Evaluating Children's Drawings as a Means of Expression in Children with Chronic Diseases.

Background: Children's drawings are considered an important tool for detecting emotions and experiences that a child may be unable or unwilling to express verbally. Objective: This study aimed to assess the emotional state, psychological development, and adjustment mechanisms of children with chronic diseases using projective drawing tests, and to compare their responses with those of healthy children. Methods: A cross-sectional design was implemented in one region of Greece, involving 100 children aged 6-12 years. The sample included 50 children with chronic diseases (25 with type 1 diabetes and 25 with cystic fibrosis) and 50 healthy children serving as a control group, selected from pediatric clinics and schools. Data collection took place between January and June 2023. Participants completed three projective tests: the Kinetic Family Drawing Test (KFD), Tree Drawing Test, and House Drawing Test, which assessed emotional expression and psychological functioning. Results: Children with chronic diseases expressed emotions differently compared to healthy peers. In the KFD, they depicted fewer smiling faces, indicating higher emotional distress and a more negative perception of their family environment. In the tree drawings, symbolic elements such as birds-representing freedom or hope - were more common among children with chronic diseases, while healthy children more often drew roots, suggesting emotional stability. The House Drawing Test revealed no significant differences between the two groups. Conclusion: Projective tests such as the KFD and Tree Drawing Test appear to be effective in identifying emotional issues in children with chronic illnesses, unlike the House Drawing Test. These findings support the integration of such tools into psychological assessments and therapeutic interventions for pediatric chronic disease populations.