INVESTIGATION OF THE DEVELOPMENTAL STAGE AND RELIABILITY OF HUMAN FIGURE DRAWINGS IN EARLY CHILDHOOD

Ş. Tükel Akay¹, A.C. Eliasson², S. Can³, E. Oral⁴

¹İzmir University of Economics, Department of Physiotherapy and Rehabilitation, İzmir, Turkey, ²Karolinska Institutet, Department of Women’s and Children’s Health, Stockholm, Sweden, ³İzmir University of Economics, Department of Psychology, İzmir, Turkey, ⁴İzmir University of Economics, Child Development Program, İzmir, Turkey

Background: Human figure drawing (HFD) is a task that children willingly perform and is easy to implement in clinical and educational settings. The development of HFDs in the preschool period is classified into six stages (1-scribble, 2-pre tadpole, 3-tadpole, 4-transitional, 5-conventional-I, 6-conventional-II). In the previous study, these stages were shown to be mainly based on visuomotor development, as well as moderately correlated with performance intelligence quotient and general motor ability. In addition, the predictive validity of HFD classification was shown in preterm children.

Purpose: This study aims to identify the age and gender stratification and to measure the inter-rater and test-retest reliability of the HFD developmental stages.

Methods: A total of 269 children, 134 boys and 135 girls, aged between 2 years 4 months and 6 years 6 months, from 16 different public and private preschool education centers participated in the study. Given the same instruction, all children were asked to draw a human figure. Seventy percent of children (n=191) performed HFDs two times one week apart. The effects of age and gender on the developmental stage of HFD were evaluated by linear regression analysis. Age and gender stratification of HFD developmental stages was analyzed by frequency analysis. The mean percentage of agreement is calculated for two raters and the intra-class correlation coefficient (ICC) was calculated for the inter-rater and the test-retest reliability.

Results: Age and gender were found to be important determinants of HFD developmental stages in the preschool period (R²=0.51, F=36.7, p<0.05). Examining the distribution of HFD stages according to age and gender, at the age of 2 years both genders produced no recognizable figure (stage-1:scribble), at the age of 3 years boys produced stage-3: tadpole figures (57%) while girls produced stage-2: pre-tadpole figures (57%), at the ages of 4 and 5 years stage-4: transitional figures were produced by boys (47% and 53% subsequently) and girls (50% and 51% subsequently), lastly at the age of 6 years stage-5: conventional-I figures were produced by boys (70%) and girls (89%). The average percent of agreement of the raters was 77%. The ICC for the inter-rater reliability was 0.93 (95% CI: 0.90-0.96, p<0.001), for the test-retest reliability was 0.72 (95% CI: 0.64-0.78, p<0.001).

Conclusions: When age and gender stratification of HFD developmental stages was examined in the Turkish sample, girls were found to be delayed at 3 years of age but then they caught up and even got better at the age of 6 years. Inter-rater reliability of the HFD developmental classification was found to be excellent, and test-retest reliability was found to be moderate.

Implications: HFD developmental classification is a reliable tool to screen visuomotor development between the ages of 3-6. Physiotherapists can use this simple tool to identify children with fine motor delay and receive this finding as a call to further their evaluations of the motor system.

Funding acknowledgements: No funding was received for conducting this study.

Keywords:
Visuomotor
Pediatrics
Developmental delay

Topics:
Paediatrics
Intellectual disability
Neurology

Did this work require ethics approval? Yes

Institution: Izmir University of Economics

Committee: The Science and Engineering Research Ethics Committee

Ethics number: B.30.2.IEUFMB.0.05.05-020-042