Integrating ‘art’ into research with

childrenMartha Driessnack PhD, PNP-BC

Pediatric Nursing: State of the ScienceMNRS Preconference Workshop

Background Children have typically been treated as

passive objects and known primarily through Adult proxy & observation Little agreement between adult/child

Developmental, deficit-based lens human ‘becomings’ vs beings

Traditional methods of self-report are adult-centered, -directed, and dominated

The challenge…Can we hear children’s voices

without changing existing tools and methods?

Children’s Drawings Growing interest in the use of art

Natural medium for children Internal, sensory cues for retrieval

Drawings have typically been ‘ectomized’ or taken away from children and interpreted by ‘experts’

Windows vs doorways Children’s interpretations often very

different

Children’s interpretations…

Does this frighten you?

…are often different from ours!

Historical perspective The study of children’s art [drawings] has

a long tradition in the fields of psychiatry & psychology

Early work with adults with mental illness, then children with mental illness

Measures of ‘mental’ age lead to measures of intelligence (cognitive development)

Insights into emotions & feelings gave rise to ‘emotional indicators’

Historical progression (Series of Assessment Tools)

Draw-A-Man (Goodenough, 1926) House-Tree-Person (Buck, 1948) Draw-A-Person (Machover, 1949) Draw-A-Person (Harris, 1963) Emotional indicators (Koppitz, 1968) 20 basic scribbles (Kellogg, 1969) Squiggle (Winnicott, 1971) Kinetic Family Drawing (Burns, 1972) Draw-A-Story (Silver, 1978)

Used in research & clinical practice

Drawing progression Stage I Scribbling Stage II Basic forms Stage III Beginning Schemata

Human forms* Stage IV Visual schemata

Less egocentric, Stage V Realism Stage VI Adolescence….

Fine motor skill progression (Stage I-III)

Scribbling – eye follows hand hand in mouth to grasp progression hand to paper, hand leads, mark + feedback

Shapes – eye & hand work together mastering form & basic design line, circle, box, cross

Pictures – mind guides hand Combining shapes Depicting reality

Lines, circles, & squares…

*Human forms (5-12 yrs)(Stages III-VI) Tadpoles

Head, legs Facial features

Eyes, nose, mouth, hair Arms Body/neck Feet 2-D, naturalistic placement of arms/legs

“Draw a whole person” Any person you want 8 x 11 paper & pencil No time limit (~10min) No clinician guidance/probing Assessment

Cognitive/intellectual development Emotional indicators

Emotional indicators 30 specific characteristics (Koppitz, 1968)

(DiLeo, 1970; 1973; 1983) Quality signs

Shading, transparencies, lack of integration Assymetry, slant

Omissions Special features

Tiny head, crossed eyes, teeth!, emphasis on hands, legs/arms pressed together, genitals, clouds/rain/snow

Meaning of colors… Red ≠ color of hurting, rage, aggression Purple/black ≠ unhappiness, depression, death Color means different things to different people

Fads (Ex: purple increased with Barney) Culture

Lack of color? Developmental considerations

3-4 yrs beginning consciousness of color 4-6 yrs know colors 6-9 yrs rigid use/rules >9yrs realistic

NORMAL TINY FIGURE NO INTEGRATION

SlantShading

SlantTransparency

Draw yourself at home….

Here I am

This is who I am avoiding

Assessment vs communication ‘aid’? Encourage children to ‘say something’

about their drawings (Naumburg, 1949) Drawings ‘facilitate’ communication Meta-analysis (Driessnack, 2005)

Amount of information Nature of information

Often used following ‘trauma’ 9-11 Tsunami Hurricane Katrina Holocaust Wars Forensic/Abuse interviews

…but that’s not the only time…

Offer every child the opportunity to communicate through art Caution!

You will be affected by children’s imagery in personal ways that may/may not be representative of what children are experiencing or trying to communicate

Windows vs doorways Beware one-way voyeurism or ‘ectomized art’

Take the stance of ‘not knowing’ Uncensored view of children’s thoughts

The stance of ‘not knowing’… Never assume that any image always

means something specific Stay open to a variety of meanings

“Tell me all about it…”

7 yr old male, recently circumcised

7 yr old with encopresis

just lost his tooth…

If you are going to incorporate art to

facilitate communication…

The importance of tools/materials Use good quality materials

(aka no broken crayons/used pencils) Choices = control

Too many vs too little Tools (active, continuum of control) Materials (passive, receptive surface) Re-familiarize yourself with both

Most adults draw, paint, and sculpt as if they were somewhere between age 4 & 12!

Art ‘tools’ 10 point continuum

(1=least controlled;10= most controlled

Wet cla

y*

Wate

rcolo

rs

Soft p

lastice

ne

Oil p

aste

ls

Th

ick marke

rs

Colla

ge

Hard

pla

sticene

Th

in m

arke

rs

Colo

red

pen

cils

Pen

cils

1 2 3 4 5 6 7 8 9 10

*finger-paint

Pencil vs Pen Pencil

Gray mark Emotionally non-committal (vs colors) Safe, easily erased

Pen/markers Fixed, cannot be undone Decisive, commitment

Art ‘materials’ Paper

Fragile – can be cut, torn Easily manipulated – folded, wadded up Responsive, vulnerable, and open to change Different colors, textures

paper for learning disabilities, perceptual problems, visual impairments (high contrast)

Other ‘surfaces’ Blackboards, sidewalks, skin Sand trays Clay (always says ‘yes’)

ART is a powerful medium Drawings*

Person, self, family, home, school Sculptures

Tree vs forrest Islands to worlds

Shoe box self Collage Masks Life size tracing

collage

Masks…

sculpture

Study #1…CHILDREN’S FEARS

Multi Methods Design

Qualitative Quantitative

Data Collection Method

Draw & Tell Interviews

Fear Survey Schedule

Unit of Analysis Child Child

Data Analysis Approach

(within method)

Narrative analysis(structure)

Thematic analysis(content)

Number/types of fears, overall fearfulness

(compared to existing external normative values)

Data Analysis Approach

(across method)

Structure and content of Reported fears and children’s stories about fear overall fearfulness

Figure 3: Visual Model of Research Design

OO

CA R

C

E

Primary Experience

Meaning of the experience

The end

Sequence of events

How the situation was

solved

Who, when, what, where?

Labov’s Narrative Elements

Study #2…

Study #3…

Think about… Consent

Sharing children’s pictures Audio-recording

Digital vs microcassettes microphone

Storage Set up

U-shape table, small table, clipboard Paper size

Art paper is NOT sized for xeroxing

Using art to engage/relax children… Thumbprints Origami

Cup Flying bird

Gifts to take with them Compensation ‘thank you’ packs

A picture is worth a thousand words….

…but, only if we listen!

Personal reflection Children really are the best sources

of information about themselves Before we can ‘hear’ children, we

have to be willing and able to listen Listening is still one of the most

important (and relevant) tools in nursing’s armamentarium