How Drawing to Distract Improves Mood in Children.

Previous research has shown that drawing improves short-term mood in children when used to distract from rather than express negative thoughts and feelings. The current study sought to examine (a) how drawing might elevate mood in children ages 6-12 by examining the role played by absorption, enjoyment, and perceived competence as well as entering an imaginary world; and (b) whether children spontaneously use drawing to distract from a sad mood. Across three studies, children were asked to think of a disappointing event. After a sad mood induction, they drew for 5 min. Mood was measured before and after the mood induction and after drawing. Three main findings emerged. First, drawing to distract led to greater absorption and enjoyment than did drawing to express. Second, children's mood improved equally when drawing imaginary and real scenes showing that the key ingredient is that the content of the drawings be distracting in nature. Third, drawing improved mood even when children were given no instructions on the content of their drawings and children were more likely to use drawing as a way to distract themselves from a sad mood. These studies help to define the characteristics of drawing activities that foster mood improvement in children and highlight the important role of the arts in emotion regulation.

Posttraumatic Stress Disorder Diagnosis in Young Children With Burns.

The primary aim of this study was to assess the prevalence of posttraumatic stress disorder (PTSD) in young children hospitalized for burns. A secondary aim was to assess partial PTSD in this population. PTSD diagnosis and symptoms were evaluated utilizing both the diagnostic interview for children and adolescents (DICA-P) module and the PTSD semistructured interview and observational report (PTSDSSI). PTSD symptomatology was assessed from parent interviews at 1 month after discharge from a major pediatric burn center. Four of the 42 participants who completed the DICA-P met full criteria for a diagnosis of PTSD (10%).Of the 39 who also completed the PTSDSSI, 1 (3%) met full criteria for PTSD diagnosis on that measure. Twenty-seven percentage of subjects met partial criteria on the DICA-P vs 16% on the PTSDSSI, without impairment. Furthermore, 67% of subjects met DICA-P criteria for the re-experiencing cluster and 54% met the PTSDSSI re-experiencing criteria. Although only a small percentage met full PTSD diagnostic criteria by either measure, a high percentage of young children with burns manifested some posttraumatic symptoms 1 month after discharge. Because PTSDSSI diagnosis is strongly linked to the diagnostic and statistical manual-5 (DSM-5) criteria for "PTSD in children 6 years and younger," these results may offer clues to current diagnoses of PTSD in young children. Future research is needed to improve care by determining the risk factors and course of PTSD to further refine the diagnostic criteria for identifying children most in need of intervention, such as those hospitalized for burn injuries.

Knowing how to look predicts the ability to draw realistically.

Some young children are able to create stunningly realistic drawings resembling those of adult artists. What perceptual abilities underlie this talent? This study examined two candidate skills on which adult artists excel: the ability to segment a complex form mentally (measured by the Block Design Task) and the ability to see hidden forms (measured by the Group Embedded Figures Test). Sixty-seven 6- to 13-year-olds with a wide range of drawing abilities completed these tasks as well as an IQ test and an observational drawing task. While children who scored high on drawing realism outperformed those who scored low in drawing realism on both perceptual tasks, only detection of embedded figures predicted drawing realism. This occurred independently of age, gender, years of training, and verbal and non-verbal IQ. There are certainly many contributors to this complex ability, but one component appears to be the tendency to see things more as they really are and thereby recognize the continuous contour of an object despite interference from other overlapping objects.

How children use drawing to regulate their emotions.

We examined two ways in which drawing may function to elevate mood in children-venting (expressing negative feelings) and distraction (expressing something unrelated to the negative feelings). We examined the effectiveness of drawing as an emotion regulator when drawing is used to vent versus distract (Study 1) and tested whether the effects found are specific to the activity of creating one's own drawing or generalisable to a drawing activity in which children had to copy another's drawing (Study 2). To induce a negative mood, we asked children to think of a disappointing event. Mood was assessed before and after the assigned activity. In both studies, mood improved significantly more in the distract than in the vent or copy condition. Study 1 demonstrates that drawing improves mood in children via distraction and not via venting. Study 2 demonstrates that this effect is specific to a drawing task in which an image is freely constructed. When a copying task is used, the effect disappears.

Realistic drawing talent in typical adults is associated with the same kind of local processing bias found in individuals with ASD.

A local processing bias has been found in individuals with autism as well as in typical children with a gift for drawing realistically. This study investigated whether a local processing bias in typical adults is more strongly associated with drawing realism or autistic-like traits. Forty-two adults made an observational drawing (scored for realism), completed four measures that assessed a local processing bias, and completed the Autism-spectrum Quotient (AQ) which assesses autistic-like traits. Drawing Realism score and not AQ score was associated with a local processing bias as shown by performance on two of the tasks. Typical adults who score high in the ability to draw realistically show the same kind of local processing bias found in individuals with ASD.

'Autistic' local processing bias also found in children gifted in realistic drawing.

We investigated whether typically-developing children with a gift for drawing realistically show the local processing bias seen in individuals with autism spectrum disorder (ASD). Twenty-seven 6-12 year-olds made an observational drawing (scored for level of realism) and completed three local processing tasks, and parents completed the Childhood Asperger Syndrome Test (CAST). Drawing score predicted local processing performance on all tasks independently of verbal IQ, age, and years of art lessons. Drawing score also predicted more frequent repetitive behaviors as assessed by the CAST. Thus, skill in realistic drawing is associated with a strong local processing bias and a tendency towards repetitive behaviors, showing that traits found in individuals with ASD irrespective of artistic talent are also found in typically developing children with artistic talent.

Preliminary evidence for the effects of morphine on posttraumatic stress disorder symptoms in one- to four-year-olds with burns.

This study tested the hypothesis that very young children who received more morphine for acute burns would have larger decreases in posttraumatic symptoms 3 to 6 months later. This has never before been studied in very young children, despite the high frequency of burns and trauma in this age group. Seventy 12- to 48-month-old nonvented children with acute burns admitted to a major pediatric burn center and their parents participated. Parents were interviewed at three time points: during their child's hospitalization, 1 month, and 3 to 6 months after discharge. Measures included the Child Stress Disorders Checklist - Burn Version (CSDC-B). Chart reviews were conducted to obtain children's morphine dosages during hospitalization. Mean equivalency dosages of morphine (mg/kg/d) were calculated to combine oral and intravenous administrations. Eleven participants had complete 3 to 6-month data on the CSDC. The correlation between average morphine dose and amount of decrease in posttraumatic stress disorder symptoms on the CSDC (r = -0.32) was similar to that found in studies with older children. The correlation between morphine dose and amount of decrease in symptoms on the arousal cluster of the CSDC was significant (r = -0.63, P < .05). Findings from the current study suggest that, for young children, management of pain with higher doses of morphine may be associated with a decreasing number of posttraumatic stress disorder symptoms, especially those of arousal, in the months after major trauma. This extends, with very young children, the previous findings with 6- to 16-year olds.

Precocious realists: perceptual and cognitive characteristics associated with drawing talent in non-autistic children.

A local processing bias in the block design task and in drawing strategy has been used to account for realistic drawing skill in individuals with autism. We investigated whether the same kind of local processing bias is seen in typically developing children with unusual skill in realistic graphic representation. Forty-three 5-11-year-olds who drew a still life completed a version of the block design task in both standard and segmented form, were tested for their memory for the block design items, and were given the Kaufmann Brief Intelligence Test-II. Children were classified as gifted, moderately gifted or typical on the basis of the level of realism in their drawings. Similar to autistic individuals, the gifted group showed a local processing bias in the block design task. But unlike autistic individuals, the gifted group showed a global advantage in the visual memory task and did not use a local drawing strategy; in addition, their graphic realism skill was related to verbal IQ. Differences in the extent of local processing bias in autistic and typically developing children with drawing talent are discussed.

Relationships of hazardous alcohol use, alcohol expectancies, and emotional commitment to male sexual coercion and aggression in dating couples.

OBJECTIVE: The current research was designed to identify subgroups among dating couples based on individual characteristics and a couple's dyadic pairing that contribute to the risk for male perpetration of sexual aggression and female victimization. METHOD: Heterosexual dating couples (N = 164) were recruited from a large university. They separately completed measures assessing the frequency of sexually aggressive acts perpetrated by the male partner (revised Conflict Tactics Scales), hazardous alcohol use (AUDIT-C), alcohol expectancies (shortened Alcohol Expectancies Questionnaire), emotional commitment, and relationship length. RESULTS: A two-step cluster analyses revealed two distinct subgroups of dating couples. Dating partners in Cluster 2, compared with Cluster 1, were less emotionally committed, in a shorter relationship, engaged in more hazardous alcohol use, possessed stronger alcohol expectancies, and were younger. Further, male partners in Cluster 2 perpetrated more sexual aggression, sexual coercion, and threatened/forced sex compared with men in Cluster 1. CONCLUSIONS: Using cluster analytic techniques, this study extended past research by identifying individual and couple-level characteristics that contributed to the risk for male sexual aggression perpetration and female victimization. Younger couples in the early stages of a dating relationship, who are less committed to each other, and who are both engaging in hazardous drinking and possess stronger alcohol expectancies are more at risk. Including a discussion in prevention programs that make individuals cognizant of not only their own but also their partner's characteristics as a risk for sexual aggression and coercion might provide young adults with better skills to assess risky situations.

A survey of hospital quality improvement activities.

Five years after the Institute of Medicine (IOM) called for a redesigned U.S. health care system, relatively little was known about the extent to which hospitals had undertaken quality improvement (QI) efforts to address deficiencies in patient care. To examine the state of hospital QI activities in 2006, the authors designed and conducted a survey of short-term, general hospitals with 25 or more beds. In a sample of 470 hospitals, they found that many were actively engaged in improvement efforts but that these activities varied in method and impact. Hospitals with high levels of perceived quality, as reflected in assessments by their quality managers, were more likely to have embraced QI as a strategic priority, employed quality practices and processes consistent with IOM aims, fostered staff training and involvement in QI methods, engaged in an array of QI activities and clinical QI strategies, and maintained staffing levels favoring fewer patients per nurse.

Young burned children: the course of acute stress and physiological and behavioral responses.

OBJECTIVE: Symptoms of posttraumatic stress disorder (PTSD) are a focus of much research with older children, but little research has been conducted with young children, who account for about 40% of all pediatric burn injuries. This is a longitudinal study of 72 acutely burned children (12-48 months old) that assessed the course of acute posttraumatic symptoms and physiological reactivity. METHOD: Parents were interviewed shortly after their child was admitted to the hospital and 1 month after discharge. PTSD symptoms were measured with the Diagnostic Interview for Children and Adolescents (DICA) module. Nurses recorded the child's physiological data throughout the hospital stay. The child's physical and behavioral responses were assessed in a laboratory at about 1 month after discharge. RESULTS: Reduced social smiling in the children was related to PTSD symptoms, as measured by the DICA, and heart rate at 24 hours and 7 days. Reduced vocalization was related to the child's rating of pain at 24 hours. Smiling and vocalizations were also related to some DICA cluster scores but not avoidance. CONCLUSIONS: Preschool children admitted to a burn unit demonstrated PTSD symptoms and physiological reactivity. There was a relation to the frequency of smiles and vocalizations.

Trauma severity influences acute stress in young burned children.

The purpose of this study was to assess the role of trauma severity on subsequent symptoms of posttraumatic stress disorder (PTSD) and physiological reactivity in a total of 70 children, ranging from 12 to 48 months of age, who were acutely burned. Parents were interviewed shortly after the child was admitted to the hospital. PTSD symptoms were measured using the Posttraumatic Stress Disorder Semi-Structured Interview and Observational Record for Infants and Young Children and the Diagnostic Interview for Children and Adolescents. Nurses completed a questionnaire about the child's symptoms and recorded the child's physiological data throughout the hospital stay. Significant relationships were found between severity of childhood trauma and the total number of PTSD symptoms and physiological reactivity. This study supports the hypothesis that severity of trauma experienced by young children influences psychological and physiological stress indicators after burn injuries. These findings provide new directions for the assessment and prevention of PTSD in this age group.

Acute stress symptoms in young children with burns.

OBJECTIVE: Posttraumatic stress disorder symptoms are a focus of much research with older children, but little research has been conducted with young children, who account for about 50% of all pediatric burn injuries. This is a 3-year study of 12- to 48-month-old acutely burned children to assess acute traumatic stress outcomes. The aims were to (1) assess the prevalence of acute traumatic stress symptoms and (2) develop a model of risk factors for these symptoms in these children. METHOD: Acute stress symptoms were measured using the Posttraumatic Stress Disorder Semi-Structured Interview and Observational Record for Infants and Young Children. Children's responses were then assessed, including behavior and physiological measures for developmental/functional consequences. A path analysis strategy was used to build a model of risk factors. Risk factors assessed in this model included observed pain (Visual Analogue Scale), parent symptoms (Stanford Acute Stress Reaction Questionnaire), and magnitude of trauma (total body surface area burned). RESULTS: Of the 64 subjects meeting inclusion criteria, 52 subjects agreed to participate. These children were highly symptomatic; almost 30% of these children had acute stress symptoms. A path analysis model yielded two independent pathways to acute stress symptoms: (1) from the size of the burn to the mean pulse rate in the hospital to acute stress symptoms and (2) from the child's pain to the parents' stress symptoms to acute stress symptoms. This model accounted for 39% of the variance of acute stress symptoms and yielded excellent fit indexes. CONCLUSIONS: A high percentage of acute stress symptoms were identified in young children with burns. A model of risk factors, including the size of the burn, pain, pulse rate, and parents' symptoms, was identified.