Académique Documents
Professionnel Documents
Culture Documents
discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/223980347
CITATIONS
READS
147
2 AUTHORS, INCLUDING:
Brian Allen
Penn State Hershey Medical Center and Pen
24 PUBLICATIONS 205 CITATIONS
SEE PROFILE
Abstract
Clinical observations have suggested that children who experience physical or sexual abuse may provide indicators in their
drawings that can distinguish them from nonabused children. Some have even suggested that a childs drawings and the interpretive
testimony of a trained mental health clinician should be admissible in court as evidence of a childs abuse status. Many of these
comments, however, may reflect a limited consideration of the available research. The current article provides a comprehensive
literature review of the controlled research to determine whether any graphic indicators (e.g., genitalia, omission of body parts) or
predefined scoring system can reliability and validly discriminate abused from nonabused children. Results indicate that, although
individual studies have found support for various indicators or scoring systems, these results are rarely replicated, many times
studies finding significant results suffer from serious methodological flaws and alternative explanations for findings (e.g., mental
illness) are often present. No graphic indicator or scoring system possessed sufficient empirical evidence to support its use for
identifying sexual or physical abuse. A discussion of the legal ramifications of these results is provided.
Keywords
physical abuse, child abuse, sexual abuse, forensic interviewing, projective drawings
98
and justifications for their use. Twenty-eight participants
(90%) believed that childrens drawings were useful, some citing research suggesting the presence of sexually explicit material distinguishes sexually abused from nonabused children,
and that emotional upset at the drawing of the abuse suggests
molestation occurred.
Near the turn of the 21st century, the appropriate use of projective techniques in the assessment of child abuse was controversial. A significant advancement in this debate, however, was
the application of more sophisticated statistical techniques. A
meta-analysis by West (1998) examined 12 studies using projective techniques, including drawings, to discriminate whether
a child had experienced sexual abuse. She calculated an average effect size of d .81, commonly considered large (Cohen,
1988) and concluded that projective techniques are an effective
tool in identifying sexually abused children. However, Garb,
Wood, and Nezworski (2000a) point out that West systematically excluded all nonsignificant findings from her metaanalysis and calculated an effect size for only those findings
that resulted in significant statistical results. Garb, Wood, and
Nezworski (2000b) reanalyzed the data used by West, including all nonsignificant results from the identified studies, and
obtained a more modest estimated average effect size ranging
from .35 to .46.
The nature of the data used by West (1998) and Garb et al.
(2000b) prevents making definitive conclusions about the ability of projective drawings to detect child sexual abuse for three
primary reasons. First, many of the studies compared children
experiencing sexual abuse and displaying psychiatric symptoms to normative data or a control group of children not drawn
from a clinical sample. This leaves open the possibility that any
significant results may have detected emotional distress of
unknown origin as opposed to the experience of sexual abuse.
Second, the meta-analyses did not examine the type of test used
or the scoring system employed, but rather grouped findings
from all identified studies together. It is possible that one particular scoring system or graphic indicator did perform adequately across studies. Third, these meta-analyses were not
comprehensive. Many examinations of the utility of projective
drawings were inexplicably omitted from the West metaanalysis, and correspondingly from the Garb et al. analysis.
These limitations call for a comprehensive evaluation of the
research to determine the suitability of projective drawings in
the evaluation of child sexual abuse.
Numerous authors have evaluated the extant research pertaining to the use of drawings in determining the validity of
sexual abuse allegations. The results of these reviews vary
widely, from conclusions that drawings are useful in distinguishing victims from nonvictims (Burgess & Hartman,
1993; Cohen-Liebman, 1995; Miller et al., 1987), to those suggesting inconclusive findings (Hagood, 1994; Trowbridge,
1995; Veltman & Browne, 2002), and others eschewing the use
of these techniques for the identification of abuse (Murrie,
Martindale, & Epstein, 2009). However, each of these reviews
is limited in some way. Some draw primarily on case reports as
evidence (Burgess & Hartman, 1993; Miller et al., 1987), while
Procedure
Inclusion Criteria
The goal of this review was to identify and examine all studies
meeting each of the following criteria:
1.
2.
3.
4.
Literature Search
An exhaustive literature search was performed to identify studies meeting inclusion criteria. The PsycINFO, MEDLINE, and
Literature Review
Even though some protocols and techniques were evaluated
with sexually abused and physically abused populations,
results from these two populations may be expected to differ
because of the phenomenological differences in the experiences. As such, studies pertaining to these populations are
examined separately. Two primary methods of interpreting
childrens drawings are evident in the research: One focused
on identifying specific features of the childs drawing, or
graphic indicators, and the other attempting to define a scoring system or algorithm that can distinguish between abused
and nonabused children. A primary goal of this review is to
identify any scoring systems and/or graphic indicators of
childrens drawings that are consistently indicative of
abuse. Therefore, studies are grouped together based on the
type of assessment protocol utilized (e.g., human figure
drawings, kinetic drawings), and the scoring procedure evaluated. Finally, studies are evaluated in light of their methodological rigor, including interrater reliability, blinding of
the raters to participant condition, the degree of match
between the abused and control groups on extraneous factors (e.g., mental health status), and statistical procedures
employed.
99
100
Total Score
Total score
None
None
Lower LILIF score
Penis or vagina
EI category: anxiety
D-A-M: 4 indicators
HFD: Koppitz
H-T-P: 12 indicators
KFD: 12 indicators
Free Draw: 12 indicators
H-T-P: 12 indicators
KFD: LILIF
HFD: Koppitz
Significant Findings
None
None
Total Score
Total Score
None
Non-significant findings
89 CSA survivors
77 psychiatric controls
Technique: Scores
Note. D-A-M Draw-a-Man; DAP Draw-a-Person; HFD Human Figure Drawing; H-T-P House-Tree-Person; KFD Kinetic Family Drawing; LILIF Like to Live in Family rating procedure.
a
The three groups differed significantly on these variables, but no indication was provided regarding the differences between the three groups and the accurate classification of cases based on these variables was 43.14% and
49.02%, respectively.
b
This study included the subjective opinion of raters on 15 separate dimensions; however, only the two indicators identified here were of sufficient detail to accurately describe what was being rated.
Note. All significant findings indicate that the CSA groups scored significantly more maladaptive than the control group.
Study 2
Hackbarth, Murphy, and
McQuary (1991)
Hibbard and Hartman (1990a)
Hibbard and Hartman (1990b)
20 CSA survivors;
Sample
Study
101
exposure, for instance, drawing transparent clothes. In a more
psychoanalytic sense, some have suggested that drawing elongated objects, wedges, or circles are representative of a phallus,
which can cause harm (Malchiodi, 1990) and are suggestive of
sexual abuse. Only three identified studies examined these
indicators.
Sidun and Rosenthal (1987) examined a total of 74 indicators in their study of 30 psychiatric clients with CSA histories
and 30 psychiatric control clients. Among these indicators were
hands covering the pelvic region, trouser fly, circles, wedges,
and phallic-like objects. The only indicator significantly different between the two groups was the presence of a trouser fly;
however, the results ran opposite to the hypothesis with the
control group drawing more pictures with a trouser fly than the
CSA group. When combining circles (e.g., buttons on clothes,
balls, suns), wedges, and phallic-like objects (e.g., canes, cigarettes) into one composite score, analyses were able to distinguish between the two groups, with the CSA group drawing
significantly more of these objects than the control group. The
authors note that these results must be interpreted with caution
because the large number of analyses (80) could produce significant results at the p .05 level by chance at least 4 times.
Howe et al. (1987), in their study with runaway youth, studied a total of 20 indicators in the drawings of sexually abused
and nonabused children, including covering of the genital area,
transparent clothing, dark lines on the clothing around the genital area, and legs being pressed together or crossed. None of
these features distinguished the CSA group from the nonabused
group. Similarly, a study by Hibbard and Hartman (1990a) did
not find significant differences between the control group and
the CSA group on the number of drawings displaying transparencies or legs pressed together. These results do not support the
contention that sexually abused children draw more sexually
related graphic indicators than nonabused children. The only
significant finding in this realm (Sidun & Rosenthal, 1987)
required a composite scale of indicators to detect a significant
difference, and the number of analyses in the study significantly increased the possibility that this difference was
obtained in error.
Body parts/organization. Cohen-Liebman (1995) notes that
sexually abused children may draw elongated arms or legs as
a sign of victimization, omission of body parts as a sign of helplessness or abandonment, and disorganized body parts may
suggest a loss of control or severe psychopathology. Others
suggest that compartmentalization of the figure or individual
parts may suggest one is seeking protection (Miller et al.,
1987). As with sexually related features, only three studies
have examined these indicators.
The study by Hibbard and Hartman (1990a) included 16 of
these indicators, including the omission of numerous body
parts (e.g., eyes, arms, legs, feet, mouth, neck, hands), poor
integration of parts, big hands, short arms, long arms, and
asymmetrical limbs. None of these indicators discriminated
between the CSA and nonabused groups. Similarly, Howe
et al. (1987) found no evidence to suggest that sexually abused
102
children are more likely to draw incomplete figures, omit body
parts, or emphasize the face or hair. Sidun and Rosenthals
(1987) analyses were unable to find significant differences for
any overemphasized body parts, asymmetrical or abnormal
limb length, or the omission of fingers or eyes; however, they
did report two significant findings. First, the CSA group was
more likely than the control group to omit hands from their
drawings. Second, the control group displayed poorer body
integration than the CSA group, counter to the expectation that
CSA survivors would display poorer body integration. As
before, given the large number of analyses, it is quite possible
that these significant results were found in error. In summary,
the preponderance of available controlled research does not
demonstrate that the human figure drawings of sexually abused
children are any more likely than control groups of normal or
emotionally disturbed children to omit, display abnormal size,
or poorly integrate body parts.
Other indicators. Numerous other graphic indicators of sexual
abuse have been proposed and studied. In reviewing the controlled research, no studied indicators were replicated as more
often present in the drawings of sexually abused children.
Howe et al. (1987) found that sexually abused children may
be more likely to draw figures with less ambiguous gender and
to display a faint line quality; however, Sidun and Rosenthal
(1987) were unable to replicate the finding in regard to line
quality and did not find a significant difference in the drawing
of sexually undifferentiated figures. Additional findings suggest that the following graphic indicators do not differentiate
sexually abused and nonabused children: shading, monsters,
clouds, presence of teeth, slanting figure, small figure, big figure, and the use of color (Hibbard & Hartman, 1990a; Howe,
Burgess, & McCormack, 1987; Sidun & Rosenthal, 1987).
Composites. In addition to individual graphic indicators,
some researchers have constructed composite scores of indicators in an attempt to define a scale that may discriminate sexually abused from nonabused children. For instance, Cohen and
Phelps (1985) constructed a scale that included 12 individual
graphic items they hypothesized would manifest more frequently in the drawings of sexually abused children. Utilizing
the House-Tree-Person technique, they compared the total
number of these indicators present in the drawings of 89 CSA
survivors and 77 children receiving mental health services.
They found that the CSA group included significantly more
of these indicators than the control group; however, the actual
magnitude of the difference was small (less than .5 of an indicator) and only one rater scored each drawing. The authors conducted a second study, utilizing the drawings of 40 individuals
from each of the two groups. Initial results from this analysis
demonstrated that the interrater reliability between two scorers
was moderate (.51), prompting the researchers to use four raters
for each drawing and only count an indicator as present if at
least three raters agreed. Using this method, the composite
score of indicators did not discriminate between the sexually
abused and control groups. The moderate interrater reliability
Kinetic Drawings
Kinetic drawings, as the name implies, are designed to include
motion or an activity within the picture. The most popular of
these drawings is the Kinetic Family Drawing (KFD; Burns
& Kaufman, 1970), which asks children to draw their family,
including themselves, engaged in an activity. It is believed that
this type of drawing displays the interpersonal communication,
emotional support, and activities characteristic of the family
from the childs perspective (Peterson & Hardin, 1997). Only
three controlled studies were identified that examined the presence of specific indicators or a composite score of indicators in
the KFDs of sexually abused children.
Piperno, Di Biasi, and Levi (2007) examined the KFDs of 12
sexually abused children receiving mental health services and
12 control group children selected from local schools. The
drawings were scored for graphically expressive maturity,
omitted subjects, body distortions, identification roles, and
emotional proximity. Scoring involved a decision of present
or absent and, although the criteria were described in a general
sense, no procedures were defined in the article to aid the
reader in determining whether any one indicator was present.
One assessor administered and evaluated the drawings, and the
decisions of the rater were examined and approved by a clinical
team. A series of chi-squared analyses revealed significant differences between the groups on each of the identified indicators. In addition, the researchers constructed two scales,
depressive feelings and feelings of relationship anxiety and/
or anguish, which required the presence of at three of the five
indicators scored separate from the indicators listed above.
Again, the scoring of these scales was on a present or absent
basis. As before, significant differences were obtained for both
scales between the sexually abused and control groups. The
results of this study are limited due to the fact that raters do not
appear to have been blinded as to the childs abuse status and
the agreement among independent raters was not examined.
The authors note that the findings of this study do not support
Scoring Systems
Although individual graphic indicators appear the most popular
method of interpreting childrens drawings, others have
attempted to develop and validate a defined scoring system
in an effort to detect sexual abuse. Most often, these scoring
systems utilize a number of individual indicators and provide
summary scores. For the purposes of this review, a scoring system is defined as a published guide that directs investigators on
the features of indicators necessary for their scoring and the
proper method of computing a summary score. Two scoring
systems were identified in the literature that had been utilized
in controlled trials.
103
drawings (e.g., genitals, hands cut off), and omissions of typical features (e.g., no eyes, no arms). In her comparison of 76
public school children and 76 children receiving mental health
services, 8 of these features were significantly different at the
p < .05 level (poor integration, shading limbs, slanting figure,
tiny figure, big figure, short arms, hands cutoff, no neck).
Her most noteworthy conclusion was the finding that the
emotionally disturbed children drew significantly fewer
total indicators than their counterparts (p < .001). Although
this initial study had several limitations (e.g., one evaluator,
evaluation was not blind, the school children were selected
because of their superior academic and emotional functioning), Koppitz (1968) concluded her system was successful
and published a volume devoted to describing the appropriate manner of using her approach for screening childrens
human figure drawings.
Although she did not hypothesize that her scoring criteria
could discriminate sexual abuse, two studies have evaluated
the use of these indicators for that purpose. Hibbard and
Hartman (1990a) examined the drawings of 65 alleged victims of sexual abuse and 64 children drawn from general
medical clinics. In addition to not finding any significant
individual indicators (as noted above), no significant difference was found for the total number of indicators drawn.
Additionally, they examined differences in the scores of the
emotions/behaviors categories proposed by Koppitz (1984)
for classifying the indicators according to their presumed
underlying emotional symptom (impulsivity, insecurity/inadequacy, anxiety, shyness/timidity, anger/aggressive). The only
significant finding was that the sexually abused group scored
higher on the anxiety category. Given that the authors performed over 35 separate statistical analyses in this study, it
raises the possibility that this lone significant result was
found in error.
Chantler, Pelco, and Mertin (1993) collected human figure
drawings from 26 sexually abused children, 37 children receiving therapy, and 39 children attending a public school. They
examined whether the total score of Koppitz indicators could
effectively discriminate between the three groups. Although
they found that the sexually abused group drew the most indicators (p < .001), a discriminant function analysis found that
these indicators classified children in their correct group only
43% of the time. They also examined the utility of total red flag
items, those indicators that Koppitz (1968) identified as being
especially indicative of emotional problems. As before, they
found that the sexually abused group drew significantly more
of these items (p < .01), but correct classification rate was only
49%. These findings contradict the results of Hibbard and Hartman (1990a), suggesting that a definitive conclusion is not
available. However, Chantler and colleagues demonstrated
that, even with a statistically significant difference, the use of
the total score or total red flag items by clinicians may lead
to more incorrect classifications of cases than correct ones.
These results do not support using the Koppitz total score, emotions/behaviors categories, or red flag item total score, to assess
for a history of sexual abuse.
104
105
None
None
Three indicators, including: incomplete figures, disproportionate size of family
members, disproportionate size of self in
relation to family
KFD: Burns
KFD: 33 indicators
FKD: Manning
DAP: 17 indicators
DAP: 8 indicators
DAP: Koppitz
Significant Findings*
None
None
Nonsignificant findings
Note. DAP Draw-A-Person; ED emotionally disturbed; FKD Favorite Kind of Day; HFD Human Figure Drawing; H-T-P House-Tree-Person; KFD Kinetic Family Drawing; KGD Kinetic Group Drawing; LD
learning disabled.
a
The authors reported only that there were significant differences among the three groups, but did not complete pair-wise comparisons to delineate which groups were significantly different; however, in each of the
significant findings they note the physically abused group scored the highest.
b
Not all studied indicators were reported by the authors.
Note. All significant findings indicate that the CPA groups scored significantly more maladaptive than the control group, at the p < .05 level.
H-T-P: 15 indicators
H-T-P: 15 indicators
Technique: Scores
Sample
Study
106
treatment, 32 nonabused children receiving mental health treatment, and 45 children selected from a local school. When comparing the abused group with the school group, analyses
showed that abused children were significantly more likely to
omit feet from their drawings; however, this difference was not
observed when the abused group was compared to the nonabused clinical group. These results suggest that the omission
of feet may be attributable to the status of receiving mental
health services as opposed to the experience of physical abuse.
Taken together, there is no replicated evidence to suggest that
omitting a bodily feature from a drawing distinguishes physically abused children from their nonabused peers.
Kinetic Drawings
Controlled research has studied a number of different
approaches to interpreting the kinetic drawings of physically
abused children. Veltman and Browne (2003) examined the
kinetic family drawings of 6 physically abused children and
12 children drawn from local schools for the presence of 33
indicators originally cataloged by Peterson and Hardin
(1997). Of these, they found significant differences for only
three: incomplete figures, disproportionate size of family members, and disproportionate size of self in relation to family.
Prino and Peyrot (1994) found that physically abused children
were more likely to omit feet and noses from a kinetic group
drawing, but found no differences for the omission of mouth
or presence of teeth. Piperno et al. (2007) observed significant
differences between 12 physically abused children receiving
therapy and 12 normal controls for each of their four indicators
(graphic-representative immaturity, omission of subjects, body
distortion, emotional proximity) and two scales (depression,
anxiety); however, as noted above, the scoring criteria used
by Piperno et al. was vague and it is unclear what constituted
the presence or absence of an indicator.
None of the identified significant findings have been replicated and conflicting evidence exists in the case of some of
these findings. For instance, the study by Veltman and Browne
(2003) did not find significant differences for the omission of
persons, distorted limbs, and a scale of feeling/mood, which
appears to contradict the Piperno et al. findings pertaining to
omission of subjects, body distortion, and scales of emotional
functioning. It is also unclear if significant findings are indicative of physical abuse or the result of emotional disturbances
that may be observed in nonabused children. In addition, a
study by Veltman and Browne (2001) found that raters were
unable to distinguish maltreated children from nonmaltreated
children by identifying the number of indicators present in their
drawings and had an exceptionally high false identification
rate. At the present time, the available controlled research does
not support the interpretation of kinetic drawings as a tool in
identifying physical abuse.
Conclusions
The use of childrens drawings in determining sexual or physical abuse was initially supported by case reports and uncontrolled research, leading many to assert that clinical
interpretation was a valid approach to identifying signs of
abuse. Controlled research, which more systematically examines the differences between abused and nonabused children,
107
was slower to develop. Over the past 30 years, controlled
research examined various scoring systems and individual graphic indicators. The quality of these studies varied widely and,
accordingly, interpretations of the findings are often difficult.
Previous reviews and commentaries commonly singled out significant findings as evidence of the validity of this approach
and neglected contradictory findings, methodological weaknesses, and poor reliability.
Although many studies found myriad significant findings
(e.g., omitted hands, poor body integration), other trials failed
to observe similar results. In addition, as the methodological
rigor of the study increased, the likelihood of finding significant results decreased. The failure of consistent replication,
especially under more rigorous conditions, suggests the likelihood of erroneous findings. Therefore, one cannot assert from a
scientific perspective that any identified indicator or scoring
system is valid for the purpose of identifying child sexual or
physical abuse.
The most often identified and studied indicator of sexual
abuse in children is the explicit drawing of genitalia. The result
of this review suggests contradictory findings. A series of studies by Hibbard and colleagues (1987, 1990a, 1990b) found a
significant difference only once and identified a nonsignificant
trend in the other two studies, with sexually abused children
drawing a penis or vagina more often than their nonabused
peers. Studies by other researchers were unable to find significant results or identify trends, including two studies that utilized a clinical control group (as opposed to the Hibbard and
colleagues studies that utilized a nonclinical control group).
Although many clinicians believe the drawing of explicit genitalia is suggestive of a history of sexual abuse (Oberlander,
1995), the current review finds that the sensitivity of this technique to the experience of sexual abuse is poor as very few
sexually abused children actually draw explicit genitalia. Even
findings that did suggest possible merit, observed relatively
small differences between the abused and nonabused groups.
Therefore, even if drawings of genitalia are more common
among sexually abused children, the rarity of such drawings
and the significant likelihood of incorrectly classifying a child
as sexually abused, discourage the use of this indictor in
assessment.
As well as problems with the validity of interpreting drawings to detect abuse, many of the identified indicators and scoring systems displayed poor interrater reliability. Sufficient
interrater reliability is generally considered .80 or greater (Heiman, 1999; Landis & Koch, 1977). Many of the studies identified failed to report interrater reliability; however, those that
did displayed a wide variation. Although some individual indicators displayed acceptable interrater reliability, none of the
scoring systems examined consistently reported reliabilities
above .80. This suggests that, even when using a defined scoring system or graphic indicator, results may depend a great deal
on the judgment of the clinician interpreting the drawings.
Proponents of the interpretive value of drawings maintain
that other factors also must be considered when evaluating for
a history of abuse, such as interviews and collaborative reports
108
(Cohen-Liebman, 1999; Peterson & Hardin, 1997). In other
words, projective drawings may be only another piece of information to consider. However, the consideration of invalid and
unreliable forms of data may reduce the accuracy of ones judgment; more information is not always better if the information
is poorly suited for answering the question at hand (Erickson,
Lilienfeld, & Vitacco, 2007). The poor reliability and validity
demonstrated by projective drawings suggests that giving
weight to these techniques may reduce the accuracy of ones
judgment. For instance, Chantler et al. (1993), in the only identified study of its kind, compared the predictive accuracy of the
Louisville Behavior Checklist (LBC; an objective standardized
questionnaire) to the number of Koppitzs red flag indicators
present in childrens drawings. Using the LBC, 75% of children
were correctly classified as sexually abused, nonabused and
emotionally disturbed, or nonabused and nondisturbed. The
total number of Koppitz red flag indicators correctly classified
49% of children. When used in combination, the number of red
flag indicators and the LBC correctly classified 77% of the
children; a minimal improvement over the LBC alone.
Although confidence intervals were not provided, the small
magnitude of difference between the combination of scores and
only the LBC suggests little, if any, benefit to the addition of
the Koppitz flag indicators. However, given that clinicians
rarely use statistical or algorithmic procedures when arriving
at conclusions, it may be expected that weight given to results
of the Koppitz indicators during the assessment procedure may
actually reduce the accuracy of ones assessment than if the
LBC was used solely.
The poor results found for the interpretation of childrens
projective drawings should not detract from other uses of drawings. For instance, some research suggests that children may
provide more details of an event if asked to draw the event
or are shown a human figure drawing after providing a verbal
description of their experience (Aldridge, Lamb, Sternberg,
Orbach, Esplin, & Bowler, 2004; Katz & Hershkowitz,
2010). Although still in need of further research, these
approaches utilize drawings as aids in prompting child recall.
The current literature review demonstrates that attempts to
identify projective indicators of sexual and physical abuse in
drawings completed by children are not supported by the existing evidence.
Legal Implications
Practitioners are urged to carefully consider the results from the
current review. While the implementation of psychological
tests, and use of projective drawings, continues in forensic
assessment, the court system has been involved in the ongoing
development of criteria for admissibility of expert testimony.
In order to be accepted as an expert, the professional should
have scientific, technical, and/or specialized knowledge that
will assist the fact finder with the legal question.
The original legal standard developed to guide expert testimony was Frye v. United States (1923), which states that an
expert opinion should be based on procedures that have
Funding
The authors received no financial support for the research, authorship,
and/or publication of this article.
References
Aldridge, J., Lamb, M. E., Sternberg, K. J., Orbach, Y., Esplin, P. W.,
& Bowler, L. (2004). Using a human figure drawing to elicit information from alleged victims of child sexual abuse. Journal of Consulting and Clinical Psychology, 72, 304316.
*Blain, G. H., Bergner, R. M., Lewis, M. L., & Goldstein, M. A.
(1981). The use of objectively scorable House-Tree-Person
109
indicators to establish child abuse. Journal of Clinical Psychology,
37, 667673.
*Blanchouin, C., Olivier, M.-C., Lighezzolo, J., & de Tychey, C.
(2005). Dysharmonie devolution, abus sexuel et dessin: approche
comparative chez lenfant par la grille diagnostique de Van Hutton.
Annales Medico Psychologiques, 163, 465475.
Buck, J. N. (1948). The H-T-P technique: A qualitative and quantitative scoring manual. Journal of Clinical Psychology, 4,
317396.
Burgess, A. W., & Hartman, C. R. (1993). Childrens drawings. Child
Abuse & Neglect, 17, 161168.
Burgess, A. W., McCausland, M. P., & Wolbert, W. A. (1981). Childrens drawings as indicators of sexual trauma. Perspectives in
Psychiatric Care, 19, 5057.
Burns, R. C. (1982). Self-growth in families. New York, NY: Brunner/
Mazel.
Burns, R. C., & Kaufman, S. M. (1970). Kinetic Family Drawing
(K-F-D): An introduction to understanding children through
kinetic drawings. New York, NY: Brunner/Mazel.
*Chantler, L., Pelco, L., & Mertin, P. (1993). The psychological
evaluation of child sexual abuse using the Louisville Behavior
Checklist and human figure drawing. Child Abuse & Neglect,
17, 271279.
*Cohen, F. W., & Phelps, R. E. (1985). Incest markers in childrens
artwork. Arts in Psychotherapy, 12, 265283.
Cohen, J. (1988). Statistical power analysis for the behavioral
sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.
Cohen-Liebman, M. S. (1995). Drawings as judiciary aids in child sexual abuse litigation: A composite list of indicators. Arts in Psychotherapy, 22, 475483.
Cohen-Liebman, M. S. (1999). Draw and tell: Drawings within the
context of child sexual abuse investigations. Arts in Psychotherapy, 26, 185194.
Committee on Ethical Guidelines for Forensic Psychologists. (1991).
Specialty guidelines for forensic psychologists. Law and Human
Behavior, 15, 655665.
Committee on the Revision of the Specialty Guidelines for Forensic
Psychology. (2011, March 18). Specialty guidelines for forensic
psychologists, [6th draft]. Retrieved from http://www.ap-ls.org/
aboutpsychlaw/3182011sgfpdraft.pdf
Conte, J. R., Sorenson, E., Fogarty, L., & Rosa, J. D. (1991). Evaluating childrens reports of sexual abuse: Results from a survey of
professionals. American Journal of Orthopsychiatry, 61, 428437.
*Culbertson, F. M., & Revel, A. C. (1987). Graphic characteristics on
the Draw-A-Person test for identification of physical abuse. Art
Therapy, 4, 7883.
Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S.
Ct. 2786 (1993).
DiLeo, J. H. (1973). Childrens drawings as diagnostic aids. New York,
NY: Brunner/Mazel.
Erickson, S. K., Lilienfeld, S. O., & Vitacco, M. J. (2007). A critical
examination of the suitability and limitations of psychological tests
in family court. Family Court Review, 45, 157174.
Federal rules of evidence. (1992). Boston: Little, Brown.
Federal rules of evidence, 28, U.S.C. (West, 1975).
Federal rules of evidence, 702 (2011).
110
Finkelhor, D., Hotaling, G., Lewis, I. A., & Smith, C. (1990). Sexual
abuse in a national survey of adult men and women: Prevalence,
characteristics, and risk factors. Child Abuse & Neglect, 14, 1928.
Frye v. United States, 292 F. 1013 (D.C. Cir. 1923).
Garb, H. N., Wood, J. M., & Nezworski, M. T. (2000a). Letter to the
editor: Projective techniques and the detection of child sexual
abuse. Child Abuse & Neglect, 24, 437438.
Garb, H. N., Wood, J. M., & Nezworski, M. T. (2000b). Projective
techniques and the detection of child sexual abuse. Child Maltreatment, 5, 161168.
General Electric Co. v. Joiner, 118 S. Ct. 512 (1997).
Goodenough, F. (1926). Measurement of intelligence by drawing.
Yonkers, NY: World Book.
Goodwin, J. (1982). Use of drawings in evaluating children who
may be incest victims. Children and Youth Services Review,
4, 269278.
*Hackbarth, S. G., Murphy, H. D., & McQuary, J. P. (1991).
Identifying sexually abused children by using Kinetic Family
Drawings. Elementary School Guidance and Counseling, 25,
255260.
Hagood, M. M. (1994). Diagnosis or dilemma: Drawings of sexually
abused children. Art Therapy, 11, 3742.
Hammer, E. F. (1958). The clinical application of projective drawings. Oxford, England: Charles C. Thomas.
Heilbrun, K. (1992). The role of psychological testing in forensic
assessment. Law and Human Behavior, 16, 257272.
Heiman, G. W. (1999). Research methods in psychology (2nd ed.).
Boston: Houghton-Mifflin.
*Hjorth, C. W., & Harway, M. (1981). The body-image of physically
abused and normal adolescents. Journal of Clinical Psychology,
37, 863866.
*Hibbard, R. A., & Hartman, G. L. (1990a). Emotional indicators in
human figure drawings of sexually victimized and nonabused
children. Journal of Clinical Psychology, 46, 211219.
*Hibbard, R. A., & Hartman, G. L. (1990b). Genitalia in human figure
drawings: Childrearing practices and child sexual abuse. Journal of
Pediatrics, 116, 822828.
*Hibbard, R. A., Roghmann, K., & Hoekelman, R. A. (1987). Genitalia in childrens drawings: An association with sexual abuse.
Pediatrics, 79, 129137.
*Howe, J. W., Burgess, A. W., & McCormack, A. (1987). Adolescent
runaways and their drawings. Arts in Psychotherapy, 14, 3540.
Katz, C., & Hershkowitz, I. (2010). The effects of drawing on childrens
accounts of sexual abuse. Child Maltreatment, 15, 171179.
Kelley, S. J. (1984). The use of art therapy with sexually abused children. Journal of Psychosocial Nursing, 22, 1218.
Koppitz, E. M. (1966). Emotional indicators on human figure drawings of children: A validation study. Journal of Clinical Psychology, 22, 466469.
Koppitz, E. M. (1968). Psychological evaluation of childrens human
figure drawings. New York, NY: Grune & Stratton.
Koppitz, E. M. (1984). Psychological evaluation of human figure drawings of middle school pupils. New York, NY: Grune & Stratton.
Kumho Tire v. Carmichael, 119 S. Ct. 1167 (1999).
Lally, S. J. (2001). Should human figure drawings be admitted into
court? Journal of Personality Assessment, 76, 135149.
111
Bios
Brian Allen, PsyD, is an assistant professor in the department of psychology at Sam Houston State University. His research interests are in the
areas of personality development following childhood trauma, the applications of attachment theory to clinical practice with maltreated children,
and the development, implementation, and dissemination of evidencebased practices for children. His research has been published in outlets
such as Child Maltreatment, Journal of Traumatic Stress, Trauma, Violence, & Abuse, and Journal of Interpersonal Violence, among others. He
provides training to doctoral students in the use of Trauma-Focused CognitiveBehavioral Therapy and ParentChild Interaction Therapy, and
maintains a small practice utilizing these interventions.
Chriscelyn Tussey, PsyD, is the director of psychological assessment in
the department of psychiatry at the New York University/Bellevue Hospital Center. Her research and clinical interests are in the areas of civil and
criminal forensic assessment and neuropsychological assessment, symptom validity testing in psychiatric populations, and public policy
informed by the interface of psychology and law. She currently provides
supervision to graduate students and doctoral interns in the administration and interpretation of psychological instruments and assessment
procedures.