www.ejop.org Expression of Aggressive Tendencies in the Drawings of Children and Youth Who Survived the Northern Pakistan Earthquake

The study focused on the presence of aggressive tendencies in the drawings of children who survived the northern Pakistan earthquake. The data was collected one year after the earthquake from Sahara Children Academy (Mallot Tehsil) and Surbuland (camp school set up by the Army at District Bagh). The sample consisted of 75 children (44 boys and 31 girls) age range from 5 to 15 years with a mean age of 8 years. The Human Figure Drawing as projective test (Koppitz, 1969) was used. The drawings were analyzed utilizing a list of emotional indicators for aggression. The list, consisting of 24 indicators, was drawn from the literature on assessment of human figure drawings (Gilbert, 1980). The results indicated the presence of aggressive tendencies among these children with straight lines as the most frequently occurring indicator among both genders. Chi square analysis was conducted to compare males and females for the frequency of occurrence of emotional indicators in drawings. Findings reflect significant differences in frequency of occurrence of aggression related indicators between genders with calculated X2 =4.37, p<.05. However, there was no significant difference observed with reference to the content of emotional indicators for boys and girls.


Introduction
Natural disasters such as earthquakes, floods and storms may produce psychological trauma which has profound effects on the intrapsychic, interpersonal, emotional, social, intellectual and neurological development of children and youth.The effects of these traumatic events on the psyche of the child depend on his age, airplanes crashing into buildings.Perhaps the friendliest of all psychological tools, drawing and story making tasks are especially suitable when dealing with children.
They talk while they draw and express their feelings through this simple task, with or without colors.The basic assumption is that the child projects things onto the drawings that by this come to talk about him.Moreover, children try to make sense of the event by discussing their pictures and try to correct the event by drawing patriotic symbols (Myers, 2002).Machover (1949) was among the first clinicians to be interested in the Human Figure Drawings as a projective instrument, focusing on how the drawings reflected the anxieties, impulses, self-esteem, and personality of the test taker.Many studies have been conducted using the human figure drawings in the diagnosis of psychoses, symptoms of anxiety, depression and schizophrenia (Deslauriers & Halpern, 1947, Baldwin 1964, Arieti, 1974).DiLeo, (1973)   He claimed that drawings of the family can be an aid to assess the emotional life of the child.This is especially true for children who are going through the latency period i.e. younger children ranging from age 6 to 10 years who are not willing or able to give verbal expression to their emotional conflicts, thus becoming imperative to ask them to draw a family figure.The indicators of the family relationship -for example, omission of a family member, omission of self, relative position, similarly relative size, role in the family interaction and isolation -all these become a valuable aid in the interpretation of the child's psychopathology.
Moreover, Daum (1983) explored the level of association between a feature in a drawing and a behavioral or personality trait.In this study the human figure drawings of 200 aggressive or withdrawn male delinquents were evaluated and compared with both undifferentiated delinquents and non delinquents with the expectation that the former groups would show a higher incidence of those features which have been associated with these respective traits.Significant differences were found for 6 of the 16 features, and predictive power was substantially increased by using all the features as indicators of their respective traits.Glazer (1999) describes art as having an inherent therapeutic value, constituting the symbolic speech of suppressed feelings.Stronach-Buschel (1990) explains that art therapy is described as a method of non-verbal communication, for example a child drawing a picture to express his or her emotions.
Furthermore, the Human Figure Drawing test is also used in the educational and clinical settings.One of the most attractive features of this projective measure is the near universality of drawing.It is easy to administer with reasonable standardization in a wide variety of age and cultural groups.The fact the response is not mediated by language suggests that the technique may be less subjective to cultural and age limits than many other projective techniques.It can be administered individually or in a group condition.It can be administered in a brief period of time.The purpose of the test is well cloaked from all but the most sophisticated subjects.Thus it is not easy for the subjects to create a desired impression (Lindzey, 1961).Sundberg (1959)  to fifth from second and the terms "objective test" and "projective test" have recently come under criticism in the Journal of Personality Assessment (Klopfer, Taulbee, 1976).There remain some controversy regarding the utility and validity of projective testing which is based on Freud's concept of projecting one's own personality attributes onto a neutral stimulus.However, many practitioners continue to rely on projective testing.
Human figure drawings have become a popular mode of child assessment, along with numerous systems for interpretation of the drawings, due to time economy, ease of administration, and the clinical information provided, and are widely used cross-culturally to evaluate personality by anthropologists and social psychologists (Dennis, 1966, Gardiner, 1969, Gonzales, 1982).
Considering the fact that there is dearth of all kinds of psychological tests in Pakistan, the Human Figure Drawing test was especially chosen as the interpretation norms for this test have been already established in Pakistan (Hasan & Ahmad, 1990).Utilizing Koppitz's (1969) method, the test was found to be highly valid as a measure of emotional indicators (EI) when correlated with the ratings of the teachers on the Kopptiz questionnaire for the measurement of emotional problems.The study also Moreover, a list of emotional indicators containing 24 aggression indicators was utilized in this study for analyzing the drawings, this list was drawn from the literature on drawings analysis (Gilbert, 1980), and the exact same list was used in the present study for scoring and analyzing the drawings.Marsee (2008) conducted a study to explore the association between exposure to Hurricane Katrina and reactive aggression via post traumatic stress disorder (PTSD) symptoms and poorly regulated emotions.In this research 166 adolescents (61% female, 63% Caucasian) recruited from high schools of Gulf Coast of Mississippi participated in the study.
The present study explores the psychological after effects of the earthquake that shook the Northern Region of Pakistan.The earthquake of 8th October 2005 in the Northern Regions of Pakistan left 2.8 million homeless, more than 80,000 dead, and an equal number injured.It destroyed 0.2 million houses (Akhtar, Anwar, Khan., Noshab, Sadiq, Bashir, and Sarwar, 2006).
The study aims at scientifically analyzing the presence of aggressive tendencies in the drawings of the children who survived the Northern Pakistan earthquake.Bano, Irshad & Ahmad (2004) was used in the present study (this list was drawn from the literature for analyzing by Gilbert, 1980).
Human Figure Drawing test as a projective test was used in the present study as the use of language is at its minimum and simple instructions are given by the examiner during the test administration, therefore it is easier to translate them into Urdu or any other regional language of Pakistan without changing the spirit of the real test.
List of emotional indicators (Gilbert, 1980

Procedure
The students were met after a year of the earthquake and were approached in their classrooms.
This time frame was chosen as frequently a person's reactions to trauma initially meet the criteria for Acute Stress Disorder in the immediate aftermath of the trauma (this lasts for a minimum of two days and a maximum of 4 weeks).Symptoms for PTSD usually begin within the first three months after the trauma; there may be a delay of months or even years before symptoms appears, complete recovery occurs within three 3 months in approximately half of the cases, however, many may have persistent symptoms longer than 12 months after the trauma (DSM IV TR, 2000).It was therefore the best time to acknowledge that survivors can be involved with the disaster aftermath even after a year and identify individuals who were not given any formal diagnosis during the required period but may manifest behavioral problems or vulnerability to emotional issues in future.
Initial rapport was built with them.The students were provided with 81/2 x 11 inch white paper sheets and the standard instructions for the HFD as given by Koppitz (1969) were communicated to them, instruction given as follows: "On this piece of paper I would like you to draw a WHOLE person.It can be any kind of a person you want to draw, just make sure that it is a whole person and not a stick figure or a cartoon figure".It was ensured that they understood it and drew a whole person.
The drawings were then analyzed for the presence of emotional indicators of aggression as given by Gilbert (1980).The data received was then sorted by gender and age along with the frequency of the aggression indicators.Percentages were calculated for both genders separately as well as by summing up the entire data to find out the occurrence of emotional indicators irrespective of gender differences.

Results
The results shown in Table 1 and

Discussion
The results displayed in Table 1 and 2  The results clearly indicate the importance of HFD as a tool in assessing for signs of aggression and other behavioral symptoms.These drawings exhibit controlled, uncontrollable, repressed, passive anger, which can further be taken in account when helping these children.
When males and females were compared for the frequency of occurrence of aggressive emotional indicators they seem to significantly differ as indicated in Table No 3, with high frequency of males associated with most of the emotional indicators for aggression.Thus it becomes evident that there is a significant difference observed in drawing of both the genders with regard to expression of aggression.
This may be because the cultural norms and values with relevance to expression of aggression for both the genders differ in Pakistan (Hasan & Ahmad, 1990).The results shown in These research findings have implications for post disaster mental health services.
Traditionally researchers focus on the internalized problems such as anxiety, depression and post traumatic stress disorder symptoms.Very little attention is paid to post disaster externalized problems such as aggression.Specific types of aggression responses, particularly those that involve poorly regulated emotion (i.e. reactive aggression), have been found to be associated with history of trauma (Marsee, 2008) and thus may be especially common following a traumatic event such as an earthquake.Marsee (2008) proposed a theoretical model illustrating a potential pathway to reactive aggression through exposure to traumatic event.The findings of the current study support the association between exposure to traumatic event and presence of aggression indicators in the drawings of children with the history of trauma.However, the association between exposure to trauma and reactive aggressive behavior via poorly regulated emotions couldn't be confirmed by findings of the present study as data about the actual levels of aggressive behavior of children could not obtained through, parents, teachers or observation, due to language barrier, lack or time and resources.Therefore, this is one limitation of this study and in future this information could be added to validate the children trauma through other means as well.This study was also limited on participants, number of participants could be increased in future study so that the difference between the content of aggressive indicators may also be studied with the reference to both the genders and this would be another very interesting area to explore.
Finally on the basis of the findings of the present study it can be safely concluded that drawing is an powerful tool to measure aggressive tendencies in youth who have difficulty expressing their feelings in words, or may have problems expressing themselves either due to language barriers or due to any other inhibitions related to cultural norms for both the genders.
after using the human figure drawing effectively in many researches came to various conclusions:  Drawing by well adjusted children are 'strikingly similar', and those drawings done by the emotionally disturbed children are 'strikingly different' from the well adjusted children's drawings and from each other, 'as each child is disturbed in his own special way'. As a projective test he enumerates a number of signs on the Human Figure Drawing test that can be indicators of feelings and personality traits.This test also is an indicator of security and insecurity for example insecure children can draw small figures.Maladjusted children tend to omit arms, hidden hands are considered as an expression of guilt.This test was also used by him as an indicator of aggressive tendencies which are shown by the exaggerated size of hands.In case the exaggerated size of hands is portrayed in the self figure the drawing indicates aggression towards another.But when the same drawing of exaggerated drawing is portrayed in the figure of parents it indicates aggression incurred by the patient from the environment.He also concludes that an explicit manifestation of genitals in the human figure drawings is and indicator of behavior disorders, aggression and phobias.
used a survey to determine which tests were mostly used by the psychologists in their clinical work and found that Human Figure Drawing test ranked two after Rorscach among all the 62 projective and objective diagnostic tests reported in the survey.However the Human Figure Drawing test utilization in a clinical context has dropped indicated that the cut off point is three emotional indicators (per drawing, out of 30 emotional indicators) in Pakistan instead of a point of two emotional indicators in the advanced countries.The findings of the study also showed a cluster of frequent and rare emotional indicators for the Pakistani culture.Furthermore, in a study conducted by Bano, Irshad & Ahmad (2004) on the Afghan refugee children Human Figure Drawing test (HFD) was used to tap aggression as an emotional indicator reflected in the drawings.The findings of the study indicated the frequency of occurrence for specific indicators related to aggression among refugee children; differences between males and females were also reported.
Furthermore, it focuses on a theoretical model illustrating a potential pathway to reactive aggression through exposure to a traumatic event.In light of the current literature it was assumed that the drawings of children and youth effected by the Northern Pakistan earthquake will exhibit aggressive tendencies.Method Participants The sample consists of 75 children (44 boys and 31 girls) age range from 5 to 15 years.The students were studying at the Sahara Children Academy (Mallot Tehsil) and Surbuland (camp school set up by the Army at District Bagh).Materials The material included the Human Figure Drawing test (Koppitz 1969); a list of 24 aggression indicators utilized by indicate the presence of aggressive tendencies among these children with straight lines as the most frequently occurring indicator among both genders.The presence of aggressive indicators in these drawings thus verifies the association of reactive aggression indicators in the drawings of children with the history of trauma.The impact of environment and natural disasters is clearly seen among these children as their drawings revealed their anger.Emotional Indicators, long arms, powerful hands as well as teeth, occurred significantly more often on the HFDs of the aggressive children than on the drawings of the shy children.These three items seem to reflect aggressiveness and acting out behavior (Koppitz, 1969).Furthermore, Machover (1949) also found emotional indicators of power hand, hands overlong and extended, heavy pressure, among children who have aggressive tendencies.Hammer (1963) found teeth well defined as an emotional indicator among children having aggressive tendencies.Moreover, presence of teeth might indicate not only oral aggression but also sadistic tendencies teeth seem to be a valid indicator for measurement of aggression by human figure drawing.Teeth occurred most often on the records of the overtly aggressive children, it may also be concluded that teeth are sign of aggressiveness and not only of oral aggression (Kopitz , 1969).The findings of the present research reconfirms the presence of similar emotional indicator related to aggression (e.g.pressure, teeth, long arms or arms extended, claw fingers) in the drawings of Pakistani youth with the history of trauma which gives the clue for aggressive tendencies in these children.This confirms that these indicators have good interpretive value and are valid emotional indicators for measurement of aggressive tendencies on Human Figure Drawings test for Pakistani children as well.However, it is interesting to note here that "straight line" as an emotional indicator has more interpretive value for measurement of aggressive tendencies in the drawings of Pakistani children with the history of trauma.

Furthermore, once aggressive
tendencies are screened out in children though frequency of occurrence of emotional indicators for aggression in drawings, the same technique may be used as a therapeutic tool for catharsis and providing an outlet for the children in stress or with a history of trauma.Drawing could also be used as a medium of choice by children to express and regulated their emotion (e.g anger).Brenkman (1999)  found that Art therapy is becoming a popular tool to work with children.The findings of this study do not only support the use of the Human Figure Drawing test as diagnostic tool for identifying aggressive tendencies in Pakistani children with the history of trauma, but suggests that the test may also act as a preventive measure, helping to screen out aggressive tendencies through aggression indicators in drawings and by this to provide timely support to highly vulnerable youth with history of trauma.

Table 3 :
Showing difference in the chi square values for frequency of occurrence of emotional indicators for aggression in both the genders

Table 4 :
Showing frequency of emotional indicators for aggression in each drawing 1 Hasan & Ahmad (1990)based on the cut off point identified for Emotional Indicators and norms established for HFD test in Pakistan byHasan & Ahmad (1990)utilizingKoppitz (1969)