Assessment of Drawing Age of Children in Early Childhood and Its Correlates

doi:10.4236/psych.2011.24059

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Psychology

2011. Vol.2, No.4, 376-381

Assessment of Drawing Age of Children in Early

Childhood and Its Correlates

Saziye Senem Basgul1, Ozden Sukran Uneri2, Gulcan Basar Akkaya3,

Nilay Etiler4, Aysen Coskun5

1Department of Child and Adolescent Psychiatry, Goztepe Education and Research Hospital,

İstanbul, Turkey;

2Department of Child and Adolescent Psychiatry, Bakirkoy Mental Health, Education and Research

Hospital, Ankara, Turkey;

3Atatürk Faculty of Education, Department of Education for Mentally Handicapped,

Marmara University, İstanbul, Turkey;

4Faculty of Medicine, Department of Public Health, Kocaeli University, Kocaeli, Turkey;

5Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli University, Kocaeli, Turkey.

Email: [email protected]

Received January 24th, 2011; revised March 28th, 2011; accepted May 7th, 2011.

Aim: The drawing ability of children develops parallel to their mental and physical development. The present

study aims to investigate the compatibility of children’s drawings with their mental and physical development

and variables affecting this compatibility in early childhood. Methods: Children between the ages 3 and 5 were

asked to draw a human/child figure on a given sheet of paper and their drawings were analyzed. Results: 175

children were evaluated. The mean age was found to be 3.94 ± 0.81 and the mean drawing age was 3.42 ± 1.75.

The drawing age was found to be statistically lower than the calendar age. It was found that children who had

low birth weights, who did not go to kindergarten and who masturbated had lower drawing age. Low drawing

age was not found to be related with psychological disorders. Discussion: Drawing can be utilized by mental

health professionals as an important assessment tool for young children. Further studies with larger sample sizes

are required to generalize.

Keywords: Early Childhood, Drawing Age, Psychiatry

Introduction

Children’s drawings have long been utilized to assess per-

sonality traits and psychological disorders of children (Sayil,

2004; Brown & Pipe, 2007; Bonoti & Metallidou, 2010). Some

studies on plastic arts and human psychology aim to detect

direct links between these two domains (Kellog, 1970). A sig-

nificant change occurs in a child’s artistic activities in parallel

with his/her physical and mental development. There are five

periods of development in children’s drawings (Samurcay,

1975):

1) Scribbling Period (Age 2 - 4)

2) Pre-symbolism Period (Age 4 - 7)

3) Symbolism Period (Age 7 - 9)

4) Realism Period (Age 9 - 12)

5) Apparent Naturalism Period (Age 12 - 14)

Early childhood, which is also defined as pre-school or play

period, is a period that includes development in physical, cog-

nitive, language, motor and psychosocial domains. Children

between the ages of 2 and 4 who are at the scribbling period

draw random lines and figures on the paper. Human figures

appear in the drawings of children after the age 4 (Senemoglu,

2004).

Child drawings are known to be an easy-to-use and often

employed economical method by professionals working with

children (Malchiodi, 1998). A literature review indicates that

there is a scarce number of studies in Turkey on children’s

drawing age and the sociodemographic and psychological cor-

relates. The primary aim of the present study was to detect the

children’s physical and mental compatibility as well as drawing

age through assessing drawings in early childhood. Our second

aim was to find sociodemographic variables affecting drawing

age, and to examine possibly related psychological disorders

while the third aim was to assess the differences between chil-

dren who accepted and did not accept to draw in terms of so-

ciodemographic characteristics, children’s habits and psycho-

logical disorders.

Method

Sample

The study was conducted in the center settlement of Kocaeli,

Turkey. It included clinical and population samples. The gen-

eral population sample was selected among 3- to 5-year-old

children (range, 3 years 0 months - 5 years 11 months) residing

in the area served by the Central Kocaeli Health Authority.

There were about 26,000 children in that age group according

to the population data from primary healthcare units for 2004.

The number of subjects to be enrolled was calculated by using

the sample size formula to test a single proportion (Dawson,

1990). In the formula, the probability value (p) was taken as the

incidence of psychiatric morbidity in 3- to 5-year-old children.

The Mental Health Profile of Turkey, published following a

S. S. BASGUL ET AL. 377

study carried out in 1995 and 1996, reported the incidence of

problematic behavior to be 16.5% for 2- to 3-year-old children

and 16.7% for 4- to18-year-old children (Erol, 2001). In the

present study, the p-value was accepted to be 15%. The calcu-

lation revealed the smallest sample size for the general popula-

tion sample to be 196, and as a result 200 children were en-

rolled in the study. In the clinical sample, a total of 111 children

between the ages of 3 and 5 years (range, 3 years 0 months - 5

years 11 months) admitted consecutively to the Child and Ado-

lescents Psychiatry Clinic in Kocaeli University Faculty of

Medicine between March and September 2006 with various

psychiatric complaints were evaluated and 105 children were

enrolled in the study after 6 were excluded due to unreliable

data.

Procedure

One of the parents of the child in the field sample was

phoned to provide information about the study and families

who accepted to participate were invited to the health care cen-

ter with their children. One of the parents of the child in the

clinical sample was informed about the aim of the study during

their referral to the Kocaeli University Faculty of Medicine

Child Psychiatry Clinic.

Families in the field and clinical samples were interviewed

for clinical assessment on the basis of the DSM-IV Diagnostic

Classification (Köroğlu, 1994). After the assessment interview,

each child was invited to the drawing room that was designed

to include few stimuli. Children were asked to draw a hu-

man/child figure on a given sheet of paper and the instruction

was repeated one more time without insisting if they did not

want to draw. Drawings of the children were analyzed and the

drawing age was assessed by the third author who was blind to

sociodemographic data and the results of the clinical assess-

ment. Each child was evaluated to determine whether the

drawing age was different from the chronogical age. Children

whose drawing was suitable to their chronogical age were

categorized as “same or high”. If the child’s drawing age was

lower the chronological age, these children were defined as the

“low” group.

Materials

Goodenough-Harris Draw-A-Person Test

Goodenough-Harris Draw-A-Person Test aims to measure

mental development (Harris, 1963). It is a drawing test that

gives information about the general aptitude level of young

children. It provides information on mental retardation. How-

ever, it should not be the only test used for assessment. It is not

a periodic test. It is applied individually to children between the

ages of 3 and 14. The test was adapted into Turkish in 1988

(Ozguven, 1996).

Statistical Analysis

Data were analyzed using the Statistical Package for Social

Sciences (SPSS) for Windows, version 10.0. The Pearson chi

square test and Fisher test were employed to compare various

features of the clinical group and population sample. The sig-

nificance level of the statistical tests was set at p < 0.05.

Results

A total of 309 children between the ages of 3 and 5 partici-

pated in the study. Two hundred and four children were in the

field sample while 105 were in the clinical sample. 187 (60.5%)

were boys and 122 (39.5%) were girls. 16 children (11 boys, 5

girls) in the clinical sample and 159 children (82 boys and 77

girls) in the field sample accepted to draw and their drawings

were analyzed. The mean age of these children was found to be

3.94 ± 0.81. The mean drawing age was 3.42 ± 1.75. The dif-

ference between the drawing age and calendar age was statisti-

cally significant in both the field and clinical samples for 175

children who accepted to participate in the study. It was found

that their drawing age was lower than their calendar age.

The differences between the drawing age and calendar age

are presented on Table 1.

There was no statistically significant relationship between

drawing age and gender, maternal employment, presence of

sibling(s), age and education level of parents, psychological

disorders assessed in children, nail biting and finger sucking in

the group of 175 children who accepted to draw pictures.

Drawing age was lower than the calendar age in children who

did not go to kindergarten compared to those who attended

kindergarten, those who had low birth weight compared to

children with normal birth weight, and those who were reported

to masturbate compared to children who did not for the 175

children who accepted to draw pictures (Table 2).

No significant difference was found between two groups in

terms of age when the 309 children were divided into two

groups as children who accepted and did not accept to draw.

There was no gender difference in the group that accepted to

draw but the number of boys was significantly higher in the

group that did not accept to draw. There was no significant

difference between the two groups in terms of education level

of parents, employment status, and kindergarten status. The rate

of children with divorced parents was significantly was higher

in the group that did not accept to draw compared to children

whose parents were together. There was no significant differ-

ence between the two groups in terms of nail biting and mas-

turbation but frequency of finger sucking was significantly

higher in the group that did not draw (Table 2).

It was found that diagnoses of disruptive behavior disorders

were significantly more frequent than other diagnoses in the

group that did not draw. None of the children with a diagnosis

of pervasive developmental disorder accepted to draw. In the

group that did not draw, the frequency of having at least one

diagnosis of psychological disorder was significantly higher

than the group that accepted to draw (Table 3).

Discussion

In the present study, it was found that for children aged be-

Table 1.

Difference between the drawing age and calendar age in the study

group.

Difference from calendar age No Percent

Same or high 75 24.3

Low (<1 year) 100 32.4

Did not draw 134 43.4

Total 309 100.0

S. S. BASGUL ET AL.

378

Table 2.

Comparison of the independent variables with the difference from the children’s calendar age.

Variables

Same/high

No. (%) Low (at least 1 age)

No. (%) D i d not draw

No. (%) Total



2 p value

Groups

Population sample 67 (32) 92 (45.1) 45 (22.1) 204 111.1 0.00

Clinic group 8 (7.6) 8 (7.6) 89 (84.8) 100

Gender

Girls 43 (35.2) 39 (32) 40 (32.8) 122 15.21 0.00

Boys 32 (17.1) 61 (32.6) 94 (50.3) 187

Age

3 31 (27.4) 36 (31.9) 46 (40.7) 113 1.91 0.75

4 22 (21.8) 36 (35.6) 43 (42.6) 101

5 22 (23.2) 28 (29.5) 45 (47.4) 95

Parent Employm ent Status

Working 6 (19.4) 10 (32.3) 15 (48.4) 31 0.57 0.75

Not Working 69 (24.9) 90 (32.5) 118 (42.6) 227

Sibling

Presence 52 (23.2) 76 (33.9) 96 (42.9) 224 0.99 0.60

Absent 23 (27.4) 24 (28.6) 37 (44.0) 84

Mother’s level of education

Primary school and under 43 (23.0) 69 (36.9) 75 (40.1) 187 4.28 0.11

Secondary school and higher 32 (26.4) 31 (25.6) 58 (47.9) 121

Parents

Together 74 (24.7) 100 (33.3) 126 (42.0) 300 8.09 0.01

Separate 1 (11.1) 0 (.0) 8 (88.9) 9

Pre-school education

Attending 21 (27.6) 19 (25.0) 36 (47.4) 76 2.52 0.28

Never attended 54 (23.2) 81 (34.8) 98 (42.1) 233

Birth weight

Over 2500 gr 67 (25.9) 79 (30.5) 113 (43.6) 259 8.10 0.01

Under 2500 gr 4 (12.1) 18 (54.5) 11 (33.3) 33

The age of speaking

Under 9 months 22 (33.3) 25 (37.9) 19 (28.8) 66 15.02 0.005

9 - 16 months 32 (29.1) 38 (34.5) 40 (36.4) 110

Over 16 months 21 (16.7) 37 (29.4) 68 (54.0) 126

Masturbation

Yes 69 77 109 255 6.88 0.032

No 6 23 24 53

S. S. BASGUL ET AL. 379

Table 3.

Relationship between psychiatric disorders and difference from the children’s calendar age.

Psychiatric Disorders Groups Same/high

No. (%) Low (at least 1

age) No. (%) Did not draw

No. (%) Total



2 p value

Disruptive behavior disorder

Yes 13 (18.1) 18 (25.0) 41 (56.9) 72 7.05 0.02*

No 62 (26.2) 82 (34.6) 93 (39.2) 237

Anxiety Disorders

Yes 14 (19.7) 22 (31.0) 35 (49.3) 71 1.58 0.45

No 61 (25.6) 78 (32.8) 99 (41.6) 238

Mood Disorders

Yes 6 (30.0) 5 (25.0) 9 (45.0) 20 0.66 0.71

No 69 (23.9) 95 (32.9) 125 (43.3) 289

Tic Disorders

Yes 8 (22.9) 7 (20.0) 20 (57.1) 35 3.62 0.16

No 67 (24.5) 93 (33.9) 114 (41.6) 274

Eating Disorders

Yes 8 12 13 33 0.31 0.85

No 67 88 121 276

Elimination Disorders

Yes 5 (13.5) 11 (29.7) 21 (56.8) 37 3.83 0.14

No 70 (25.7) 89 (32.7) 113 (41.5) 272

At least one morbidity

Yes 41 (19.3) 69 (32.5) 102 (48.1) 212 10.2 0.00*

No 34 (35.1) 31 (32.0) 32 (33.0) 97

tween 3 and 6 who drawing age is lower than calendar age both

in the field and clinical samples. Evaluation of the design and

findings of our study did not reveal any finding that may have

led to this situation. The lower drawing ages of the children

accepting to participate in their study compared to their calen-

dar ages may be a characteristic of the sample. The frequency

of drawing was lower in children who applied to the clinic than

in the field sample. This might be related to the children’s

awareness of being in the clinic as a result of their problems.

Children in the field sample were assessed in the registered

health care center without their parents’ application for assess-

ment of psychological problems. This might have led children

in the field sample to have a more accepting attitude. When

field and clinical samples were considered together, the pres-

ence of at least one psychopathology in children who did not

accept to draw might imply that children with psychological

problems have lower compliance to draw in the first meeting. It

might be more suitable to have assessments such as drawing

after an alliance is established with children in clinical settings

(Charman, 2008). Our study supports this recommendation.

When factors related with drawing and calendar age are ana-

lyzed, it was found that gender, education levels of parents and

employment status of the mother did not affect the drawing age

of children but kindergarten attendance, masturbation and fin-

ger sucking were related with a drawing age that is lower than

the calendar age. A review of the literature indicates that habits

like masturbation and finger sucking are more frequent in chil-

dren with inadequate stimulation (Foster, 1998; Lindblad, 1998;

Unal, 2000; Yorukoglu, 2004; Traisman & Traisman, 1958).

Professionals emphasize that the quality of time spent with

children rather than parental education level and employment

status is important for children’s mental development (Gins-

burg KR, 2007). Our findings also underline the importance of

stimulation for mental development of children. The finding

that indicates lower drawing age of children who do not go to

kindergarten is meaningful to show the importance of pre-

school education. Children with lower birth weight are known

to have motor developmental delays more frequently than those

with a normal birth weight (Barnett, 2011). Lower drawing age

in children with low birth rate might be explained by slower

development of fine motor skills in these children.

Two types of usage are found for drawings of a person by

S. S. BASGUL ET AL.

380

children. The first one is using them for a rough analysis of the

child’s cognitive development as with other visual-motor tests

(Brown, 1990; Cherney ve ark, 2006; Koppitz, 1968). The sec-

ond use is to obtain information on the emotional structure and

or current emotional status of the child (Catte & Cox, 1999;

Matto, 2002, Tharinger & Stark, 1990). The presence of any

psychopathology in the children was not found to affect draw-

ing age. Conduct disorder and major depressive disorder were

found to be significantly higher in children who did not draw. It

might be useful, especially for the clinician, to consider this

finding in clinical application. The findings of the present study

that children with some psychological disorders did not accept

to draw, and that children who have habits that might appear

secondary to inadequate stimulation like masturbation and fin-

ger sucking have lower drawing age support the notion that

drawing is a useful assessment tool for children. There are other

articles on the drawing in children with diffuse developmental

disorder (Evans & Dubowski, 2001; Lee & Hobson, 2006; Ste-

fanatou, 2008). We did not come across any information on

when the drawing activity was held or whether any group re-

fused to draw in these articles. Children with this diagnosis did

not accept to draw in our study. This may indicate that trying to

get children who find it difficult to form social relationships

may not be appropriate. However, we do not know whether

these children accepted to draw in future interviews due to the

design of our study. New drawing studies with these children

could use a study design that also included longitudinal fol-

low-up of children who accepted and did not accept to draw to

determine which visit may be best to use a test such as drawing

evaluation.

Inadequate distribution of sample between field and clinical

samples and small sample size might be considered among the

limitations of the present study. However, when sample size is

evaluated, the fact that clinical interviews were conducted with

all children and their families who participated in the study

should be considered.

Conclusion

A literature review indicates that there is no other study on

the drawing age of children, sociodemographic and psycho-

pathological correlates, accepting to draw and its association

with psychological disorders. Considering the importance of

drawing as an assessment tool for health care professionals,

further studies with larger sample size and more variables are

warranted to generalize assessments of children in the field of

drawing and to utilize findings in clinical studies.

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