Doodling has always been an effective way of keeping boredom at bay.

But a doodle is also said to speak volumes about its creator, be it a sketch of a flower or of a knife dripping with blood.

That a drawing can give insight into one's personality and mental state is a fact that has not been overlooked by psychologists and therapists.

This is certainly the case in dialogic-diagnostic art therapy (DDAT), a relative of the better known expressive art therapy.

Mentally disturbed

This family portrait (above) was drawn by a boy, six, whose mother thought he was was 'posessed by a monkey spirit'. There has been no diagnosis done by a hospital yet and his case is still pending. However, note the disproportionate black eyes and the distorted figure. Therapists say that when this boy comes in for therapy, it is obvious that he is mentally disturbed, and he often engages in confused self talk. He also hallucinates.

Possible abuse victim

This is a drawing (above) by a boy, seven, suspected of being the victim of sexual abuse by his 'big brother' - a family friend - whom he drew bigger than the rest. He only drew legs on the figures and himself into the picture when asked to do so. He exhibits bizzare behavioural issues, like urinting on the floor, playing with fire, using objects to poke his sister's genitals as well as playing with his own. He's also a bed wetter.

Younger mental age

From the picture (above), this eight-year-old girl has a projected mental age of five, almost three years younger than she actually is. At this age, say therapists, most children should be able to draw figures in proportion, with the trunk clearly and distinctly drawn with limbs attached at correct positions. PHOTOS: LISABEL TING

Analyses: Dr K.H. Chia, Madam Salenah Mohd Ismail, Madam Loke Ying Ying, Madam Christabel Hong (counselling psychologist)

While expressive art therapy is geared towards having a curative effect on a mental, emotional or behavioural disorder, DDAT allows a trained therapist to access the subconscious elements of a client's psyche and to interpret drawings to help diagnose his condition.

Madam Salenah Mohd Ismail, a registered DDAT therapist with the International Association of Counsellors and Therapists (IACT) and the founder of the DDAT company, Art Heals, says that DDAT can let a therapist know more than just how a child is feeling.

'DDAT tells us about the somatic (physical) situation in a child. It can also tell us about the future... drawing is a bit like dreaming, there's always a subconscious element in the images,' says Madam Salenah.

She cites the example of a young boy who drew a self-portrait with a dark band around his throat, metaphorically suffocating himself. Two months later, the boy was diagnosed with asthma.

Aside from being a window into the subconscious, these drawings can also be used as a springboard for the therapist to broach more personal issues.

'At first she was very quiet, and didn't want to talk,' says Madam Selenah of one of her clients, a nine-year-old girl.

'But in her drawing, she used deep, dark bold strokes for her house compared to everything else in the picture. So I knew that something was not right. When I asked her about it, she began to relate her story... and it turned out she had been sexually abused.'

DDAT can also be used to evaluate a child's mental age and intelligence.

Through tests like the Goodenough Draw-A-Person test (a drawing test devised by pioneering American p sychologist Florence Goodenough to evaluate children for a variety of reasons), we can find out a child's drawing quotient (DQ). It can tell us about their IQ, says Madam Loke Ying Ying, principal of the Ananias Centre in Clementi and a registered DDAT therapist with the IACT.

A young child goes through several drawing stages, such as the 'tadpole man', where a figure's legs are joined directly to an oversized head. More details are added as the child ages.

A DDAT therapist can determine a child's mental age and DQ by tallying the number of certain pre-determined characteristics such as fingers, eyes with pupils and hair partings. The more of these indicators present, the higher a child's DQ.

DDAT can also be used as an indicator of possible mental problems such as autism and schizophrenia.

While a child's drawing in itself is not sufficient to make a diagnosis, DDAT can be useful in early detection.

For example, if a child repeatedly and obsessively draws a single feature, it could point towards the obsessive-compulsive behaviour often displayed by autistics.

Hidden problems

Childish doodles may look simple to most. But DDAT tests and analyses can reveal hidden problems.

It is not always easy to get a small child to sit down and draw, say therapists, as they can be easily distracted. But this is a small problem compared to the tedious nature of the analysis.

In order to get a complete picture of a child's condition, therapists have to review every single bit of the drawing process, taking note of whether the child draws from left to right, top to bottom, erases a lot or flips the paper over.

Madam Loke tapes everything with a video camera to review later.

Then the drawings are analysed. Colours can be important indicators, say therapists, who also look out for anything that deviates from a normal childish drawing.

These include consistently missing limbs or distorted proportions in body parts. Or when one family member is drawn exaggeratedly larger compared to the rest.

'It takes a child five minutes to draw, but it takes us a week to analyse,' says Madam Loke.

However, although DDAT may seem extremely useful, is it really reliable?

Accuracy and reliability depend heavily on the years of experience and advance training that these professionals have gone through, says Dr K.H. Chia, an educational therapist and the only trainer registered with the IACT that conducts DDAT programmes in Singapore.

Thus, if a parent suspects that his child is consistently drawing something unusual, it is best to refer the case to a therapist instead of immediately jumping to conclusions.

'I had a case where a seven-year-old girl, drew a tree, a house, a light blue sky and an open blue field,' says Madam Salenah.

''That worried me... but when I asked her why the field was blue, her reply was simply this: 'I have no green crayon.' '

This article was first published in Mind Your Body, The Straits Times on Mar 26, 2008.