DRAW-A-PERSON AND KINETIC FAMILY DRAWING sult of these interviews, 14 children received a diagnosis of a mood the three exploratory items, depicted in Table 3, ranged from 77% to isorder, ll, a diagnosis of an anxiety disorder, and 19, a diagnosis of 100%, Disagreements were resolved through discussions by the two both a mood and anxiety disorder. As mentioned earlier, 5 of these scorers. Total scores on the Koppitz DAP System were obtained by subjects were not included in this study because of missing human. summing the number of emotional indicators present, excluding the figure drawing data. three exploratory items. eliability of the diagnoses was evaluated through the fo Each DAP also was scored using a second approach that is a qualita- procedure. a summary form was constructed that listed the DSM-Il tive, integrative scoring system designed to measure Psychological diagnosis of (a) major depression, (b)dysthymic Functioning of the Individual on a scale from I to 5. On this scale, I disorder,(c)depressive disorder not otherwise specified, (d)over- equals the absence of psychopathology (ie, very healthy psychological anxious disorder, (e)generalized anxiety disorder, (f)separation anxi- functioning), and 5 equals the presence of severe psychopathology (i.e ety, and (g)anxiety disorder not otherwise specified. Two raters, ery poor psychological functioning). To develop the system, called doctoral level psychologist and a doctoral student in psychology inde pendently transferred the symptom ratings from the depressive and previous training and experience scoring and evaluating projective anxiety symptoms of the K-SADS interviews of each child to the sum- drawings (who had not participated in the scoring using the Koppitz ary forms. During the process of assigning diagnoses, the raters DAP System), completed a forced sort of the 52 drawings into five piles compared the symptom ratings on the summary forms to the dsM- of equal number on the l to 5 scale(the actual distribution was 10, 10, III-R diagnostic criteria. The following decision rules were used when 11, 11, 10). The sorters were unaware of the group membership of ead determining whether a symptom was present at a severe enough level to child and were only aware of each childs age. Subsequently, the two be considered symptomatic of a disorder. A symptom rating of 4 or sorters were interviewed by Deborah J. Tharinger to determine what greater on the K-SADS was considered clinically significant on the integrative features of the drawings influenced their ratings and differ- symptoms, and a rating of 3 or greater was considered to be inically significant for the anxiety symptoms. On the overlapping Four characteristics of Psychological Functioning of the Individual symptoms, a rating of at least 4 was necessary for the symptom to be were identified as representing the process experienced by the two onsidered clinically significant. On the basis of these rules and the raters and include(a)inhumanness of the drawing (b) lack of agency symptom ratings, DSM-Il-R diagnoses were independently assigned (i. e, inability of the individual in the drawing to effectively interact ith the world ) (c) lack of well l sion diagnoses was 91%, and it was 93% for the anxiety disorders diag- and (d) the presence of a hollow, vacant, or stilted sense in the individ- noses. Where there were disagreements, the raters came to a consensus ual portrayed in the drawing. a clearer sense of these characteristics is and then assigned a diagnosis where appropriate. gained through placing oneself in the position of the individual de Concurrent to completion of the aforementioned K-SADS inter- picted. The pathological end of the scale will now be described. inhu- views, additional parental permission and child assent were secured manness of the drawing refers to a quality whereby one would feel ani- for children who scored in the nondepressed and nonanxious range on malistic, grotesque, or monstrous, or if clearly human, as though one he screening administration of the CDi and rCMAs (n=30). These were missing essential body parts either because they were absent or youngsters completed a second administration of the measures in disconnected Lack of agency refers to a sense that the individual de- small groups. Permission was received for all but one child. All 29 of picted would be unable to effect any change in his or her world; a sense the children again scored in the nondepressed and nonanxious range of powerlessness that was often reflected in the pose of the individual on the second administration of the CDi and the roMAs They then Lack of well being, as mentioned above is reflected in negative facial were individually interviewed with the K-SADS. One of the children expressions of the individual, such as an angry, scared, or sad face. a teen children who were least symptomatic on the K-sads and com- interacting (i. e has sufficient power or force but is somehow frozen pleted all other measures of interest were selected to be the control and unable to move or use the power that may well be available to him or her). These four characteristics constitute a holistic and impression Additional measures were then completed by the clinical and con- istic sense of the drawings. That is, it is not a matter of rating a drawing trol samples in a small group format (4 to 8 children). During the first a 5 on each of the four characteristics that results in a score of 5 on the of these group assessments, the children were asked to produce a daP drawing. Rather, it is an integrative combination of the four character and a K FD. Each drawing took approximately 10 min to complete The istics that results in the overall rating of the drawing. children were seated at desks and tables, separated from each other. In Following the explication of these characteristics and methods, a ubsequent group assessment sessions, numerous self-report measures new rater, also experienced with projective drawings, was trained in were obtained from the children. Of interest to this study were the the resulting method, and she sorted the DAPs according to the set CSei and nine selected scales of the srmFf-c distribution on the five-point scale. In addition, one of the original Scoring of projectives. The daP drawings were scored using two raters again sorted the drawings, taking into account changes and clari- methods, The Koppitz DAP System ( Koppitz, 1968), which consists of fications in the system Reliability was computed between the scores of 30 individual emotional indicators that are scored for presence or ab. these two raters. The Spearman rho, a correlation coefficient for sence, was used (see Table 3 for a list of the indicators). Three explor- ranked data, was computed to be 84. Disagreements were resolved atory items, presence ofa happy face, a sad face, and a worried face also through discussion between the two raters, and an agreed-on score were included. Two psychology graduate students, who were unaware assigned of all other information except the age of the child, used the Koppitz The 52 K FD drawings also were scored using two methods. Becaus DAP System to score the DAPs Scorers were required to reach 90% of the poor performance of scoring systems based on the Burns and agreement on example drawings before scoring the actual drawings, To Kaufman( 1970, 1972)method (reviewed earlier). none of them wer obtain a measure of interrater agreement, 50% of the drawings(26) chosen. Instead, an approach similar to that used in the Koppitz were scored by both scorers. The G Index of Agreement was calculated tem was sought, For thestudy, the Reynold s guide was adapted into the to be 92% for the entire Koppitz DAP System of 30 emotional indica- Reynolds KFD System, consisting of the 37 individual indicators(see tors. The G Index of Agreement for the 30 individual items as well as Table 4 for a list of the indicators). The signs were scored for presenceDRAW-A-PERSON AND KINETIC FAMILY DRAWING 369 result of these interviews, 14 children received a diagnosis of a mood disorder, 11, a diagnosis of an anxiety disorder, and 19, a diagnosis of both a mood and anxiety disorder. As mentioned earlier, 5 of these subjects were not included in this study because of missing human￾figure drawing data. Reliability of the diagnoses was evaluated through the following procedure. A summary form was constructed that listed the DSM-1II￾R symptoms for a diagnosis of (a) major depression, (b) dysthymic disorder, (c) depressive disorder not otherwise specified, (d) over￾anxious disorder, (e) generalized anxiety disorder, (f) separation anxi￾ety, and (g) anxiety disorder not otherwise specified. Two raters, a doctoral level psychologist and a doctoral student in psychology inde￾pendently transferred the symptom ratings from the depressive and anxiety symptoms of the K-SADS interviews of each child to the sum￾mary forms. During the process of assigning diagnoses, the raters compared the symptom ratings on the summary forms to the DSM￾III-R diagnostic criteria. The following decision rules were used when determining whether a symptom was present at a severe enough level to be considered symptomatic of a disorder. A symptom rating of 4 or greater on the K-SADS was considered clinically significant on the depression symptoms, and a rating of 3 or greater was considered to be clinically significant for the anxiety symptoms. On the overlapping symptoms, a rating of at least 4 was necessary for the symptom to be considered clinically significant. On the basis of these rules and the symptom ratings, DSM-IH-R diagnoses were independently assigned to each youngster that met the diagnostic criteria. Interrater agree￾ment was then computed. The percentage of agreement for the depres￾sion diagnoses was 91%, and it was 93% for the anxiety disorders diag￾noses. Where there were disagreements, the raters came to a consensus and then assigned a diagnosis where appropriate. Concurrent to completion of the aforementioned K-SADS inter￾views, additional parental permission and child assent were secured for children who scored in the nondepressed and nonanxious range on the screening administration of the GDI and RCMAS (n = 30). These youngsters completed a second administration of the measures in small groups. Permission was received for all but one child. All 29 of the children again scored in the nondepressed and nonanxious range on the second administration of the GDI and the RCMAS. They then were individually interviewed with the K-SADS. One of the children reported a diagnosable mood disorder during the interview. The thir￾teen children who were least symptomatic on the K-SADS and com￾pleted all other measures of interest were selected to be the control group. Additional measures were then completed by the clinical and con￾trol samples in a small group format (4 to 8 children). During the first of these group assessments, the children were asked to produce a DAP and a KFD. Each drawing took approximately 10 min to complete. The children were seated at desks and tables, separated from each other. In subsequent group assessment sessions, numerous self-report measures were obtained from the children. Of interest to this study were the CSEI and nine selected scales of the SRMFF-C. Scoring of projectives. The DAP drawings were scored using two methods. The Koppitz DAP System (Koppitz, 1968), which consists of 30 individual emotional indicators that are scored for presence or ab￾sence, was used (see Table 3 for a list of the indicators). Three explor￾atory items, presence of ahappyface, a sad face, and a worried face also were included. Two psychology graduate students, who were unaware of all other information except the age of the child, used the Koppitz DAP System to score the DAPs. Scorers were required to reach 90% agreement on example drawings before scoring the actual drawings. To obtain a measure of interrater agreement, 50% of the drawings (26) were scored by both scorers. The G Index of Agreement was calculated to be 92% for the entire Koppitz DAP System of 30 emotional indica￾tors. The G Index of Agreement for the 30 individual items as well as the three exploratory items, depicted in Table 3, ranged from 77% to 100%. Disagreements were resolved through discussions by the two scorers. Total scores on the Koppitz DAP System were obtained by summing the number of emotional indicators present, excluding the three exploratory items. Each DAP also was scored using a second approach that is a qualita￾tive, integrative scoring system designed to measure Psychological Functioning of the Individual on a scale from 1 to 5. On this scale, 1 equals the absence of psychopathology (i.e., very healthy psychological functioning), and 5 equals the presence of severe psychopathology (i.e., very poor psychological functioning). To develop the system, called the DAP Integrative System, two psychology doctoral students with previous training and experience scoring and evaluating projective drawings (who had not participated in the scoring using the Koppitz DAP System), completed a forced sort of the 52 drawings into five piles of equal number on the 1 to 5 scale (the actual distribution was 10,10, 11,11,10). The sorters were unaware of the group membership of each child and were only aware of each child's age. Subsequently, the two sorters were interviewed by Deborah J. Tharinger to determine what integrative features of the drawings influenced their ratings and differ￾entiations. Four characteristics of Psychological Functioning of the Individual were identified as representing the process experienced by the two raters and include (a) inhumanness of the drawing, (b) lack of agency (i.e., inability of the individual in the drawing to effectively interact with the world), (c) lack of well being of the individual in the drawing, typically reflected in facial expressions indicating negative emotions, and (d) the presence of a hollow, vacant, or stilted sense in the individ￾ual portrayed in the drawing. A clearer sense of these characteristics is gained through placing oneself in the position of the individual de￾picted. The pathological end of the scale will now be described. Inhu￾manness of the drawing refers to a quality whereby one would feel ani￾malistic, grotesque, or monstrous, or if clearly human, as though one were missing essential body parts either because they were absent or disconnected. Lack of agency refers to a sense that the individual de￾picted would be unable to effect any change in his or her world; a sense of powerlessness that was often reflected in the pose of the individual. Lack of well being, as mentioned above, is reflected in negative facial expressions of the individual, such as an angry, scared, or sad face. A hollow, vacant, or stilted sense suggests that the individual is capable of interacting (i.e., has sufficient power or force but is somehow frozen and unable to move or use the power that may well be available to him or her). These four characteristics constitute a holistic and impression￾istic sense of the drawings. That is, it is not a matter of rating a drawing a 5 on each of the four characteristics that results in a score of 5 on the drawing. Rather, it is an integrative combination of the four character￾istics that results in the overall rating of the drawing. Following the explication of these characteristics and methods, a new rater, also experienced with projective drawings, was trained in the resulting method, and she sorted the DAPs according to the set distribution on the five-point scale. In addition, one of the original raters again sorted the drawings, taking into account changes and clari￾fications in the system. Reliability was computed between the scores of these two raters. The Spearman rho, a correlation coefficient for ranked data, was computed to be .84. Disagreements were resolved through discussion between the two raters, and an agreed-on score was assigned. The 52 KFD drawings also were scored using two methods. Because of the poor performance of scoring systems based on the Burns and Kaufman (1970, 1972) method (reviewed earlier), none of them were chosen. Instead, an approach similar to that used in the Koppitz Sys￾tem was sought. For the study, the Reynold's guide was adapted into the Reynolds KFD System, consisting of the 37 individual indicators (see Table 4 for a list of the indicators). The signs were scored for presence