Investigated the effect of stress and preparation for stress on emotional indicators (EIs) of 68 children, aged 4 to 12 years, who were hospitalized for elective surgery. All children were asked twice to draw a human figure, once shortly after admission and again 90 minutes later. In the interim, they received stress (venipuncture or "blood test") or no stress (venipuncture delayed until after second drawing), and were either prepared (information, rehearsal and supportive care) or not prepared (free play) for the stressful situation. EIs increased only in the group that was stressed and ucprepared. this effect remained when adjusted for mental age score of drawing. Pre-and post-measures of coping behavior and pulse also were assessed. EIs correlated with pulse taken at the time of the venipuncture. Examiners who interpret drawings by this method must consider the effect of current stress and the child's understanding of stress.
Koppitz (1968) has found 30 human figure drawings (HFD) features or emotional indicators (EIs), such as presence of teeth, absence of hands, and tiny figure, that significantly differentiate between normal children and those found to have chronic psychopathology. Replication of her research has yielded similar findings (Fuller, Preuss & Hawkings, 1970;Goldman, 1972). These results are consistent with findings of a relationship between measures of the child's characteristic level of anxiety (trait anxiety) and HFD features (Engle & Suppes, 1970).
The above studies and numerous others (cf. Roback, 1968; Swenson, 1968) have centered primarily on the relationship between chronic psychological reactions and HFD features. Considerably less attention has been given to the relationship between acute disturbances or state anxiety and HFD features. An advantage in studying acute state disturbances is that they are accompanied by measurable physiological and behavioral changes. Chronic trait disturbances are more difficult to assess. Another advantage in examining acute state disturbances is that causative factors can be manipulated. Logistical difficulties and ethical considerations prohibit such an investigation with regard to long-term processes.
Only a few studies have been designed to examine the effects of situational manipulations of stress on EIs in adults' drawings, and these studies suffer from weak manipulations and failure to provide independent assessments of their validity. Attempts to induce stress include staged events (Goldstein & Rawn, 1957) and the presence of an examiner in the room (Camel, Johnson, & Burns, 1958). One of the few studies that attempted to validate stress manipulation (Exner, 1962) did not find significant effects of stress on EIs. However, the artificiality of Exner's experimental procedure (administration of shock in a laboratory setting) makes it difficult to draw conclusions with regard to effects of naturally occurring stress. Furthermore, none of these studies has used a clinically validated or commonly used set of HFD features.
Only two groups of investigators have examined the effect of acute stress on drawings by children (Engle & Suppes, 1970;Melamed & Siegel, 1975). These investigators did not find a relationship between stress and specific drawing changes.