Sketching Silence: Exploring the Use of Children's Drawings as an Early Bullying Detection Tool

Can an innovative projective drawing test assist children in disclosing their bullying exposure? Bullying leads to recurrent emergency department visits for physical or emotional trauma, hindered by children's reluctance to verbalize. Identifying patterns, referred to as graphic indicators, can characterize forms of trauma linked to bullying.

Sixty-four children aged 7 to 18 years with psychosomatic complaints at a pediatric hospital emergency department were asked to draw themselves on paper. Drawings were scored blindly by counting the frequency of 22 graphic indicators on self-figure drawings used to assess various forms of child abuse. Children were categorized using the Illinois Bully Scale score. Discriminant analysis evaluated the relative weighting of the 22 graphic indicators, aiming for optimal discrimination between the bullied and non-bullied groups. ROC analysis was utilized to maximize the diagnostic accuracy of the drawing test.

Four graphic indicators emerged as potential markers of bullying: (1) missing legs or feet, (2) dots, hollowed or crossed eyes, (3) double line, hollowed, or shaded facial contours, and (4) asymmetric or horizontal arm positions. Discriminant scores ranged from 0.00 (indicating no bullying) to 4.76 (indicating bullying). The criterion separating the two groups was a discriminant score >1.90. The resulting area under the curve was 0.88 ( P < 0.001), indicating good predictive ability. The test demonstrated a sensitivity of 69% and a specificity of 91%.

Identifiable drawing cues in children may signal bullying, highlighting the need for further research to develop a standardized tool for early identification of bullying exposure before it can be applied in practice.