Study Finds Children's Art Helpful in Determining Anxiety, Self-Esteem Issues Linked to Their Appearance

Evaluating children's artwork helps plastic surgeons determine their patients' emotions associated with having plastic surgery to correct congenital, traumatic and aesthetic conditions, reports the May issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Non-verbal communication with art is a time-tested tool in understanding and interpreting the feelings of children under stress. Frederick Lukash, MD, assistant clinical professor of surgery at Albert Einstein College of Medicine in New York, authored the study and has been a strong proponent of the tool for more than 25 years. The study includes evaluations by child psychiatrist Robert Dicker, MD, and art therapist Joan Alpers, MPS, ATR-BC, CCLS, of 200 drawings that were obtained from Dr. Lukash's pediatric patients before and after plastic surgery. The drawings showed marked changes in the self-concept and body image of the children who drew them. This is the first study of its kind as it relates to plastic surgery, according to Dr. Lukash.

"Children typically have difficulty communicating their emotions to adults," said Dr. Lukash. "Since 1973, I have encouraged my pediatric patients (aged 4 to 13) to provide me with color drawings before and after surgery. Their pictures clearly demonstrate very strong emotions around physical flaws."

The 200 drawings evaluated could be placed into distinct patterns. Before surgery, children often used exaggerated body parts, faces with tears, dark imagery with clouds and rain and visual or written expressions of fear regarding their anxiety and sadness. After surgery, drawings were more colorful, with frequent use of the sun and body parts appearing more normal. Overall, boys tended to use the exaggerated body part image more than girls, who tended to draw themselves as sad and isolated.

The evaluations found clear indications of low self-esteem, isolation, unhappiness and fear in pre-surgical drawings. In contrast, the post-surgical art revealed improved self-esteem, happiness and increased socialization.

"The pictures provide a valuable opportunity to dialogue with patients and their parents about feelings and fears and to build relationships based on trust," said Dr. Lukash. "For older kids, the use of poems and short stories can be just as valuable as a picture in identifying their feelings."

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