Draw-a-Man Test

Evidence Reviewed as of before: 19-08-2008
Author(s): Lisa Zeltzer, MSc OT; Anita Menon, MSc
Editor(s): Nicol Korner-Bitensky, PhD OT; Elissa Sitcoff, BA BSc

Purpose

The Draw-A-Man Test (Goodenough, 1926) has been widely used as a measure of intellectual maturation in children, to elicit personality type and unconscious material, and as part of neuropsychologic test batteries. The test has also been used to identify the presence of unilateral spatial neglect (USN) in adult patients post-stroke.

In-Depth Review

Purpose of the measure

The Draw-A-Man Test (Goodenough, 1926) has been widely used as a measure of intellectual maturation in children, to elicit personality type and unconscious material, and as part of neuropsychologic test batteries. The test has also been used to identify the presence of unilateral spatial neglect (USN) in adult patients post-stroke.

Available versions

The Draw-A-Man test was published by Goodenough in 1926.

Features of the measure

Items:

There are no actual items in the Draw-A-Man Test. Patients are given a blank piece of paper (8.5 x11) entitled “Draw an Entire Man” and pencil, and are asked to draw an entire man from memory.

Scoring:

Chen-Sea (2000) developed a new scoring method for the Draw-A-Man Test specifically for examining the presence of USN. Rather than use the original quantitative 10-point scoring method that was not able to distinguish patients with personal neglect from healthy controls, this new method scores drawings that show only homogenous unilateral body parts as having USN and those with homogenous bilateral body parts as normal. This scoring system was found to have a high inter-rater reliability. Agreement between two raters was 95.45% for the participants without brain insult and 100% for the participants with stroke, demonstrating the ability for this scoring method to discriminate patients with personal neglect from those without personal neglect.

Time:

It takes less than 5 minutes to complete the Draw-A-Man Test.

Training:

The examiner must be able to distinguish homogenous unilateral body parts (indicates presence of USN) from homogenous bilateral body parts (indicates normal functioning), as drawn by the patient.

Subscales:

None.

Equipment:

A pencil and a blank piece of paper (8.5 x11) entitled “Draw an Entire Man”.

Alternative Forms of the Draw-A-Man Test

Quantitative 10-point scoring method of the Draw-A-Man Test.

  • Using a blank piece of paper and a pencil, the seated patient must draw an entire man. The picture is scored by giving one point for the presence of each of the following body parts: head, trunk, right arm, left arm, right hand, left hand, right leg, left leg, right foot, and left foot. The total score of this version of the test is 10 (see Figure 1). This method has not been found to be able to distinguish patients with personal neglect from healthy controls (Chen-Sea, 1995b).

Figure 1. Perfect score of 10 points.

(Source: Chen-Sea, 2000)

Client suitability

Can be used with:

Patients with stroke.

  • Patients must be able to hold a pencil to complete the test.

Should not be used with:

  • Patients who have had a left stroke and patients who are left handed.
  • Need to rule out the presence of apraxia, given that this may impact the validity of testing results.

In what languages is the measure available?

Not applicable.

Summary

What does the tool measure? Unilateral Spatial Neglect (USN) in the personal and extrapersonal space (as well as the presence of anosagnosia).
Other constructs: intellectual ability/cognitive function/body image.
What types of clients can the tool be used for? Adults with stroke.
Is this a screening or assessment tool? Screening.
Time to administer Less than 5 minutes.
Versions Quantitative 10-point scoring method of the Draw-A-Man Test
Other Languages Not applicable.
Measurement Properties
Reliability
  • No studies have examined the internal consistency of the Draw-A-Man Test.
  • Two studies have examined the test-retest reliability of the Draw-A-Man Test and both reported
  • One study examined the inter-rater reliability of the Draw-A-Man Test and reported excellent inter-rater.
Validity

Construct:

Convergent:

Correlated with activities of daily living (ADL) performance measured by the Klein-Bell ADL Scale.

Known groups:

The Draw-A-Man Test was able to discriminate patients with personal neglect from those without personal neglect.

Does the tool detect change in patients? Not applicable.
Acceptability The Draw-A-Man Test should be used as a screening tool rather than for clinical diagnosis of USN. Apraxia must be ruled out as this may affect the validity of test results. This test cannot be completed by proxy. Patients must be able to hold a pencil. Patients with hemiparesis on their dominant side may have difficulty completing the test.
Feasibility The Draw-A-Man Test takes only 5 minutes to complete and requires minimal training to score (must be able to distinguish homogenous unilateral body parts from homogenous bilateral body parts). Only simple equipment is required (a pencil and paper).
How to obtain the tool? All that is required is a blank piece of paper (8.5×11) entitled “Draw an Entire Man”, and a pencil. The patient is asked to draw an entire man from memory.

Psychometric Properties

Overview

The Draw-A-Man Test has rarely been used with patients with stroke in the right hemisphere to determine USN. For the purposes of this review, we conducted a literature search to identify all relevant publications on the psychometric properties of the Draw-A-Man Test as a measure of USN.

Reliability

Internal consistency:

No evidence.

Test-retest:

Chen-Sea (1995, reported in Chen-Sea, 2000) administered the Draw-A-Man Test to 19 patients with stroke in a pilot study, and found that the test showed adequate test-retest reliability (r = 0.50).

Gordon et al. (1984) also reported an adequate test-retest reliability for the Draw-A-Man Test (r= 0.62) in patients with right brain damage.

Inter-rater:

Chen-Sea (1995, reported in Chen-Sea, 2000) administered the Draw-A-Man Test to 19 patients with stroke in a pilot study, and found that the test showed excellent inter-rater reliability (r = 0.96).

Chen-Sea (2000) administered the Draw-A-Man Test to 51 patients with stroke and 110 age-matched controls without brain injury. The test had a high inter-rater reliability, as two blinded raters had 96% agreement for the patients with neglect and 100% for those without neglect.

Validity

Construct:

Chen-Sea (2000) reported significant correlations of the Draw-A-Man Test with activities of daily living (ADL) performance measured by the Klein-Bell ADL Scale (Klein & Bell, 1979). Subjects with personal neglect had lower scores in five areas of ADL as compared to those without personal neglect.

Known groups:

Chen-Sea (2000) administered the Draw-A-Man Test to 51 patients with stroke and 110 age-matched controls without brain injury and found that all of the controls were correctly classified as normal, and 13 of the 51 stroke patients were categorized as having USN. The results of this study demonstrate the ability of the Draw-A-Man Test to discriminate patients with personal neglect from those without personal neglect.

Criterion:

No evidence.

Responsiveness

No evidence.

References

  • Chen-Sea, M-J. (1995a). Test-retest reliability of Draw-A-Man Test. Unpublished manuscript, National Cheng Kung University, Tainan, Taiwan.
  • Chen-Sea, M-J. (1995b). Performance of normal and right CVA patients on Draw-A-Man Test. Unpublished manuscript, National Cheng Kung University, Tainan, Taiwan.
  • Chen-Sea, MJ. (2000). Validating the Draw-A-Man Test as a personal neglect test. Am J Occup Therap, 54, 391-397.
  • Goodenough, F. L. (1926). The measurement of intelligence by drawing. New York: World Books.
  • Gordon, W. A., Ruckdeschel-Hibbard, M., Egelko, S., Diller, L., Simmens, S., Langer, K. (1984). Single Letter Cancellation Test in Evaluation of the Deficits Associated with Right Brain Damage: Normative Data on the Institute of Rehabilitation Medicine Test Battery. New York: New York University Medical Center.
  • Klein, R. M., Bell, B. J. (1979). Klein-Bell Activity of Daily Living Scale: Manual. Seattle: Division of Occupational Therapy, University of Washington.

See The Measure

How to obtain the Draw-A-Man Test?

All that is required is a blank piece of paper (8.5 x11) entitled “Draw an Entire Man”.

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