Human Figure Drawing Test (HFD) is not a valid or reliable measure.

See http://isites.harvard.edu/fs/docs/icb.topic1349060.files/Freud/sa1_2.pdf

Thanks Amir for quick response. I will see the suggested article

May I ask with what intention you plan to use the HFD with the said population? If you'd like to use a projective technique, then there are alternate ones available, more suited to use with adults. Their reliability and validity are dubious, but still.

Human Figure Drawings actually do enjoy some measure of validity, at least with children. When scored for developmental indicators, the results correlate at about r = .60 with scores on clinical IQ tests. And systems such as Koppitz's emotional indicators can differentiate well-adjusted from clinically referred individuals reasonably well. The DAP-SPED (Naglieri et al.) presents an updated scoring system with better reliability and pretty decent validity evidence. But inferences based on single indicators are very dicey. At best, they may lend support to hypotheses based on other test data, or perhaps suggest avenues to explore with other measures.

But none of this speaks to the HFD's use with adults. Here, as far as I know, the developmental (intellectual) scoring systems simply don't work - except perhaps with intellectually disabled adults (and if we already know they're intellectually disabled, why bother?). And the emotional/personality scoring systems aren't really set up for this use. The big problem here is that our experiences with art production diverge sharply after about age 12. Some people study art formally, some continue to draw for their own amusement, and some basically stop drawing altogether. Thus, when you test (say) a 25-year-old, what you get is as much a function of their continued involvement in art as anything else.

Some variables may still work in adults. One study (Robins et al.) showed that the degree of "tilt" lessened significantly over the course of long-term psychotherapy, for example. But there is limited evidence to go on.

What we can say for the HFD is that it is quickly and easily administered. As long as we stay with the limited scoring systems that are available, we can derive some useful and valid information from these drawings when rendered by children or adolescents. But we should not rely on it to make strong inferences about specific personality features.

I should add another caveat. I see that you are writing from Pakistan. The extent to which a person has engaged in drawing human figures before will obviously affect his or her renderings. If some of your cases are people who for religious reasons have not been encouraged to depict human figures, the test will yield very different results.

Thanks Stephen Joy.Its really helpful

I think you can use it as I have used it years ago with persons with schizophrenia. Not so much as indicator of emotional problems, but to assess "developmental functioning, or regression" as well as improvement in functioning due to therapeutic intervention using Goodenough-Harris scoring system. The assumption is that as client's clinical status is improving, more details in the figure will be included.due to improvement in reality testing. See Mohiuddin Ahmed, Ph.D. & Judith A Goldman, Ph.D. Cognitive Rehabilitation of adults with severe and persistent mental illness: a group model, Community Mental Health Journal, August 1994, 30: 385-394.

My follow-up comment on the use of HFD with South Asian population. I have some questions about its use with adults, having grown up in South Asia, Many children from that part of the world may not be exposed to drawing human figures as part of school learning, as such , as adults their drawings may reflect considerable "immaturity: when compared to Western based children's norm. A point of caution.

We do use body drawings from patients with severe somatoform disorders as a qualitative measure of body-relatedness, based on the experience that talking about the drawing will give more diagnostic information than just self report questionnaires. The quantifiable aspects, like size, absence of bodyparts and position on the paper are the subject of our research. I don’t think they relate to emotion or personality in adults but the way in which a patient draws his troubled body might reflect how he/she relates to it. We developed a model for body-relatedness, described in this article: http://dx.plos.org/10.1371/journal.pone.0042534

Dear Hansika Kapoor, I want to use it see the emotional stability in adults, and related indicators as proposed by Koppitz etc.

In response to Dr. Mohiuddin Ahmed, I am not sure that training contribute to the drawing, specially when we are interested to see the emotional indicators and these indicators are depicted in (i.e.,big figure,small figure, slanting figure, transparency, big head,arms clinging to body,long arms, and legs pressed to gather, etc.)

I agree with the previous comments. If you're using the HFD with persons in the somatoform area of disorders, it makes a lot of sense. In fact, even for individuals with eating disorders of trichotillomania. But if you'd like to simply explore emotional stability, I'd recommend an objective tool to assess the same, like the MMPI.

I also agree with the previous comments. HFD has so many disadvantages in evaluation of emotional states, it is well-documented, among others in critical to projective methods works of Lilienfeld, Wood or Garb. I conduct research in Poland using this method with child sexual offenders, but I do so after a detailed refining the method itself and assessment of drawings procedure. It allows to deal with the described limitations and brings some interesting results (still working on them). But, as pointed predecessors, maybe quicker for You would be use a method which you will not need to revise?

Dear Naeem,

It is a personal preference, but I always use drawings as part of my full battery assessment. And, I always do a full battery assessment. I typically ask the client to perform a House-Tree-Person drawing which I then view projectively and cognitively/developmentally. I do this as a matter of routine in that I can observe many traits, abilities, and disabilities from administration of this one simple test. These tests are never used in isolation, except perhaps in very young preschool children. In observing a client drawing a H-T-P (of which the HFD may be ‘generally’ scored) I can monitor for sensory motor control, ADHD tendencies, generalized personality traits, signs of emotional concern, speed of processing, attention to detail, etc. General cognitive functioning may also be gleaned. However, we must keep in mind, and note in our reports, that these tests were administered in an ‘out-of-limits’ basis. As such, the findings are to be viewed with caution.

When we view ‘out-of-limits’ tests in this manner they can provide us a quick synopsis of the client’s basic skills and abilities. For instance, if the norms of the test top out at around age 12 (Dependent on the test)(Note too that on these types of tests a 12 year old who achieves a maximum score will be viewed as being within the ‘normal’ cognitive range), and if an older client achieves at or near the maximum score, although we cannot assume normal intelligence per-se, we can generally rule out intellectual deficiency / mental retardation. Conversely, if the drawings are exceptionally deficient, and not due to attentional, motor, or motivational factors, then we can assume that a cognitive deficiency may exist, at least in the client’s nonverbal realm, and further in-depth assessment is required. As such, human figure drawings may be effectively utilized as screening instruments that can either rule-out or point-up gross area deficiencies in the client. Such screening can then guide the practitioner into a more targeted evaluation. I hope this explanation may be helpful.

Thanks Scubby Mack, its really helpful

With age, hfd is less of memory drawing and turns more of manipulative and thus does not reflect pure characters or traits or emotions in most cases..

Thanks Kishan Kotak, Is there there any research evidence that supports your above mentioned thesis, that with the increase of age it turns more of manipulative and thus does not reflect pure traits?

I find H-T-P to be very helpful in working with eating disorder sufferers. It is helpful in looking at body image, self-esteem and interpersonal relationships. I also use a technique in which I complete the H-T-P and then ask them to draw themselves, how they would like to look and how they think they will look in 15 years which gives more information which is useful in the clinical setting.

Please look for the relevant references appear below.

Drawing, Draw a Person (DAP), and self-figure drawing as diagnostic tool:

Drawing oneself or drawing figure is a well-known and frequently used projective drawing technique in psychological assessments (Thomas & Jolley, 1998). It is based on the idea that the figure drawn represents the subject, while the paper represents the subject’s environment (Machover, 1949, Draw-A-Person test). Recently, several attempts to analyze art creations and to develop art measures of patients with mental illness were published (e.g., Billingsley, 1999; Kent, 1999). For example, Hacking, Foreman, and Belcher (1996), who analyzed paintings of psychiatric patients and compared them to paintings of non-patients, reported that the diagnostic group's paintings differed on at least 4 of 13 variables (e.g., color, color intensity, quality of line, and space covered). Kent (1999) found a high correlation between the psychometric properties of the DAP test and the Rorschach Schizophrenia Index conditions. DAP test was found to be differentiated between violent offenders (domestic and general) and nonviolent offenders, and was suggested as an effective tool for detecting violent behavior among male prisoners (Lev-Wiesel& Hershkovitz, 2000). Self-drawings of individuals diagnosed with schizophrenia differed significantly from non-schizophrenics' self-figure drawings in each of the chosen assessment indicators (Lev-Wiesel & Shvero, 2003). In colorectal cancer patients undergoing stoma surgery, self-figure drawings were also found to reflect psychological distress and the profound threat to physical integrity and self-concept with the change of body image (Lev-Wiesel, Ziperstein, & Rabau, 2007). Gillespie (1996) who analyzed paintings of women with ED, using the DAP technique in anorexics and the Mother-and-Child (M/C) technique in obese women, indicated that the drawings differentiated between those groups. She argued that art therapy techniques enable individuals with eating disorders to project their discontent with their inner sense of self into concrete body images.

Thanks Jonathan Guez, it very helpful indeed. Will you comment on the Koppitz (1968) Human Figure Drawing (HFD) scoring system

Please look at the way we scored the DAP (Draw-A-Person test developed by Machover (1949)). This might be relevant to your work.

Guez, J., Lev-Wiesel, R., Valetsky, Sh., Kruszewski Sztul, D., and Pener, B. (2010). Self-Figure Drawings in Women with Anorexia, Bulimia, Overweight, and Normal weight: A Possible Tool for Assessment. The Art in Psychotherapy, 37, 400-406.

Best regards

Jonathan

.

Thanks

For a neuropsychologist, the draw a person test can provide hints about cerebral impairment in adult patients.   I have not seen huge clinical differences in human drawings between different categories of psychiatric patients, except as follows.  Some severely ill treatment-resistant schizophrenic patients were unable to produce any identifiable drawing of a person, but were later on able to draw it after they  somewhat recovered on clozapine about 5 months later.  Patients who feel emotionally vulnerable perhaps tend to produce stick figures (a line for arms and legs and torso, with a circle or ellipse for the head).  Those that feel they cannot cope with life, often omit fingers or draw no hand at the end of the arm.  Socially expansive patients (manic) produce large drawings.  These are only intuitive impressions by some clinicians, I do not have any statistical data on this.  It is often of more interest to use a more encompassing drawing test, the House-Tree-Person test, both neuropsychologically and in other clinical respects.

With respect to neuropsychology of the Draw a Person test, there is a good discussion on page 588 in Muriel Deutsch Lezak et al: Neuropsychological Assessment, 5th edition, Oxford University Press, New York, 2012.

Yes, we have used HFD using  Goodenough Harris Quality Scoring criteria to determine age level scoring as well as use of  qualitative analysis of changes in details in drawing as one of the criterion of outcome in evaluating our initial report of a group therapy project using an earlier version of Mind stimulation therapy model (see  http://mindstimulationtherapy.com/). See also the original article: Mohiuddin Ahmed, Ph.D. & Judith A Goldman, Ph.D. Cognitive Rehabilitation of adults with severe and persistent mental illness: a group model, Community Mental Health Journal, August 1994, 30: 385-394. 

I have also used it with adolescent (behaviorally disordered youths in SPED program)and adult clients (specifically adults with severe and persistent mental illness such people with schizophrenia) in outpatient practice. It is a quick way of assessing a degree of clinical progress by noticing changes in the quality and details in the drawing without necessarily using projective interpretations.

One other reference for using the DAP with adults is the book: A Primer of Projective Techniques of Psychological Assessment. 1990. The DAP is covered in chapter 6 by  Dr. Crumbaugh.

Hello! 

I find this thread of conversation very informative and helpful for my on-going study. Presently, I would like to investigate the utility of human figure drawing to identify characteristics of impulsivity and hostility among public utility vehicle drivers. I intend to use the quantitative scoring of Human Figure Drawing Test developed by Mitchell and colleagues. I would like to ask if you have knowledge where I can purchase the test and scoring manual? Unfortunately it is not available here in my country, Philippines anymore. I hope you can help me. I would highly appreciate it. Thank you very much! 

The Mitchell book was published by Western Psychological Services. But it is indeed out of print. I ran a quick search and found a couple of used copies, but they're being sold for very high prices ($399 in one case!). Basically, I'd advise you to consider the Mitchell system to be a dead end unless your university library has a copy. Even then, I don't know of anyone actually using the system.

You might have better luck with Naglieri's DAP-SPED ("draw a person screening procedure for emotional disturbance). Or, failing that, fall back on Koppitz' system. Her book is out of print, but used copies are readily available at low cost. Good luck!

Thank you very much Dr. Stephen! Your response is a great help for me. I'll try to consider your suggestions.