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Children's drawings as a measure of anxiety level: a clinical pilot study
Arto Puura1, Kaija Puura, Michael Rorarius
1Department of Anaesthesiology, District Hospital of Valkeakoski, Tampere, Finland. arto.puura@pshp.fi
Insights
Children's drawings can identify those needing premedication. Agitated children showed higher anxiety scores in drawings upon hospital arrival, indicating a potential diagnostic tool for preoperative anxiety.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Medical Diagnostics
Background:
- Distinguishing children requiring premedication is challenging.
- Preoperative anxiety assessment in pediatric patients lacks simple methods.
- This study explored using children's drawings to gauge anxiety levels.
Purpose of the Study:
- To evaluate the utility of children's drawings in assessing preoperative anxiety.
- To determine if drawing analysis can identify children needing sedative premedication.
- To correlate drawing-based anxiety scores with observed agitation levels.
Main Methods:
- Sixty children (4-7 years) undergoing adenoidectomy were assessed.
- Children were grouped by agitation during venous cannulation (AGIT vs. CALM).
- Drawings were analyzed for anxiety indicators at three time points; premedication (diazepam, placebo, none) was administered.
- A 10-point anxiety score was derived from drawing features (size, line, color, clarity).
Main Results:
- Agitated children exhibited significantly higher drawing anxiety scores upon hospital arrival (P=0.029).
- No significant differences in anxiety scores were found between premedication groups.
- Drawing analysis showed potential in differentiating anxiety levels based on observed behavior.
Conclusions:
- Children's drawings can serve as a tool to identify those who may benefit from sedative premedication.
- This method may be valuable when routine premedication is not administered.
- Drawing analysis offers a non-invasive approach to assessing preoperative anxiety in young children.
Background:
No simple method exists to distinguish children in need for premedication. The present study was planned to detect preoperative anxiety levels of children by rating their drawings.
Methods:
Sixty ASA I children aged 4-7 years undergoing adenoidectomy were divided into AGIT and CALM groups according to agitation level observed during venous cannulation. All children drew a picture at three different times: (i) just after arrival in the day-case unit, (ii) 10 min before operation and, (iii) prior to leaving for home. The children were also randomized to three premedication groups: group D, rectal diazepam 0.5 mg x kg(-1); group P, 0.9% NaCl 0.1 ml x kg(-1) rectally; group NT, no premedication. Five features (size of the drawing, form of the drawing line, colors used, mark of the pen and clarity of the picture) from the children's drawings were rated with a 3-point scale. The ratings of each feature were made to form a sum score of anxiety ranging from 0 to 10. In the analysis of variance for repeated measures both the premedication group and agitation score were taken into the model as factors.
Results:
The anxiety score of the drawings of the agitated children (during venous cannulation) was significantly higher already after arrival in the hospital [AGIT 4.76 (95% CI: 3.56-5.96) Vs CALM 3.67 (95% CI: 2.97-4.37) P = 0.029], but there were no statistical differences between the different premedication groups.
Conclusions:
When routine sedative premedication is not used the drawings of the children might detect the children needing sedative premedication.
