DEBORAH J. THARINGER AND KEVIN STARK ence Koppitz has reported that three or more emotional indi- method, however, has been harshly criticized because their cators on her system appear to diferentiate the DAPs of groups manuals include no information on reliability or validity and of children with and without emotional and behavioral prob- fail to define precisely the scoring variables(Harris, 1978) lems(Koppitz, 1968) Other scoring systems for the KFD, based on the Burns and Researchers have examined the relationship between certain Kaufman features, have been proposed by McPhee and Wegner emotional indicators in DAPs and depression and anxiety in 1976), Meyers(1978), Nostkoff and Lazarus ( 1983),and both adults and children. According to Machover (1949), OBrien and Patton(1974). Although these four systems have deeply regressed or neurotically depressed persons are likely to obtained satisfactory interrater reliabilities, they have not been draw small or diminutive figures. To test this hypothesis, Lew- successful at consistently differentiating the drawings of chil- nsohn(1964)compared the drawings of 50 depressed and non- dren with and without emotional problems(see reviews by depressed adult psychiatric patients and reported a statistically Cummings, 1986; Knoff Prout, 1985). Reynolds(1978)has significant, but actually quite small, difference between the offered a quick reference guide for developing clinical hy pothe heights of the drawings produced by the depressed and normal ses from childrens K FDs. His guide includes 37 signs, secured groups. Roback and Webersinn(1966)and Holmes and wie- from numerous scoring methods, that have been proposed as derhold(1982)failed to find a significant difference in the size being clinical indicators of family dysfunction. Although infor of drawings produced by an adult normal and depressed psychi- mation on reliability and validity of the guides as a scoring atric sample. In a study with depressed children, Gordon, Lef- system are not provided the guide may prove to be a useful kowitz,and Tesiny(1980)investigated three structural charac- tool. Studies specifically investigating the KFDs of depressed teristics of DAPs: size, vertical placement on the page, and line and anxious children, regardless of the scoring system used intensity. They found a significant relationship with size for girls have not been reported and no significant relationships between vertical placement on Overall, research findings indicate that the results of scoring the page or line intensity with depression as rated by the chil- systems based on individual emotional indicators have not dif- en or their teachers. On the basis of their study ferentiated the human-figure drawings of children with specific and from interpretation of previous research, these authors internalizing disorders from those of normal children In prac- questioned the validity of assessing depression in children us- tice, it often is the gestalt of a human figure drawing that is ing structural characteristics of human-figure drawings. clinically evaluated to derive a sense of the overall degree of a Manifestations of anxiety in figure drawings have been the childs disturbance or distortion in relation to the self and the subject of a great deal of speculation and a moderate number of family. It was hy pothesized here that the clinical usefulness of empirical investigations(Sims, Dana, Bolton, 1983). Studies human-figure drawings may lie in their overall presentation of have been of two types: experimental studies of stress induc- the psychological functioning of the individual and of the fam tion(e.g Doubros Mascarenhas, 1967; Sturner, Rothbaum, ily and not in their interpretation by a single or sum of specific Visintainer, Wolfer, 1980)and correlational studies of valid emotional indicators. The aim of the present study was to inves ity (e.g, Craddick, Leipold, Cacauas, 1962; Viney Aitkin, tigate empirically this holistic practice to determine if it would Floyd, 1974). In studies of stress induction, the frequency of prove to differentiate children with distinct internalizing dis- anxiety indices is compared for subjects receiving stressful orders from normal children. This study compared two meth treatments and for control subjects. In correlational studies ods of scoring DAPs and Kfds in a sample of children diag- anxiety score derived from the daP is related to an indepen- nosed according to the revised third edition of the diagnostic dent measure of anxiety. Although different indices of anxiety and Statistical Manualof Mental Disorders(DSM-1II-R, Ameri- n the drawings have been used in the various studies(typical can Psychiatric Association, 1987)as having a mood disorder, indicators of anxiety include shading, erasures, and line rein- anxiety disorder, or both, along with a normal control group forcement), results have generally failed to support an interpre - For each type of drawing, a scoring method based on existing tation that anxiety is manifested in, and can be interpreted individual emotional indicators was contrasted with a newly from, human-figure drawings constructed scoring method based on a qualitative, integrative, Another projective drawing technique that commonly is and holistic approach. In addition, to evaluate the often-made sed with children is the Kinetic Family Drawing(KFD; Burns claim that the DAP is a projective measure of self-concept, the Kaufman, 1970, 1972), which purportedly assesses a childs childrens scores on the two methods of scoring the DAPs were perceptions of the interpersonal relations within his or her fam- examined in relation to an objective measure of self-reported ily. The kFd has achieved moderately widespread use among self-concept. Similarly, to explore the hypothesis that the KFd psychologists who work with children because of the recogni- is a projective measure of perception of one's family, the chil- and treatment of emotional disorders of children(Reynolds, correlated with an objective measure of self-reported family 1978). On the kFD, the child is asked to draw a picture of functioning everyone in his or her family doing something. Burns and Kauf man hy pothesized that the stipulation that everyone in the drawing had to be doing something would permit self and fam- Method ily attitudes to become more apparent. Burns and Kaufman( 1970, 1972)have developed two als for scoring the KFD. Their system is based The participants were 52 children, 4i girls and i l boys in grades 4 tation of actions, styles, and symbols in the drawings. Their through 7, from five suburban schools. They were drawn from a sample366 DEBORAH J. THARINGER AND KEVIN STARK ence. Koppitz has reported that three or more emotional indi￾cators on her system appear to differentiate the DAPs of groups of children with and without emotional and behavioral prob￾lems (Koppitz, 1968). Researchers have examined the relationship between certain emotional indicators in DAPs and depression and anxiety in both adults and children. According to Machover (1949), deeply regressed or neurotically depressed persons are likely to draw small or diminutive figures. To test this hypothesis, Lew￾insohn (1964) compared the drawings of 50 depressed and non￾depressed adult psychiatric patients and reported a statistically significant, but actually quite small, difference between the heights of the drawings produced by the depressed and normal groups. Roback and Webersinn (1966) and Holmes and Wie￾derhold (1982) failed to find a significant difference in the size of drawings produced by an adult normal and depressed psychi￾atric sample. In a study with depressed children, Gordon, Lef￾kowitz, and Tesiny (1980) investigated three structural charac￾teristics of DAPs: size, vertical placement on the page, and line intensity. They found a significant relationship with size for girls and no significant relationships between vertical placement on the page or line intensity with depression as rated by the chil￾dren, their peers, or their teachers. On the basis of their study and from interpretation of previous research, these authors questioned the validity of assessing depression in children us￾ing structural characteristics of human-figure drawings. Manifestations of anxiety in figure drawings have been the subject of a great deal of speculation and a moderate number of empirical investigations (Sims, Dana, & Bolton, 1983). Studies have been of two types: experimental studies of stress induc￾tion (e.g., Doubros & Mascarenhas, 1967; Sturner, Rothbaum, Visintainer, & Wolfer, 1980) and correlational studies of valid￾ity (e.g., Craddick, Leipold, & Cacauas, 1962; Viney, Aitkin, & Floyd, 1974). In studies of stress induction, the frequency of anxiety indices is compared for subjects receiving stressful treatments and for control subjects. In correlational studies, an anxiety score derived from the DAP is related to an indepen￾dent measure of anxiety. Although different indices of anxiety on the drawings have been used in the various studies (typical indicators of anxiety include shading, erasures, and line rein￾forcement), results have generally failed to support an interpre￾tation that anxiety is manifested in, and can be interpreted from, human-figure drawings. Another projective drawing technique that commonly is used with children is the Kinetic Family Drawing (KFD; Burns & Kaufman, 1970,1972), which purportedly assesses a child's perceptions of the interpersonal relations within his or her fam￾ily. The KFD has achieved moderately widespread use among psychologists who work with children because of the recogni￾tion of the important role of family dynamics in the etiology and treatment of emotional disorders of children (Reynolds, 1978). On the KFD, the child is asked to draw a picture of everyone in his or her family doing something. Burns and Kauf￾man hypothesized that the stipulation that everyone in the drawing had to be doing something would permit self and fam￾ily attitudes to become more apparent. Burns and Kaufman (1970,1972) have developed two man￾uals for scoring the KFD. Their system is based on the interpre￾tation of actions, styles, and symbols in the drawings. Their method, however, has been harshly criticized because their manuals include no information on reliability or validity and fail to define precisely the scoring variables (Harris, 1978). Other scoring systems for the KFD, based on the Burns and Kaufman features, have been proposed by McPhee and Wegner (1976), Meyers (1978), Nostkoff and Lazarus (1983), and O'Brien and Patton (1974). Although these four systems have obtained satisfactory interrater reliabilities, they have not been successful at consistently differentiating the drawings of chil￾dren with and without emotional problems (see reviews by Cummings, 1986; Knoff& Prout, 1985). Reynolds (1978) has offered a quick reference guide for developing clinical hypothe￾ses from children's KFDs. His guide includes 37 signs, secured from numerous scoring methods, that have been proposed as being clinical indicators of family dysfunction. Although infor￾mation on reliability and validity of the guides as a scoring system are not provided, the guide may prove to be a useful tool. Studies specifically investigating the KFDs of depressed and anxious children, regardless of the scoring system used have not been reported. Overall, research findings indicate that the results of scoring systems based on individual emotional indicators have not dif￾ferentiated the human-figure drawings of children with specific internalizing disorders from those of normal children. In prac￾tice, it often is the gestalt of a human-figure drawing that is clinically evaluated to derive a sense of the overall degree of a child's disturbance or distortion in relation to the self and the family. It was hypothesized here that the clinical usefulness of human-figure drawings may lie in their overall presentation of the psychological functioning of the individual and of the fam￾ily and not in their interpretation by a single or sum of specific emotional indicators. The aim of the present study was to inves￾tigate empirically this holistic practice to determine if it would prove to differentiate children with distinct internalizing dis￾orders from normal children. This study compared two meth￾ods of scoring DAPs and KFDs in a sample of children diag￾nosed according to the revised third edition of the Diagnostic and Statistical ManualofMental Disorders(DSM-III-R; Ameri￾can Psychiatric Association, 1987) as having a mood disorder, anxiety disorder, or both, along with a normal control group. For each type of drawing, a scoring method based on existing individual emotional indicators was contrasted with a newly constructed scoring method based on a qualitative, integrative, and holistic approach. In addition, to evaluate the often-made claim that the DAP is a projective measure of self-concept, the Children's scores on the two methods of scoring the DAPs were examined in relation to an objective measure of self-reported self-concept. Similarly, to explore the hypothesis that the KFD is a projective measure of perception of one's family, the chil￾dren's scores on the two methods of scoring the KFDs were correlated with an objective measure of self-reported family functioning. Method Subjects The participants were 52 children, 41 girls and 11 boys in Grades 4 through 7, from five suburban schools. They were drawn from a sample