integrating ‘art’ into research with children martha driessnack phd, pnp-bc pediatric nursing:...
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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