A retrospective cross-sectional study assessed records from January 2022 to June 2024. Data related to the socio-demographic profile, psychosocial factors, psychiatric disorders, charged offenses, and psychological assessments (Draw a Picture Test [DAPT], Rorschach Inkblot Test [RIBT]) were extracted and analysed.

Results

The mean age of the subjects was 17.24 years, and all participants were male. A history of child labor was reported in 29.26% of the subjects, while 41.46% (N = 17) experienced familial neglect. Hyperactivity and impulsivity, consistent with ADHD (7.31%), were the most common psychiatric disorders, followed by depression (4.87%) and anxiety disorders (4.87%). In the DAPT, most subjects scored higher on inadequacy, followed by anxiety and social immaturity. In contrast, intact cognitive mediation and an avoidant style were more prevalent in the RIBT. The most common offenses were registered under the Unlawful Activities (Prevention) Act, followed by the Arms Act and the Protection of Children from Sexual Offenses (POCSO) Act.

Conclusion

Our study observed a link between juvenile delinquency and developmental, psychological, and social factors. Anxiety, hyperactivity, and peer influence were frequently reported among the cases analysed, highlighting areas requiring further exploration. The findings underscore the importance of addressing developmental and mental health conditions, as well as psychosocial factors, in juveniles in conflict with the law. Future research should explore targeted rehabilitation programs and longitudinal studies to establish causality. In limitation, this retrospective study used descriptive statistics, limiting the ability to infer causation.

Analysis of the screening and predicting characteristics of the house-tree-person drawing test for mental disorders: A systematic review and meta-analysis

BACKGROUND

The house-tree-person (HTP) drawing test has received growing attention from researchers as a common projective test. However, the methods used to select and interpret drawing indicators still lack uniformity.

OBJECTIVE

This study aims to integrate drawing indicators into the process of screening for or classifying mental disorders by conducting a systematic review and meta-analysis of the application of the HTP test.

METHODS

A search of the following electronic databases was performed in May 2022: PubMed, Web of Science, Embase, EBSCO, CNKI, VIP, and Wanfang. Screening and checking of the literature were performed independently by two researchers. The empirical studies published on the use of the HTP test in mental disorders and studies providing specific data on the occurrence frequency of drawing characteristics were analyzed. A total of 30 studies were included in the meta-analysis, including 665 independent effect sizes and 6,295 participants. The strength of the association between drawing characteristics of the HTP test and the prevalence of mental disorders was measured by the ratio (OR) with a 95% CI. Publication bias was assessed using a funnel plot, Rosenthal's fail-safe number (N fs), and the trim and fill method.

RESULTS

The results revealed 50 drawing characteristics that appeared at least three times in previous studies, of which 39 were able to significantly predict mental disorders. The HTP test can be divided into the following four dimensions: house, tree, person, and the whole. These dimensions reflect the structure, size, and other characteristics of the picture. The results showed that the greatest predictor of mental disorders was the whole (OR = 4.20, p < 0.001), followed by the house (OR = 3.95, p < 0.001), the tree (OR = 2.70, p < 0.001), and the person (OR = 2.16, p < 0.001). The valid predictors can be categorized into the following four types: item absence, bizarre or twisted, excessive details, and small or simplified. The subgroup analysis showed that the affective-specific indicators included no motion, leaning house, and decorated roof; thought-specific indicators included excessive separation among items, no window, loss of facial features, and inappropriate body proportions; and common indicators of mental disorders included no additional decoration, simplified drawing, very small house, two-dimensional house, and very small tree.

CONCLUSION

These findings can promote the standardization of the HTP test and provide a theoretical reference for the screening and clinical diagnosis of mental disorders.

Body knowledge in children with spina bifida

BACKGROUND

Patients with spina bifida suffer from motor paralysis and sensory disturbance, secondary deformation of the lower extremities, and development of decubitus ulcers. A deep understanding of one's body, such as identifying the names, functions, relationships, homology (e.g. upper and lower limbs) and relative position of body parts, may prevent secondary disorders. The awareness of the body and its characteristics in children with spina bifida has not been fully elucidated. This study aimed to investigate how children with spina bifida perceive their bodies, especially their paralyzed parts and related or homologous ones.

METHODS

Participants included 36 children with spina bifida and 14 control children, aged 5-11 years. They were asked to draw self-portraits, and to answer questions about the names of body parts. The number of drawn body parts in the pictures and the correct response rates to the questions were quantified and compared between children with spina bifida and control children.

RESULTS

Children with spina bifida drew fewer hands, legs, and feet than control children. In the verbal tests, children with spina bifida had a lower correct response rate than control children on questions concerning the upper limbs, hands, trunk, and feet.

CONCLUSIONS

Children with spina bifida have diminished visuospatial and lexical-semantic body knowledge of the paralyzed parts and related organs.

Body knowledge in children with congenital lower limb deficiency

BACKGROUND

In order to effectively improve motor function, a sound understanding of one's body - for example, relative spatial position, relationships, names and functions of body parts - is essential. The aim of this study was to explore how children with congenital lower limb deficiency (LLD) perceive their bodies, particularly their legs.

METHODS

Six children with congenital LLD and 14 controls, aged 5-12 years, were recruited for this study. They drew self-portraits and answered questions about names of body parts. These body part-related questions consisted of a production test, in which an examiner pointed to body parts on each child and asked the child to name them, and a comprehension test, in which the examiner mentioned body parts and asked the child to point to them on their own body.

RESULTS

No differences were found between the self-portraits of children with LLD and those of the control children. In the verbal tests, children with LLD responded correctly at lower rates to questions on body trunk, upper limbs, arms, hands and feet than the control children.

CONCLUSION

Children with LLD have diminished lexical-semantic body knowledge of the upper limbs and feet compared with children without LLD.

Cognitive and physical development in HIV-positive children in South Africa and Malawi: A community-based follow-up comparison study

BACKGROUND

Child development is negatively impacted by HIV with children that are infected and affected by HIV performing worse than their peers in cognitive assessments.

METHODS

We conducted a descriptive follow-up comparison study (n=989) in South Africa and Malawi. We tracked child development in 135 HIV-positive children compared to 854 uninfected children aged 4-13 years attending community-based organizations at baseline and again 12-15 months later.

RESULTS

Children with HIV were more often stunted (58.8% vs. 27.4%) and underweight (18.7% vs. 7.1%). They also had significantly poorer general physical functioning (M=93.37 vs. M=97.00). HIV-positive children scored significantly lower on digit span and the draw-a-person task.

CONCLUSIONS

These data clearly show that HIV infection poses a serious risk for child development and that there is a need for scaled up interventions. Community-based services may be ideally placed to accommodate such provision and deliver urgently needed support to these children.

What Does the DAP:IQ Measure?: Drawing Comparisons between Drawing Performance and Developmental Assessments

Human figure drawing tasks such as the Draw-a-Person test have long been used to assess intelligence (F. Goodenough, 1926). The authors investigate the skills tapped by drawing and the risk factors associated with poor drawing. Self-portraits of 345 preschool children were scored by raters trained in using the Draw-a-Person Intellectual Ability test (DAP:IQ) rubric (C. R. Reynolds & J. A. Hickman, 2004). Analyses of children's fine motor, gross motor, social, cognitive, and language skills revealed that only fine motor skill was an independent predictor of DAP:IQ scores. Being a boy and having a low birth weight were associated with lower DAP:IQ scores. These findings suggest that although the DAP:IQ may not be a valid measure of cognitive ability, it may be a useful screening tool for fine motor disturbances in at-risk children, such as boys who were born at low birth weights. Furthermore, researchers who use human figure drawing tasks to measure intelligence should measure fine motor skill in addition to intelligence.

The value of early and comprehensive diagnoses in a human fetus with hydrocephalus and progressive obliteration of the aqueduct of Sylvius: Case Report

Background

Mutant rodent models have highlighted the importance of the ventricular ependymal cells and the subcommissural organ (a brain gland secreting glycoproteins into the cerebrospinal fluid) in the development of fetal onset hydrocephalus. Evidence indicates that communicating and non-communicating hydrocephalus can be two sequential phases of a single pathological phenomenon triggered by ependymal disruption and/or abnormal function of the subcommissural organ. We have hypothesized that a similar phenomenon may occur in human cases with fetal onset hydrocephalus.

Case presentation

We report here on a case of human fetal communicating hydrocephalus with no central nervous system abnormalities other than stenosis of the aqueduct of Sylvius (SA) that became non-communicating hydrocephalus during the first postnatal week due to obliteration of the cerebral aqueduct. The case was followed closely by a team of basic and clinic investigators allowing an early diagnosis and prediction of the evolving pathophysiology. This information prompted neurosurgeons to perform a third ventriculostomy at postnatal day 14. The fetus was monitored by ultrasound, computerized axial tomography and magnetic resonance imaging (MRI). After birth, the follow up was by MRI, electroencephalography and neurological and neurocognitive assessments. Cerebrospinal fluid (CSF) collected at surgery showed abnormalities in the subcommissural organ proteins and the membrane proteins L1-neural cell adhesion molecule and aquaporin-4. The neurological and neurocognitive assessments at 3 and 6 years of age showed neurological impairments (epilepsy and cognitive deficits).

Conclusions

(1) In a hydrocephalic fetus, a stenosed SA can become obliterated at perinatal stages. (2) In the case reported, a close follow up of a communicating hydrocephalus detected in utero allowed a prompt postnatal surgery aiming to avoid as much brain damage as possible. (3) The clinical and pathological evolution of this patient supports the possibility that the progressive stenosis of the SA initiated during the embryonic period may have resulted from ependymal disruption of the cerebral aqueduct and dysfunction of the subcommissural organ. The analysis of subcommissural organ glycoproteins present in the CSF may be a valuable diagnostic tool for the pathogenesis of congenital hydrocephalus.

Perceptions of diabetes obtained through drawing in childhood and adolescence

OBJECTIVE

To examine whether drawing is useful in the detection of problems of psychosocial adaptation in children and adolescents with type 1 diabetes (T1D) and in improving communication with health professionals.

METHODS

We performed an exploratory descriptive study in 199 children and adolescents with T1D aged 4-13 years. The participants were asked to render a drawing on a suggested topic. The variables analyzed were related to the drawing and to clinical and sociodemographic data.

RESULTS

Most participants showed evidence of having a well-balanced personality, but there were also signs of affective or psychosocial difficulties.

CONCLUSION

Drawing is a useful technique by which to identify children's and adolescents' feelings and possible problems in adapting to T1D, as well as to gain information directly from the children themselves. Future studies should delimit the possibilities of this technique in clinical practice in greater detail.

Prospective Assessment of Scoliosis-Related Anxiety and Impression of Trunk Deformity in Female Adolescents Under Brace Treatment

The aim of this study is to make a prospective analysis of changes in anxiety levels and determining their associations with a longitudinal subjective assessment of trunk deformity in adolescent females with scoliosis, in relation to clinical, radiological and brace-related data. The study design was comprised of three questionnaire assessments, with the second and third evaluations taking place 6 and 12 months after the beginning of the study, respectively. 36 AIS females treated conservatively were asked to fill in the Polish versions of the Spinal Appearance Questionnaire (SAQ-pl) and the trait version of the Spielberger's Anxiety Inventory for Children (STAIC-trait). High anxiety was indicated in 16.6, 8.3 and 8.3% during the 1st, 2nd and 3rd evaluations. Patients' results differ in regards to the Curve domain; the discrepancies concern the 2nd and 3rd and the 1st and 3rd evaluations (p = 0.028 and p = 0.003, respectively). The only association between STAIC-trait and SAQ-pl regards Trunk shift in the 1st evaluation (rs = 0.48). The logistic regression revealed that the duration of brace-wearing in months has a statistically significant (p = 0.021) influence on the probability of diagnosing patients' low anxiety levels in the 2nd assessment. Special attention should be paid to patients' emotional reactions later on as brace-wearing continues as well as to the results which support the point that patients' perceptions of spinal deformity do not deteriorate with treatment time. Clinicians need to be aware how patients' appearance-specific cognitions might be associated with levels of emotional distress and relate to clinical and radiological, scoliosis-related data.

Drawings of very preterm-born children at 5 years of age: a first impression of cognitive and motor development?

INTRODUCTION

The aim of this study was to examine differences in drawing skills between very preterm and term children, and to determine whether very preterm children's cognitive and motor development is reflected in the draw-a-person test (DAP) at age 5. Seventy-two very preterm children (birth weight <1,500 g and/or gestational age <32 weeks) and 60 term children at 5 years of age were compared on the DAP. Cognitive and motor skills of the very preterm children had been assessed four times, at 1/2, 1, 2, and 5 years of age. Very preterm children showed a developmental delay in drawing ability. Structural equation modeling revealed a positive relation between both cognitive as well as motor development and the DAP.

CONCLUSION

The DAP could be a crude parameter for evaluating cognitive and motor deficits of very preterm children. A worrisome result should be followed by more standardized tests measuring cognitive and motor skills.

Standardized tests of handwriting readiness: a systematic review of the literature

AIM

To establish if there are psychometrically sound standardized tests or test items to assess handwriting readiness in 5- and 6-year-old children on the levels of occupations activities/tasks and performance.

METHOD

Electronic databases were searched to identify measurement instruments. Tests were included in a systematic review if: (1) participants are 5 and 6 years old, (2) the focus was on handwriting readiness, and (3) the measurement was standardized. In the second step a further electronic search was undertaken for selected relevant measurement instruments to evaluate the content, psychometric properties, and feasibility of these instruments.

RESULTS

The search identified 1113 citations. In the final selection 39 articles with information about 12 tests were included. The content, feasibility, and psychometric properties of these 12 tests were evaluated and none of the instruments was satisfactory, according to the specific criteria.

INTERPRETATION

None of the instruments include all necessary components to evaluate writing readiness. Therefore, the development of an all encompassing assessment is necessary to test handwriting readiness and to make tailored interventions possible.

The human figure drawing as related to attention-deficit hyperactivity disorder (ADHD)

To assess the reliability and validity of the human figure drawing test among children with attention-deficit hyperactivity disorder (ADHD) and/or learning disability, boys (n = 136) between the ages of 8 and 10 years, with either or both ADHD and learning disability, were included. Two drawings were used: person and house, tree and person. The drawings were analyzed using the Koppitz emotional and developmental scales. Conners teacher and parent rating scales and the Matching Familiar Figure Test were administered. High intertest reliability for the emotional scale and a significant negative correlation between the 2 scales were found. The reported anxiety and learning were significantly correlated with the cognitive score. A combination of cognitive and emotional items resulted in 67% correct classification of ADHD and learning disability. This test can be used as part of the assessment of ADHD/learning disability.

Neuropsychological outcome of children with intrauterine growth restriction: a 9-year prospective study

OBJECTIVE

The aim was to evaluate the effect of late-onset intrauterine growth restriction on the neuropsychological profile and on academic achievements at 9 years of age using a large-scale prospective paradigm.

STUDY DESIGN

We followed up 123 infants diagnosed with late-onset intrauterine growth restriction yearly for 9 years. They were matched with 63 children for gestation age and multiple socioeconomic factors and evaluated by an extensive neuropsychological battery to assess intelligence quotient, academic achievements, learning and memory, visuomotor skills, visuospatial integration, attention, language, executive functions, and creativity.

RESULTS

Children with intrauterine growth restriction had lower intelligence quotient and more frequent neuropsychological difficulties. Difficulties in executive functioning, inflexibility-creativity, and language, indicative of frontal lobe dysfunction, were typically affected by intrauterine growth restriction and were rarely identified in the control group. Learning difficulties accompanied by lower academic achievements were more prevalent in the intrauterine growth restriction group, particularly when anthropometric catch-up was incomplete.

CONCLUSIONS

The longitudinal findings reaffirm that functional coherence depends on preestablished structural growth and reorganization of the central nervous system. The neuropsychological profile at 9 years of age indicates that late-onset intrauterine growth restriction compromises frontal network functioning.