An Assessment of Drawing Age in Pre-School Children Using ‘ Draw-A-Man ’ Test

Introduction: Goodenough-Harris ‘Draw-a-Man’ Test has been traditionally used as a simple tool to measure mental development in a child. There have very few studies looking at utility of ‘Draw a man’ test in the Indian subcontinent in the recent past. We carried out an assessment of correlation of drawing age with chronological age in pre-school children by the ‘Drawaman test’ and looked for any associations with respect to a deviation (delay or advancement) in the calculated drawing age. Materials and Methods: A cross-sectional descriptive study was conducted on 100 neurologically normal pre-school children between 36 to 72 months. The data was then analyzed with Pearson correlation and Chi square test on SPSS version 14.0 Result: There was a low positive correlation between drawing age and chronological age (Pearson correlation: r=+0.31, p=0.002).There were more boys (p=0.004) and more children with prematurity (p=0.012) in the group with low or equal drawing age compared to chronological age. Conclusion: In view of the low positive correlation found in our study, further studies with a larger sample need to be conducted to establish the ‘Draw-a-man’ test as a screening tool for mental age assessment in our subcontinent. We did find a significant association of deviation of drawing age from chronological age with respect to gender and prematurity.


Introduction
G oodenough-Harris 'Draw-a-Man' test has been used as a simple tool to measure mental development. It is a drawing test that gives informa on about the general ap tude level of young children. This is based on the fact that the nature and content of children's drawings are dependent primarily upon intellectual development. In the drawings of young children, a close rela onship exists between concept development and general intelligence. Drawing is a form of expression and a child draws what he knows. The child exaggerates the size of objects which seem interes ng or important and marked sex diff erences, usually in favor of the girls, are frequently observed. The drawing tests have been used since its concep on by Florence L Goodenough early in the 20 th century for a variety of evalua on such as those of personality, sensory deviates, intellectual development and learning diff erences 1,2,3,4,5,6 . Today, the children are exposed to a variety of environments against a backdrop of varying genotypic infl uences. Factors which may infl uence the cogni ve func ons include socio-economic status, parental educa on level, early preschool or play school infl uence, infl uence of television, birth order etc. The various environmental infl uences may advance or retard the age interpreta on by this test. There have been very few studies looking at either the correla on of drawing or This work is licensed under a Creative Commons Attribution 3.0 License. mental age assessed by Goodenough-Harris 'draw a man' test with chronological age in children from Indian subcon nent in the current context or a study aiming to look at any associa ons for a delay or advancement of age. With this background, the study was conceived to assess the u lity of this simple and innova ve test to assess mental age and also to look for any specifi c associa ons with respect to mismatch between the actual chronological age and age assessed by the 'Draw-a-Man' test.

Materials and Methods
A cross-sec onal descrip ve study was conducted in a medical college and hospital in western India over a two month period to look at the correla on of age assessed by the Goodenough 'Draw-a-man' test and actual chronological age in neurologically normal pre-school children and to fi nd any associa ons towards the reasons for their deviance from normal. We assumed that the Draw-a-man' test would give a reasonably good es mate of the mental age. A sample of 100 children between 36 and 72 months were taken (sample size based on the primary objec ve of assessment of correla on, taking a possible correla on coeffi cient of 0.5, α=0.05 and power of 0.8). The children w e r e recruited into the study f r o m immuniza on clinics, OPD and one pre-nursery school. Informa on with respect to the demographic profi le and other study variables were collected using a pre-designed performa and mental age evaluated by the 'Draw-a-man' test. The data was analysed using appropriate sta s cal tests with the help of SPSS version 14.0.

Results
The study popula on consisted of 100 children who were taken from the immuniza on clinic, OPD and one pre-nursery school. The profi le of children studied is depicted in Table 1.The Male: Female ra o was 1.78:1. 94% children were of the birth order 1 or 2.85% children were born term.Only few (15%) had no outdoor play. 55% children had more than 1 hour of TV viewing. 84% children were going to formal schools. 91% of children had educated parents and 51% children belonged to upper middle socio-economic status.
The mean (SD, 95% CI) of the chronological age and drawing age in months were 58.95(7.34, 57.49−60.41) and 58.76 (10.39, 56.68−60.84) which showed no signifi cant diff erence. In a comparison of drawing age with chronological age in the children, there were 50% who had equal or low age and 50% who had higher mental age compared to the chronological age. There was a low posi ve correla on between drawing age and chronological age.The r value (Pearson correla on coeffi cient) was +0.31(p=0.002).
The associa on of drawing age with various factors is depicted in Table 2. The associa on of drawing age (advanced or delayed) with sex showed that the percentage of children with advanced drawing age was more in case of girls than in boys with a signifi cant p value (0.004). Drawing age was low in most of the children born preterm when compared to term (p=0.012). Comparison for outdoor play showed that children who did not have outdoor play had more likelihood of low drawing age (66% children who did not play had equal or low drawing ages). However, it was not sta s cally signifi cant. Comparison for parental educa on also showed that children who had un-educated parents had a risk of equal or low drawing age (66% children who had uneducated parents had equal or low drawing age) but this too was not sta s cally significant.

Discussion
Goodenough 'Draw-a-Man' test has been tradi onally used as a simple tool to measure mental development [1][2][3][4][5][6] . There have been studies which showed good correla on between mental age assessed by 'draw a man' test with tests of IQ such as Stanford-Binet test with correla ons ranging from 0.45 to 0.72 7,8,9,10 . Hence we presumed that the 'draw-a -man' test could give us a good es mate of the mental age. With this assump on we wanted to assess the correla on of mental age with chronological age and see whether there were any signifi cant associa ons between selected variables with respect to a devia on in mental age in today's context in our country.
Our study popula on consisted of 100 children between the age group of 36-72 months. There were more male children in our study (M: F= 1.78:1). We had fewer children who had 'no educa on' (16%) as opposed to children with 'some form of educa on' (84%). We had less number of children in the group whose parents were uneducated or belonged to poor socio-economic strata. This distribu on of sample popula on could have aff ected our results. In our study, there was a low posi ve correla on between drawing age and chronological age (r= +0.31, p=0.002) though there was no signifi cant diff erence between the mean chronological age and drawing age. Fi y percent children had advanced drawing age and 50 % had equal or low age compared to the chronological age. This could have been because of any of the factors men oned in Table 2. In a similar study by Basgul et al, 75 out of 175 (42.85%) children had same or high drawing age and 100 out of 175 (57.14%) had low drawing age 11 . In their study, low birth weight and lack of formal schooling was associated with lower drawing age. In our study, there were more boys (p=0.004) and more children with prematurity (p=0.012) in the group with low or equal drawing age compared to chronological age.There was also a sta s cally insignifi cant associa on of the low or equal drawing age with lack of outdoor play(66% Vs 33%, p=0.161) and absence of parental educa on(66% Vs 33%, p=0.134). Birth order, TV viewing, child's educa on and parent's socio-economic status did not have a sta s cally signifi cant associa on with mismatch in drawing age and chronological age. Our study showed a low posi ve correla on between drawing age and chronological age and we found a signifi cant mismatch between the two ages with respect to prematurity and gender. An important limita on of our study was that we assumed that the 'Draw-a-man' test would correlate reliably with the mental age. This need not have been correct and could have been addressed if we had carried out a formal mental age assessment of the children as part of the study. However, this was not possible due to the nature of the study.

Conclusion
This study showed a low posi ve correla on between drawing age and chronological age and we found a signifi cant mismatch between the two ages with respect to prematurity and gender. We suggest larger studies evalua ng the rela onship between drawing age assessed by the 'Draw-a-man' test, mental age assessed by formal psychological assessment and chronological age and analyzing factors responsible for the devia on in the various ages, to validate our fi ndings and establish the role of Goodenough-Harris 'Draw-a-man' test.