CHILDREN`S DRAWINGS AS A TRIAGE TOOL FOR THE ASSESSMENT OF NEGATIVE EMOTIONALITY IN REFUGEE CHILDREN
DOI:
https://doi.org/10.19090/pp.2019.3.245-262Keywords:
drawings, expressive strategies, refugee children, trauma indicatorsAbstract
The study sought to examine the possible indirect trauma indica- tors among refugee children’s drawings. We have analyzed draw- ings of refugee children and non-refugee children as controls (5 - 9 years old). The content and Pickard’s expressive strategies for mood depiction were analyzed on 464 drawings. The content analysis revealed different content-specific categories across groups, with the category of Violence/War appearing significantly more in the drawings of the refugee group. and being used as one of the trauma indicators. The analysis revealed that negative mood was depicted by more complex and detailed drawings in both groups. An expressive strategy, namely the literal strategy, appeared to be specific to the refugee group only (e.g., absence of facial characteristics), while different patterns of non-literal ex- pressive strategies were observed in conveying mood between the two groups. Our findings suggest that the drawings can be used as a triage tool to assess the emotional status of refugee children.
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References
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Biro, M. (2017). Problems that refugees bring and problems they will face– the experiences of psychologists on the “Balkan Route”. In T. Varady (Ed.), Migrants in 21st Century Europe (pp. 217–228). Novi Sad: SANU.
Buckalew, L. W., & Bell, A. (1985). Effects of colors on mood in the drawings of young children. Perceptual and Motor Skills, 61, 689–690. doi:10.2466/ pms.1985.61.3.689
Burkitt, E., Barrett, M., & Davis, A. (2003). The effect of affective characterization on the size of children’s drawings. British Journal of Developmental Psychology, 21, 565–584. doi:10.1348/026151003322535228
Cox, M. (2005). The pictorial world of the child. Cambridge: Cambridge University Press.
Dana, R. H. (2001). Clinical diagnosis of multicultural populations in the United States. In L. A. Suzuki, J. G. Ponterotto, & P. G. Meller (Eds.), Handbook of Multicultural Assessment: Clinical, Psychological, and Educational Applications (pp. 101–131). San Francisco: Jossey-Bass.
Draguns, J. G. (1977). Problems of defining and comparing abnormal behavior in cross-cultural research. Annals of the New York Academy of Science, 285, 664–675. doi:10.1111/j.1749-6632.1977.tb29389.x
Farokhi, M., & Hashemi, M. (2011). The analysis of children’s drawings: social, emotional, physical, and psychological aspects. Procedia-Social and Behavioral Sciences, 30, 2219–2224. doi:10.1016/j.sbspro.2011.10.433
Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet, 365, 1309–1314. doi:10.1016/s0140-6736(05)61027-6
Garbarino, J., & Kostelny, K. (1996). The effects of political violence on Palestinian children’s behavior problems: a risk accumulation model. Child Development, 67, 33–45. doi:10.1111/j.1467-8624.1996.tb01717.x
Goldman, R. K., & Warren, D. (1976). Preliminary analyses of human figure drawings as a kindergarten screening measure. Perceptual and Motor Skills, 43, 58–68. doi:10.2466/pms.1976.43.1.58
Golomb, C. (1992). The child ‘s creation of a pictorial world. Berkeley: University of California Press. doi:10.4324/9781410609250
Gross, J., & Hayne, H. (1998). Drawing facilitates children’s verbal reports of emotionally laden events. Journal of Experimental Psychology: Applied, 4, 163– 179. doi:10.1037//1076-898x.4.2.163
Hassan, G., Ventevogel, P., Jefee-Bahloul, H., Barkil-Oteo, A., & Kirmayer, L. J. (2016). Mental health and psychosocial wellbeing of Syrians affected by armed conflict. Epidemiology and Psychiatric Sciences, 25, 129–141. doi:10.1017/ s2045796016000044
Hollifield, M., Warner, T., Lian, N., Krakow, B., Jenkins, J., Kesler, J., & Westermeyer, J. (2002). Measuring trauma and health status in refugees: A critical review. The Journal of the American Medical Association, 288, 611–621. doi:10.1001/ jama.288.5.611
Jolley, R. R. (2010). Children and pictures: Drawing and understanding. West Sussex: Wiley-Blackwell.
Jolley, R. P., Fenn, K., & Jones, L. (2004). The development of children’s expressive drawings. British Journal of Developmental Psychology, 22, 545–567. doi:10.1348/0261510042378236
Jolley, R. P., & Thomas, G. V. (1994). The development of sensitivity to metaphorical expression of moods in abstract art. Educational Psychology, 14, 437–450. doi:10.1080/0144341940140406
Jolley, R. P., & Thomas, G. V. (1995). Children’s sensitivity to metaphorical expression of mood in line drawings. British Journal of Developmental Psychology, 13, 335–346. doi:10.1111/j.2044-835x.1995.tb00684.x
Kazour, F., Zahreddine, N. R., Maragel, M. G., Almustafa, M. A., Soufia, M., Haddad, R., & Richa, S. (2017). Post-traumatic stress disorder in a sample of Syrian refugees in Lebanon. Comprehensive Psychiatry, 72, 41–47. doi:10.1016/j. comppsych.2016.09.007
Kleinman, A. (1981). Patients and Healers in the Context of Culture: Exploring the Borderland Between Anthropology, Medicine and Psychiatry. Berkeley: University of California Press.
Klepsch, M., & Logie, L. (2014). Children draw and tell: An introduction to the projective uses of children’s human figure drawing. London: Routledge.
Koppitz, E. M. (1968). Emotional indicators on human figure drawings of shy and aggressive children. Journal of Clinical Psychology, 22, 466–469. doi:10.1002/1097-4679(196610)22:4<466::aid-jclp2270220430>3.0.co;2-i
Leaning, J. (2001). Ethics of research in refugee populations. Lancet, 357, 1432–1433. doi:10.1016/s0140-6736(00)04572-4
Leibowitz, M. (2013). Interpreting projective drawings: A self-psychological approach. London: Routledge. doi:10.4324/9780203777992
Lindert, J., & von Ehrenstein, O. (2018). Anxiety, depression and post-traumatic stress disorder among refugees-a systematic review. The European Journal of Public Health, 28, 48–091. doi:10.1093/eurpub/cky048.091
Lumley, M., Katsikitis, M., & Statham, D. (2018). Depression, Anxiety, and Acculturative Stress Among Resettled Bhutanese Refugees in Australia. Journal of Cross-Cultural Psychology, 49, 1269–1282. doi:10.1177/0022022118786458 Lustig, S. L., Kia-Keating, M., Knight, W. G., Geltman, P., Ellis, H., Kinzie, J. D., … & Saxe, G. N. (2004). Review of child and adolescent refugee mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 24–36. doi:10.1097/00004583-200401000-00012
Malchiodi, C. (1998). Understanding children’s drawings. London: Jessica Kingsley. McElroy, T., Muyinda, H., Atim, S., Spittal, P., & Backman, C. (2012). War, displacement and productive occupations in northern Uganda. Journal of Occupational Science, 19, 198–212. doi:10.1080/14427591.2011.614681
Minihan, S., Liddell, B. J., Byrow, Y., Bryant, R. A., & Nickerson, A. (2018). Patterns and predictors of posttraumatic stress disorder in refugees: A latent class analysis. Journal of Affective Disorders, 232, 252–259. doi:10.1016/j. jad.2018.02.010
Misalidi, P., & Bonoti, F. (2014). Children’s expressive drawing strategies: the effects of mood, age and topic. Early Child Development and Care, 184, 882–896. doi:10.1080/03004430.2013.823409
Palic, S., Kappel, M. L., Nielsen, M. S., Carlsson, J., & Bech, P. (2014). Comparison of psychiatric disability on the health of nation outcome scales (HoNOS) in resettled traumatized refugee outpatients and Danish inpatients. BMC psychiatry, 14, Article 330. doi:10.1186/s12888-014-0330-8
Parsons, M. J. (1987). How we understand art: A cognitive developmental account of aesthetic experience. Cambridge: Cambridge University Press.
Pernice, R. (1994). Methodological issues in research with refugees and immigrants. Professional Psychology: Research and Practice, 25, 207–213. doi:10.1037//0735-7028.25.3.207
Picard, D., & Gauthier, C. (2012). The development of expressive drawing abilities during childhood and into adolescence. Child Development Research, Article ID 925036. doi:10.1155/2012/925063
Picard, D., Brechet, C., & Baldy, R. (2007). Expressive Strategies in Drawing are Related to Age and Topic. Journal of Nonverbal Behaviour, 31, 243–257. doi:10.1007/s10919-007-0035-5
Quosh, C., Eloul, L., & Ajlani, R. (2013). Mental health of refugees and displaced persons in Syria and surrounding countries: a systematic review. Intervention, 11, 276–294. doi:10.1097/wtf.0000000000000013
Rhema, S. H., Gray, A., Verbillis-Kolp, S., Farmer, B., & Hollifield, M. (2014). Mental health screening. In A. Annamalai (Ed.), Refugee health care: An essential medical guide (pp. 163–171). New York, NY: Springer Science and Business Media. doi:10.1007/978-1-4939-0271-2_12
Rose, S. E., Jolley, R. P., & Charman, A. (2012). An investigation of the expressive and representational drawing development in National Curriculum, Steiner and Montessori schools. Psychology of Aesthetics, Creativity and the Arts, 6, 85–93. doi:10.1037/a0024460
Sack, W. H., Clarke, G.N., & Seeley, J. (1996). Multiple forms of stress in Cambodian adolescent refugees. Child Development, 67, 107–116. doi:10.2307/1131689 Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & Van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. The Journal of the American Medical Association, 302, 537–549. doi:10.1001/jama.2009.1132
Steele, W., & Kuban, C. (2013). Working with grieving and traumatized children and adolescents: Discovering what matters most through evidence-based, sensory interventions. New York: John Wiley & Sons.
Teodorescu, D. S., Heir, T., Hauff, E., Wentzel-Larsen, T., & Lien, L. (2012). Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway. Scandinavian Journal of Psychology, 53, 316–332. doi:10.1111/j.1467-9450.2012.00954.x
UNHCR (2014). The Future of Syria: Refugee Children in Crisis. Geneva: UNHCR.
UNHCR (2015). Mediterranean Sea arrivals - 2015. Data by location, country of arrival, demographic and country of origin. Retrieved from http://data.unhcr. org/ mediterranean/download.php?id=490
UNHCR (2016). Serbia Inter-agency Operational Update: April 2017 (with monthly figures). Retrieved from http://data.unhcr.org/mediterranean/regional.php
Vane, J. R., & Eisen, V. W. (1962). The Goodenough Draw-a-Man test and signs of maladjustment in kindergarten children. Journal of Clinical Psychology, 18, 276–279. doi:10.1002/1097-4679(196207)18:3<276:aid-jclp2270180308>3.0.co;2-b
Vukcevic, M., Dobric, J., & Puric, D. (2014). Psychological Characteristics of Asylum seekers from Syria, in Survey of the Mental Health of Asylum seekers in Serbia. Belgrade: UNHCR. Retrieved from http://www.unhcr.rs/media/Mental-HealthFinal.pdf
Weber, R. P. (1990). Basic content analysis. London: Sage.
Biro, M. (2017). Problems that refugees bring and problems they will face– the experiences of psychologists on the “Balkan Route”. In T. Varady (Ed.), Migrants in 21st Century Europe (pp. 217–228). Novi Sad: SANU.
Buckalew, L. W., & Bell, A. (1985). Effects of colors on mood in the drawings of young children. Perceptual and Motor Skills, 61, 689–690. doi:10.2466/ pms.1985.61.3.689
Burkitt, E., Barrett, M., & Davis, A. (2003). The effect of affective characterization on the size of children’s drawings. British Journal of Developmental Psychology, 21, 565–584. doi:10.1348/026151003322535228
Cox, M. (2005). The pictorial world of the child. Cambridge: Cambridge University Press.
Dana, R. H. (2001). Clinical diagnosis of multicultural populations in the United States. In L. A. Suzuki, J. G. Ponterotto, & P. G. Meller (Eds.), Handbook of Multicultural Assessment: Clinical, Psychological, and Educational Applications (pp. 101–131). San Francisco: Jossey-Bass.
Draguns, J. G. (1977). Problems of defining and comparing abnormal behavior in cross-cultural research. Annals of the New York Academy of Science, 285, 664–675. doi:10.1111/j.1749-6632.1977.tb29389.x
Farokhi, M., & Hashemi, M. (2011). The analysis of children’s drawings: social, emotional, physical, and psychological aspects. Procedia-Social and Behavioral Sciences, 30, 2219–2224. doi:10.1016/j.sbspro.2011.10.433
Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet, 365, 1309–1314. doi:10.1016/s0140-6736(05)61027-6
Garbarino, J., & Kostelny, K. (1996). The effects of political violence on Palestinian children’s behavior problems: a risk accumulation model. Child Development, 67, 33–45. doi:10.1111/j.1467-8624.1996.tb01717.x
Goldman, R. K., & Warren, D. (1976). Preliminary analyses of human figure drawings as a kindergarten screening measure. Perceptual and Motor Skills, 43, 58–68. doi:10.2466/pms.1976.43.1.58
Golomb, C. (1992). The child ‘s creation of a pictorial world. Berkeley: University of California Press. doi:10.4324/9781410609250
Gross, J., & Hayne, H. (1998). Drawing facilitates children’s verbal reports of emotionally laden events. Journal of Experimental Psychology: Applied, 4, 163– 179. doi:10.1037//1076-898x.4.2.163
Hassan, G., Ventevogel, P., Jefee-Bahloul, H., Barkil-Oteo, A., & Kirmayer, L. J. (2016). Mental health and psychosocial wellbeing of Syrians affected by armed conflict. Epidemiology and Psychiatric Sciences, 25, 129–141. doi:10.1017/ s2045796016000044
Hollifield, M., Warner, T., Lian, N., Krakow, B., Jenkins, J., Kesler, J., & Westermeyer, J. (2002). Measuring trauma and health status in refugees: A critical review. The Journal of the American Medical Association, 288, 611–621. doi:10.1001/ jama.288.5.611
Jolley, R. R. (2010). Children and pictures: Drawing and understanding. West Sussex: Wiley-Blackwell.
Jolley, R. P., Fenn, K., & Jones, L. (2004). The development of children’s expressive drawings. British Journal of Developmental Psychology, 22, 545–567. doi:10.1348/0261510042378236
Jolley, R. P., & Thomas, G. V. (1994). The development of sensitivity to metaphorical expression of moods in abstract art. Educational Psychology, 14, 437–450. doi:10.1080/0144341940140406
Jolley, R. P., & Thomas, G. V. (1995). Children’s sensitivity to metaphorical expression of mood in line drawings. British Journal of Developmental Psychology, 13, 335–346. doi:10.1111/j.2044-835x.1995.tb00684.x
Kazour, F., Zahreddine, N. R., Maragel, M. G., Almustafa, M. A., Soufia, M., Haddad, R., & Richa, S. (2017). Post-traumatic stress disorder in a sample of Syrian refugees in Lebanon. Comprehensive Psychiatry, 72, 41–47. doi:10.1016/j. comppsych.2016.09.007
Kleinman, A. (1981). Patients and Healers in the Context of Culture: Exploring the Borderland Between Anthropology, Medicine and Psychiatry. Berkeley: University of California Press.
Klepsch, M., & Logie, L. (2014). Children draw and tell: An introduction to the projective uses of children’s human figure drawing. London: Routledge.
Koppitz, E. M. (1968). Emotional indicators on human figure drawings of shy and aggressive children. Journal of Clinical Psychology, 22, 466–469. doi:10.1002/1097-4679(196610)22:4<466::aid-jclp2270220430>3.0.co;2-i
Leaning, J. (2001). Ethics of research in refugee populations. Lancet, 357, 1432–1433. doi:10.1016/s0140-6736(00)04572-4
Leibowitz, M. (2013). Interpreting projective drawings: A self-psychological approach. London: Routledge. doi:10.4324/9780203777992
Lindert, J., & von Ehrenstein, O. (2018). Anxiety, depression and post-traumatic stress disorder among refugees-a systematic review. The European Journal of Public Health, 28, 48–091. doi:10.1093/eurpub/cky048.091
Lumley, M., Katsikitis, M., & Statham, D. (2018). Depression, Anxiety, and Acculturative Stress Among Resettled Bhutanese Refugees in Australia. Journal of Cross-Cultural Psychology, 49, 1269–1282. doi:10.1177/0022022118786458 Lustig, S. L., Kia-Keating, M., Knight, W. G., Geltman, P., Ellis, H., Kinzie, J. D., … & Saxe, G. N. (2004). Review of child and adolescent refugee mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 24–36. doi:10.1097/00004583-200401000-00012
Malchiodi, C. (1998). Understanding children’s drawings. London: Jessica Kingsley. McElroy, T., Muyinda, H., Atim, S., Spittal, P., & Backman, C. (2012). War, displacement and productive occupations in northern Uganda. Journal of Occupational Science, 19, 198–212. doi:10.1080/14427591.2011.614681
Minihan, S., Liddell, B. J., Byrow, Y., Bryant, R. A., & Nickerson, A. (2018). Patterns and predictors of posttraumatic stress disorder in refugees: A latent class analysis. Journal of Affective Disorders, 232, 252–259. doi:10.1016/j. jad.2018.02.010
Misalidi, P., & Bonoti, F. (2014). Children’s expressive drawing strategies: the effects of mood, age and topic. Early Child Development and Care, 184, 882–896. doi:10.1080/03004430.2013.823409
Palic, S., Kappel, M. L., Nielsen, M. S., Carlsson, J., & Bech, P. (2014). Comparison of psychiatric disability on the health of nation outcome scales (HoNOS) in resettled traumatized refugee outpatients and Danish inpatients. BMC psychiatry, 14, Article 330. doi:10.1186/s12888-014-0330-8
Parsons, M. J. (1987). How we understand art: A cognitive developmental account of aesthetic experience. Cambridge: Cambridge University Press.
Pernice, R. (1994). Methodological issues in research with refugees and immigrants. Professional Psychology: Research and Practice, 25, 207–213. doi:10.1037//0735-7028.25.3.207
Picard, D., & Gauthier, C. (2012). The development of expressive drawing abilities during childhood and into adolescence. Child Development Research, Article ID 925036. doi:10.1155/2012/925063
Picard, D., Brechet, C., & Baldy, R. (2007). Expressive Strategies in Drawing are Related to Age and Topic. Journal of Nonverbal Behaviour, 31, 243–257. doi:10.1007/s10919-007-0035-5
Quosh, C., Eloul, L., & Ajlani, R. (2013). Mental health of refugees and displaced persons in Syria and surrounding countries: a systematic review. Intervention, 11, 276–294. doi:10.1097/wtf.0000000000000013
Rhema, S. H., Gray, A., Verbillis-Kolp, S., Farmer, B., & Hollifield, M. (2014). Mental health screening. In A. Annamalai (Ed.), Refugee health care: An essential medical guide (pp. 163–171). New York, NY: Springer Science and Business Media. doi:10.1007/978-1-4939-0271-2_12
Rose, S. E., Jolley, R. P., & Charman, A. (2012). An investigation of the expressive and representational drawing development in National Curriculum, Steiner and Montessori schools. Psychology of Aesthetics, Creativity and the Arts, 6, 85–93. doi:10.1037/a0024460
Sack, W. H., Clarke, G.N., & Seeley, J. (1996). Multiple forms of stress in Cambodian adolescent refugees. Child Development, 67, 107–116. doi:10.2307/1131689 Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & Van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. The Journal of the American Medical Association, 302, 537–549. doi:10.1001/jama.2009.1132
Steele, W., & Kuban, C. (2013). Working with grieving and traumatized children and adolescents: Discovering what matters most through evidence-based, sensory interventions. New York: John Wiley & Sons.
Teodorescu, D. S., Heir, T., Hauff, E., Wentzel-Larsen, T., & Lien, L. (2012). Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway. Scandinavian Journal of Psychology, 53, 316–332. doi:10.1111/j.1467-9450.2012.00954.x
UNHCR (2014). The Future of Syria: Refugee Children in Crisis. Geneva: UNHCR.
UNHCR (2015). Mediterranean Sea arrivals - 2015. Data by location, country of arrival, demographic and country of origin. Retrieved from http://data.unhcr. org/ mediterranean/download.php?id=490
UNHCR (2016). Serbia Inter-agency Operational Update: April 2017 (with monthly figures). Retrieved from http://data.unhcr.org/mediterranean/regional.php
Vane, J. R., & Eisen, V. W. (1962). The Goodenough Draw-a-Man test and signs of maladjustment in kindergarten children. Journal of Clinical Psychology, 18, 276–279. doi:10.1002/1097-4679(196207)18:3<276:aid-jclp2270180308>3.0.co;2-b
Vukcevic, M., Dobric, J., & Puric, D. (2014). Psychological Characteristics of Asylum seekers from Syria, in Survey of the Mental Health of Asylum seekers in Serbia. Belgrade: UNHCR. Retrieved from http://www.unhcr.rs/media/Mental-HealthFinal.pdf
Weber, R. P. (1990). Basic content analysis. London: Sage.
