• unlimited access with print and download
    $ 37 00
  • read full document, no print or download, expires after 72 hours
    $ 4 99
More info
Unlimited access including download and printing, plus availability for reading and annotating in your in your Udini library.
  • Access to this article in your Udini library for 72 hours from purchase.
  • The article will not be available for download or print.
  • Upgrade to the full version of this document at a reduced price.
  • Your trial access payment is credited when purchasing the full version.
Buy
Continue searching

The Effect of Traumatic and Non-Traumatic Grief on Children's Human Figure Drawings

ProQuest Dissertations and Theses, 2011
Dissertation
Author: Cynthia D O'Flynn
Abstract:
Current national statistics highlight the large number of children who experience traumatic (death of a parent or relative living in home) and non-traumatic grief (death of relative not living in home) prior to age 18 years. Identification and treatment of this population is vital to long-term mental health. Previous research suggests children's drawings reflect experiences that arc difficult to verbalize, but to date no study has been done to differentiate children who are experiencing traumatic grief from children who are experiencing non-traumatic grief using artwork. The goal of this quantitative, quasi- experimental, correlational design was to determine if there were significant differences in the 50 archival HFDs of children between the ages of 6-12 years old who have experienced traumatic grief, and 50 archival HFDs from children who have experienced non-traumatic grief, matching them by age and gender. Three independent raters who reached 100% agreement scored the drawings. One-way ANOVAs were utilized to find significant trends in amount and type of emotional indicators, as well as differences by gender using the Koppitz Scale of Emotional Indicators. Of the thirty emotional indicators, nine were found to be significantly greater in number in the traumatically grieving children's HFDs. Three emotional indicators specific to the traumatically grieving children were monster or grotesque figure, no body, and shading of body and limbs. Significant differences on five emotional indicators also separated traumatically grieving males and females. These results expand the existing knowledge base of children's HFDs and illustrate how art therapy could be utilized to help identify and differentiate traumatic and non-traumatic grief in children, paving the way for future research with grieving children.

vi Table of Contents Abstract iv Acknowledgements v List of Tables 1 Chapter 1: Introduction 2 Background 4 Problem Statement 7 Purpose 8 Theoretical Framework 13 Research Questions 17 Hypotheses 18 Nature of the Study 20 Definitions 23 Significance of the Study 24 Summary 25 Chapter 2: Literature Review 27 Brief History of Art Therapy 29 Children's Developmental Stages in Art 30 Gender, Race, Ethnicity, and Educational Differences in Art 36 The Importance of Structure and Symbols in Art 39 Brief History of Hospice and Palliative Care 41 Impact of Trauma and Traumatic Grief on Children 43 Art Characteristics of Grief, Traumatic Grief, and Trauma 45 Grief in Children: Overview 50 How Grief Affects a Child 52 Developmental Needs of Grieving Children 53 Coping With Grief 56 Role of Spirituality When Coping With Grief 57 Complicated Grief and Bereavement 58 How and Why Art Therapy Works with Grieving Children 60 Trauma in Children 63 How Trauma Impairs Memory 64 How Trauma Impairs the Ability to Learn 66 How Trauma Impacts Risk and Resilience in Children 67 How Genetics, Environment, and Attachment Affect Brain Development 68 Brain Development and Function 69 Critical Periods of Development 73 How Stress and Trauma Affect the Brain 75 Treatment Approaches to Help Remedy Lapses in Development 79 How and Why Art Therapy Works with Traumatized and Traumatically Grieving Children 81 The Neurobiology of Trauma and Grief 87 How Attachment Affects the Brain 90 Multicultural Issues that Affect Non-Traumatic Grief and Traumatic Grief in Children 93

vii Projective Testing with Children 95 Research Methods in Art Therapy 100 Summary 103 Chapter 3: Research Methods 105 Research Method and Design 107 Selection of Participants 110 Instrumentation I l l Procedure 113 Operational Definition of Variables 114 Data Collection, Processing and Analysis 115 Methodological Assumptions and Limitations 117 Ethical Assurances 119 Summary 120 Chapter 4: Findings 123 Results 124 Evaluation of Findings 133 Summary 138 Chapter 5: Implications, Recommendations, and Conclusions 140 Implications 142 Limitations 146 Recommendations 148 Conclusions 149 References 153 Appendix A 194 Appendix B 195

1 List of Tables Table 1. Number of Children Experiencing Non-Traumatic and Traumatic Grief 125 Table 2. Independent and Dependent Variables 125 Table 3. Total Difference Between Traumatic Grief and Non-Traumatic Grief Error! Bookmark not defined. Table 4. Emotional Indicators on the Koppitz Scale 129 Table 5. Difference in Emotional Indicators Between Genders 131 Table 6. Differences in Amount of Emotional Indicators by Gender (G) 132 Table 7. Differences in Amount of Emotional Indicators by Gender (T) 132 Table 8. Differences in Type of Emotional Indicators by Gender (T) 133

2 Chapter 1: Introduction The ability of people to communicate in non-verbal ways has been an integral and important part of cultural expressions across time. As early as 1930, Jung understood the intricate connection between art and the unconscious expression of thoughts and desires as delineated in his work entitled Psychology and Literature (1930). Machover (1949) was one of the first to use projective art techniques to uncover subconscious levels of feeling and expression that were often inaccessible via language. From the inception of projective techniques to uncover suppressed emotions, art therapy has sought to find evidence that certain art characteristics correlated with certain diagnoses (Peterson, Hardin, & Nitsch, 2001). Since art has proven to be useful for uncovering emotional distress, represented in children's artwork as emotional indicators, it can be used as a tool to understand children who often communicate non-verbally (Malchiodi, 2001, 2005). Projective techniques using artwork have been useful in assessing children with emotional issues (Koppitz, 1968, 1984, 2006), but no research to date has differentiated children 6-12 years of age who are experiencing non-traumatic grief from children 6-12 years of age experiencing traumatic grief. The purpose of this study was to explore whether the Koppitz scale of emotional indicators could be utilized to differentiate the Human Figure Drawings (HFDs) of children 6-12 years experiencing non-traumatic grief (defined as the death of someone not living in the home) from the HFDs of children 6-12 years experiencing traumatic grief (defined as the death of a parent, or family member residing in the home). According to statistics, 375,000 children lose a parent before the age of 18 (Fields, 2003; Ries, et al., 2007). This number points to the enormity of traumatic grief

3 and non-traumatic grief experienced by children. The Koppitz Human Figure Drawings Emotional Indicators Scale (1968) has proven to be valid for distinguishing between groups of children, based on normal developmental aspects of children's art. For this reason it was chosen to look for features common to the HFD drawings of non- traumatically grieving and traumatically grieving children aged 6-12 years, by identifying characteristics known as emotional indicators. Emotional indicators are certain signs seen in only specific percentages of the population and have been proven to be accurate indications of emotional distress in children (Koppitz, 1968, 2006). What remained to be seen was whether the emotional indicators in the Koppitz scale would be able to differentiate HFDs of children aged 6-12 years who experienced non-traumatic grief from HFDs of children aged 6-12 years who experienced traumatic grief. If this scale could find significant differences in emotional indicators that could discriminate between the two groups, it would enhance our ability to appropriately treat these children using either the grief or trauma models. In this chapter the background and prevalence of traumatic and non-traumatic grief will be examined highlighting the identification and treatment of these populations. The objective for utilizing the Koppitz Emotional Indicators Scale to evaluate children's HFDs will be explained along with a brief history of projective art techniques and the developmental basis for using the Koppitz tool. The explanation and rationale for this study followed by the methodology and design will be delineated, along with the purpose and theoretical framework for the study. The nature and significance of the research along with pertinent definitions will also be elucidated.

4 Background According to the 1999 U.S Census Bureau, approximately 1.9 million children under 18 years old, are living in a single-family household, due to the death of a parent (Hope & Hodge, 2006). One in every 20 children under 15 will suffer the loss of one or both parents (Kirwin & Hamrin, 2005). These statistics highlight the importance of identifying an assessment instrument that can differentiate non-traumatically and traumatically grieving children 6-12 years old from one another in the general population, in order to offer appropriate therapeutic interventions to reduce long-term pathology. Distinguishing between non-traumatic grief and traumatic grief in children 6-12 years old is imperative to treatment because the interventions with these two groups are vastly different (Malchiodi, 2001, 2003; Perry & Szalavitz, 2006). The ability to assess children's psychological distress is compromised by the inability of children to contextualize stressful experiences and their immaturity in articulating the event (Malchiodi, 2005; Steele & Rader, 2001). Children who are grieving exhibit psychological signs of sadness, withdrawal, depression, anger, and anxiety (Malchiodi, 2003; Mclntyre, 1987). Children experiencing traumatic grief exhibit these same signs, but also suffer from heightened arousal, emotional dysregulation, and increased startle responses, often resulting in full-blown symptoms of posttraumatic stress disorder (Van der Kolk, 2005). Thus, children's drawings, particularly human figure drawings, have historically been used as diagnostic and therapeutic tools to circumvent problems with limited verbalization, as behavioral manifestations are often displayed in artwork in the form of emotional indicators (Lusebrink, 2004; Malchiodi, 2005).

5 Non-traumatic grief is approached sequentially by having the child draw pictures of events before the death, at the time of death, and memories of the funeral and memorial service. The grief model focuses on expression of feelings and encourages memory retrieval and self-care (Mclntyre, 1987). Traumatic grief utilizes the trauma model which is a sensory-based program that uses interventions involving decreasing arousal, de-escalation, self-care, and coping, so as not to re-traumatize an already fragile child (Klorer, 2005; Lusebrink, 2004; Perry, 2000; Stein & Kendall, 2004). This is necessary, as traumatic grief tends to overwhelm the child's resources and ability to cope. Grief interventions (DePetrillo & Winner, 2005; Horns, 2007; Mclntyre, 1987; Peterson, Nitsch, & Higgins, 2005; Rollins & Riccio, 2002; Walker & Schaffer, 2007) and trauma and traumatic grief interventions (Carew, 2005; Haen, 2005; Hanney & Kozlowska, 2002) have been studied, but research using only HFDs and the Koppitz scale with children have not been used to differentiate between these two groups. Research on memory suggests that different types of memory are stored in different parts of the brain. Traumatic events in particular, have been found to bypass the hippocampus, an area of the brain, which deals with verbalization and time sequencing (Stein & Kendall, 2004). Traumatic events are stored in the amygdala, bypassing the hippocampus, which attaches words and meaning to the event. They are literally burned into the amygdala with no delineation of time or coding of the event with words (Lusebrink, 2004; Peres, Mercante, & Nasello, 2005; Stein & Kendall, 2004; Van der Kolk, 2005). Non-traumatic grief memories are coded with words and time sequencing, and are stored in the hippocampus, which eventually moves them into long-term memory storage (Sapolsky, 2004; Stein & Kendall, 2004). As a consequence, non-traumatic grief

6 memories may be easier to verbalize and to place in a time frame, while traumatic grief memories may be impossible to talk about, or order sequentially (Malchiodi, 2005; Stein & Kendall, 2004). The implications of these findings are that traumatic grief memories may best be uncovered by other than verbal means. Since the Koppitz tool has been used to identify emotional indicators reliably in children's artwork, using children's HFD drawings may be one way of accessing these memories, and differentiating between the groups. Projective testing, based on children's art, has a long history, beginning with Goodenough (Junge & Asawa, 1994) who developed the Draw-A-Man test in 1926, to measure intelligence in children. It was revised by Harris (1963) and was followed by Koppitz (1968) who developed the Draw-A-Person test utilizing 30 developmental items, in contrast to Goodenough's 71 points. Koppitz defined emotional indicators as signs on the HFD that met the following three criteria. First, it must be able to separate children with emotional problems from those without emotional problems, to have clinical validity. Secondly, it must occur infrequently on normal children's drawings, or in less than 16% of children's drawings at any given age level. Thirdly, it could not be related solely to maturation or age, meaning that its occurrence could not be totally dependent upon the child's increasing age (Koppitz, 1968). In a study in 2006, Koppitz was able to reliably separate two groups of children (normal and clinic populations) based on the emotional indicators in their artwork. Packman, Beck, VanZutphen, Long, and Spangler (2003) showed that the HFD could distinguish non-donor and donor children's groups from one another while Malchiodi (2009) used the Koppitz scale to identify emotional indicators that identified children with PTSD.

7 Criteria used in the study of art characteristics for trauma and grief populations have shown limited usefulness in identifying characteristics specific to either group (Spring, 2004; Wegmann & Lusebrink, 2000; White, Wallace & Huffman, 2004). These studies, however, did not use Koppitz's scoring criteria and also failed to account for normal developmental stages (Graham, 2001; Wegmann & Lusebrink, 2000). Significant results were not obtained in studies that failed to match for age and gender (Graham, 2001; Hagood, 2003; Pifalo, 2006; Wadeson, 2002), as well as studies with insignificant sample sizes (Appleton, 2001; Graham, 2001; Mclntyre, 1987; Packman, Beck, VanZutphen, Long, & Spangler, 2003; White et al. 2004). The current research used the Koppitz scale to analyze the HFD drawings of children 6-12 years old, who were known to have experienced non-traumatic grief, and children 6-12 years old who had experienced traumatic grief to identify emotional indicators that could be used to make a differential diagnosis between the two groups. Problem Statement The large number of non-traumatically grieving and traumatically grieving children between the ages of 6-12 years of age highlights the importance of proper identification and treatment. Children experiencing traumatic grief exhibit signs of grief, as well as mood dysregulation, emotional lability, heightened arousal, and often characteristics of PTSD (Van der Kolk, 2005). Because the interventions for these two groups are vastly different (Steele, R, 2005; Steele, W, 2005), it is vital that these children are correctly identified during assessment, as it is important to treat trauma prior to grief (Malchiodi, 2009; Perry & Szalavitz, 2006; Steele, W, 2005). Traumatically grieving children are treated using the trauma model (Stein & Kendall, 2004) whereas

8 non-traumatically grieving children are treated using the grief model (Horns, 2007; Walker & Schaffer, 2007). Among the various assessment tools in use, the HFD has proven efficacious in identifying children who draw outside of the expected range for their developmental age (Koppitz, 1968, 1984, 2006). Because of children's limited verbalizations, artwork has been used to detect distress based on emotional indicators (Lusebrink, 2004; Malchiodi, 2003, 2005). Koppitz's diagnostic system of emotional indicators is both a reliable and valid tool (Cox & Catte, 2000; Koppitz, 1968, 1984, 2006; Malchiodi, 2009) that takes into account normal developmental stages of children and helps identify when children draw outside of what is normal and expected for their age. The HFDs of children 6-12 years old who experienced non-traumatic grief and traumatic grief were evaluated using the Koppitz Human Figure Drawings Emotional Indicators Scale (Koppitz, 1968) hypothesizing that the two groups would differ significantly in type and number of indicators, but would not differ by gender. Since no study of this kind has been done this research sought to highlight the difference between traumatically and non-traumatically grieving children in order to assess and treat them appropriately. Purpose In this research study the HFDs of children aged 6-12 years who experienced non traumatic grief (defined as the death of a person not living in the same household) were compared to the HFDs of children aged 6-12 years who experienced traumatic grief (defined as the death of a parent or other relative living in the same household) using a quantitative, quasi-experimental, correlational design. This archival study looked at the HFDs of children between the ages of 6-12 years of age, utilizing existing drawings from

9 children who had experienced non-traumatic or traumatic grief. These drawings were matched by age and gender in an effort to identify significant differences between the two groups. It was expected that the number and type of emotional indicators in the children's artwork evaluated using the Koppitz scale, would be able to reliably differentiate the drawings of these two groups of children. The independent variables were non-traumatic grief and traumatic grief in 50 children who experienced either non-traumatic or traumatic grief aged 6-12 years old. The dependent variable was the total score of the absence or presence of 30 emotional indicators, as well as the type of emotional indicators on the Koppitz Human Figure Drawings Emotional Indicators Scale (1968), and as hypothesized would vary by independent variable category. The Koppitz Human Figure Drawings Emotional Indicators Scale (Koppitz, 1968) has been proven clinically valid for identifying emotional indicators in children's HFDs and is based on normal developmental art characteristics. These emotional indicators have been weighted as absent or present based on the age of the child, so a developmentally accurate view of the artwork could be obtained. The age range of 6-12 years includes schematic and realism artistic stages, which contain styles and characteristics that are measurable (Malchiodi, 2009). The choice to use the quantitative, holistic approach was to decrease subjectivity and has proven to be more reliable and valid then qualitative research (Austin, 2006). The current study looked at HFD drawings of children between 6-12 years old who fall into the artistic stages of drawing called the schematic stage and the realism stage which roughly correspond to Piaget's and Inhelder's (1959, 1969) stages of cognitive development. It is important to understand that these stages are fluid and there

10 is overlap in artistic development and cognition. Children between six and nine years old develop a schema for their drawings and fall into the schematic stage (Deaver, 2009; Lowenfeld & Brittain, 1987). Piaget's sensori-motor period approximately corresponds to the scribbling stage of artistic development, and the following two stages are part of his pre-operational stage, which roughly lasts until age seven. These schemas are a consistent way a child represents symbols and objects in their world. Most children will develop a certain schema to depict all animals or people. Color is used based on preferences and later switches to the realistic color. For example, a child may make a blue tree when he/she is six and color it green when they are nine, showing the transition from one artistic stage to the next. Most children in the first stage will draw on a baseline and may also include a skyline as well. Size of objects will vary depending on their significance or what they wish to emphasize (Malchiodi, 2009; Peterson, Hardin & Nitsch, 2001). In the realism stage, 9-12 years of age, it is important for children to depict things as they really are. The visual schema and realism drawing stage correspond to Piaget's concrete operations stage, which spans 7-12 years. The formal operations stage that begins at 12 years is consistent with artistic development in adolescence (Malchiodi, 2009). Complex forms, lines, and shapes appear giving the drawings more detail and perspective, replacing schemas. Ground lines and skylines meet to give depth, and realistic colors and differentiating characteristics between sexes are drawn. By knowing these conventions and stages in children's art, it is possible to look for what is not normal developmentally. The scale by Koppitz was designed exclusively for these ages of children making it the appropriate tool for assessing them (Koppitz, 1968, 1984, 2006).

11 All developmental items were designated by categories of expected items (which should occur in 86-100% of the drawings), common items (which should occur in 56- 85% of the drawings), and exceptional items (which should occur in less than 15% of the drawings) (Koppitz, 1968). It was hypothesized that there would be differences in the type and amount of emotional indicators that would allow the HFDs of the two groups to be differentiated from one another. It was imperative to operationally define non traumatic grief and traumatic grief as strictly as possible to minimize the confounding variables. Variables that could be controlled include utilizing the standardized Koppitz rating scale, using identical materials and directions by the same person for the drawing task, and doing the drawings in similar settings with no distractions during the task. Confounding variables that could not be controlled were the child's innate defenses, anxiety with the drawing task, drawing ability, development, and the immediacy of the grief at the time the archival drawings were collected. Because the dependent variable (the total score of absence or presence of emotional indicators, as well as type of emotional indicator) being measured was based on a ratio scale the one-way ANOVA was used to determine if the mean between the two grief groups was significantly different. In the search for power a one-tailed chi-square test was utilized, the hypothesis being that the sample one's percentage would be greater than the sample two's percentage, or sample one's would be smaller than sample two's, but that both could not be possible. It was estimated that sample one, traumatic grief would have 50% of the group showing emotional indicators pointing to distress, and that only 10% of the non-traumatic grief group sample two would exhibit significant markers for distress. Next, the size for the matched groups was set at 50 children per group.

12 These archival samples were matched for gender and age at the time the research was conducted, with the alpha level arbitrarily set at .05. After determining these parameters, the numbers were plugged into the one tailed chi-square, giving a statistical power of 99.9%, which was higher than needed for the proposed analysis of data. Using these parameters, the power of the test sufficiently supported the design. The drawings examined in this study were archival HFD drawings from children aged 6-12 years old, from the Hospice population, collected over a ten-year period. Fifty HFD drawings from children aged 6-12 years (the age they were at the time the drawings were made) who had lost a parent or someone living in their home (traumatic grief), were matched by age and gender to 50 HFD drawings from children 6-12 years old who had lost a relative or friend not living in the home (non-traumatic grief). This Michigan Hospice population covered both urban and rural areas in about a one hundred square- mile radius, encompassing many different cultural and socioeconomic levels. All drawings examined in this study were completed in the researcher's office. At the time the drawings were obtained the child was given a blank white sheet of 8 1/2'" by 11" paper, along with a number two pencil with an eraser and given the instructions to draw a whole person, not a cartoon or a stick figure. They were told it could be any person and no other specifications were given. Following these instructions the child had ten minutes to complete the picture, and to erase as needed. The drawings were then marked on the back with age and gender and filed in their permanent record. At the time the research was done, the designations of traumatic and non-traumatic grief were written on the back of the drawings, after retrieving this information from the archival files. The drawings were matched by age and gender and distributed to three blind raters who were

13 trained on scoring the emotional indicators and had reached a 100% agreement. If all three raters did not agree upon a drawing it was omitted from the study. After a consensus on fifty drawings from both groups was reached, the scores of emotional indicators were evaluated using the one-way ANOVA to determine if the HFD drawings of non-traumatically grieving children differed from the HFD drawings of traumatically grieving children in number and type of emotional indicator, as well as by gender. Theoretical Framework In order to identify emotional indicators in the artwork of children, developmental theory was essential in understanding at what age certain art characteristics were expected. Gardner (1980), Goodnow (1977), Kellogg, (1969), Klepsh and Logie, (1982), culminating in the definitive work of Lowenfeld and Brittain, (1987), have all made contributions to the developmental theory upon which the majority of contemporary research with children and art was based. Bristow (1993) conducted a developmental study using the House-Tree-Person (HTP) and the Kinetic Family Drawing (KFD) to differentiate normal children from sexually abused children. More recently Alter-Muri (2002), Anderson (2004), Louis (2000) and Putih (1997) have contributed to the research as to what was developmentally normal and what was not. Although Piaget (1969) did not study art, he developed a cognitive developmental theory upon which art stages and developmental norms were based. How non-traumatic grief and traumatic grief are processed in the brain and stored, as well as relevant research into how art therapy is able to access those memories was explored in the following literature review examining works by Frederick (2006), Grill (2005), Klorer (2005), McNally (2003), and Stein and Kendall (2004). Characteristics

14 commonly found in the art of non-traumatically grieving and traumatically grieving children were addressed, looking at indicators described by Dewan (2007) and Farr (2005), as well as long-term implications of not addressing these issues with children, as elaborated upon by Sapolsky (2004) and Schore (2003). Crump (2007), Dewan (2007) and Malchiodi (2001, 2005) all explored how and why art therapy worked with children who have experienced trauma or grief. Since traumatic grief is a subgroup of trauma it was important to understand both trauma and grief and how it was displayed graphically in the HFD drawings of children in the form of emotional indicators. In the review of the research that has been completed, there have been no studies to differentiate the artwork of non-traumatically grieving children from that of traumatically grieving children. The studies that have explored grief and artistic characteristics have been qualitative, descriptive, and phenomenological (Brodie, 2007; Horns, 2007; Mclntyre, 1987). They have sought to establish correlations between grief and artistic productions (Mclntyre, 1987). The studies of traumatized children have been descriptive and correlational (Peterson & Zamboni, 1998), but none have been able to identify causality. The studies done on sexual abuse and manifestations of pathology, independent of artwork, have been descriptive and correlational (Kendall-Tackett, Williams & Finkelhor, 1993) and have shown only a clear connection between childhood trauma and PTSD symptomology (Perry & Szalavitz, 2006). In the research on trauma and art productions, although there were consistent forms found, as well as correlations between forms and colors, results could not distinguish trauma from the normal population or be generalized to children at large (Peterson & Zamboni, 1998; Spring, 2004).

15 The history of projective testing is discussed, beginning with Goodenough who developed the Draw-A-Man test in 1926 to measure intelligence in children. She counted the number of items a child included in a drawing to determine the cognitive intellectual ability of the child using 71 markers that were either present or absent. Although a test of intelligence, it was the starting point for Koppitz's (1968) developmental scale and the subsequent creation of the Emotional Indicators Scale she later designed. In a research study in 2006, Koppitz was able to reliably differentiate normal children from a matched clinic population. Malchiodi (2009) and Packman et al., (2003) both did follow-up studies to validate the Koppitz scale. Because children who experience the death of a parent suffer from emotional impairments due to the trauma (Adler, 2008), it was believed that the Koppitz scale would prove to be a valuable tool in differentiating the HFDs of children 6-12 years who experienced traumatic grief from non-traumatic grief. It was hypothesized that the HFDs of children 6-12 years, who were traumatically grieving, would differ in the amount and type of emotional indicators thereby distinguishing them from the HFDs of children 6-12 years who experienced non traumatic grief. It was also hypothesized that the groups would not differ based on gender alone. One of the theories concerning how and why art therapy works with non- traumatically grieving and traumatically grieving children is based on the premise that traumatic memories are stored in different parts of the brain than regular memories or grief memories, hence the artwork of non-traumatic grief is stored differently than the artwork of traumatic grief (Schore, 2003; Van der Kolk, 1994, 2005). During a trauma, impressions of the event bypass the hippocampus, which is responsible for putting words

Full document contains 205 pages
Abstract: Current national statistics highlight the large number of children who experience traumatic (death of a parent or relative living in home) and non-traumatic grief (death of relative not living in home) prior to age 18 years. Identification and treatment of this population is vital to long-term mental health. Previous research suggests children's drawings reflect experiences that arc difficult to verbalize, but to date no study has been done to differentiate children who are experiencing traumatic grief from children who are experiencing non-traumatic grief using artwork. The goal of this quantitative, quasi- experimental, correlational design was to determine if there were significant differences in the 50 archival HFDs of children between the ages of 6-12 years old who have experienced traumatic grief, and 50 archival HFDs from children who have experienced non-traumatic grief, matching them by age and gender. Three independent raters who reached 100% agreement scored the drawings. One-way ANOVAs were utilized to find significant trends in amount and type of emotional indicators, as well as differences by gender using the Koppitz Scale of Emotional Indicators. Of the thirty emotional indicators, nine were found to be significantly greater in number in the traumatically grieving children's HFDs. Three emotional indicators specific to the traumatically grieving children were monster or grotesque figure, no body, and shading of body and limbs. Significant differences on five emotional indicators also separated traumatically grieving males and females. These results expand the existing knowledge base of children's HFDs and illustrate how art therapy could be utilized to help identify and differentiate traumatic and non-traumatic grief in children, paving the way for future research with grieving children.