Article Reviews & Commentary
Article Reviews by Thomas J. Mancuso, MD, FAAP
The Usefulness of Children's Drawings
in the Diagnosis of Headache.
Stafson CE, Rostasy K, Minster A Pediatrics 2002:109;460-472
The authors sought to determine whether or not a drawing done by a child could aid in the differential diagnosis of that child's headache. Children seen at a pediatric neurology clinic were asked to draw a picture of their headache before any history was taken from them or their family. The children were referred from local pediatricians, family practitioners or other pediatric neurologists. The study was comprised of 226 consecutive referrals. The child was given a blank sheet of white paper, a #2pencil and asked: "Please draw a picture of yourself with your headache. Where is your pain? What does your pain feel like? Are there any other changes or symptoms…you could show me?" No leading questions or other instructions were given. The ages of the children were 4-19 years with 105 boys and 121 girls. Some children made more than one drawing. Drawings were completed in a few minutes during which the neurologist spoke with the parent(s). Once it was completed, the examining neurologist talked with and examined the child but did not view the drawing. Later, the drawings were analyzed by 2 pediatric neurologists who were unaware of the clinical history. These neurologists were asked to make a determination whether the drawings were more consistent with a diagnosis of migraine or non-migraine type headache.
The drawings were considered insightful by the authors. The clinical diagnosis was the standard with which the drawings were compared. In that comparison, the drawings had a sensitivity of 93.1%, a specificity of 82.7% and a positive predictive value for migraines of 87.1%. The authors conclude that drawings, obtained as these were, are a simple aid in the diagnosis of headache type.
Commentary
This is an interesting investigation into the diagnosis of headache in children that is a value to those of us who see children in pain treatment clinics. Although the statistical accuracy of the drawings compared to the clinical diagnosis is impressive, the drawings included in the article itself make an even stronger case for including this as part of the evaluation of a child with complaint of headache. Take a look at the original paper which includes quite a few examples of the children's drawings #include ./footer_include.iphtml