International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 10 , ISSUE 1 ( January-March, 2017 ) > List of Articles

Original Article

Identifying Dental Anxiety in Children's Drawings and correlating It with Frankl's Behavior Rating Scale

Jyoti Mathur, Amish Diwanji, Bhumi Sarvaiya, Dipal Sharma

Keywords : Children's drawings, Dental treatment anxiety, Stress markers

Citation Information : Mathur J, Diwanji A, Sarvaiya B, Sharma D. Identifying Dental Anxiety in Children's Drawings and correlating It with Frankl's Behavior Rating Scale. Int J Clin Pediatr Dent 2017; 10 (1):24-28.

DOI: 10.5005/jp-journals-10005-1401

License: CC BY-NC 4.0

Published Online: 01-12-2008

Copyright Statement:  Copyright © 2017; The Author(s).


Aim: To develop a simple method to assess the level of anxiety by using children's drawings and correlating them with Frankl's behavior rating scale. Materials and methods: A total of 178 patients aged of 3 to 14 years were handed out two-page forms which contained three sections on coloring and drawing, along with general information, and Frankl's behavior rating scale for the visit. The three types of drawing exercises given to the patients were geometric copy drawings, coloring a nonthreatening figure, and an empty sheet for freehand drawing. Results: Out of 178 patients, 60 showed definitely positive behavior, 73 exhibited positive behavior, 37 showed negative behavior, and 8 were definitely negative on Frankl's behavior rating scale; 133 children had none or, 1 stress marker and 45 exhibited 2 or 3 stress markers in their drawings. Chisquare (ƒÔ2) analysis was done with a 2 ˜ 2 contingency table. Observed ƒÔ2 value was 46.166, which at 1 degree of freedom was much greater than that at 0.995 percentile. Therefore, the result was highly significant. Conclusion: Children requiring specialized behavioral techniques can be identified by the presence of stress markers in their drawings. This nonverbal activity by itself can have an overall positive effect on the behavior displayed in the dental clinic.

PDF Share
  1. Goettems ML, Ardenghi TM, Demarco FF, Romano AR, Torriani DD. Children's use of dental services: influence of maternal dental anxiety, attendance pattern and perception of children's quality of life. Community Dent Oral Epidemiol 2012Oct;40(5):451-458.
  2. Kyristi MA, Dimou G, Lygidakis NA. Parental attitudes and perceptions affecting children's dental behavior in Greek population: a clinical study. Eur Arch Pediatric Dent 2009 Jan;10(1):29-32.
  3. Bankole OO, Aderinokun GA, Denloye OO, Jeboda SO. Maternal and Child's anxiety-effect on child's behviour at dental appointments and treatments. Afr J Med Sci 2002 Dec;31(4):349-352.
  4. Lee CY, Chang YY, Huang ST. The clinically related predictors of dental fear in Taiwanese children. Int J Paediatr Dent 2008 Nov;18(6):415-422.
  5. Conners CK, Sitarenios G, Parker JD, Epstein JN. The revised Conners' Parent Rating Scale (CPrS-R): factor structure, reliability and criterion validity. J Abnorm Child Psychol 1998 Aug;26(4):257-268.
  6. Frankl SN, Shire FR, Fogels HR. Should the parent remain with the child in the dental operatory? J Dent Child 1962 Apr;29(2):150-162.
  7. Dentistry AA. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent 2011;43:28-32.
  8. Clatworthy S, Simon K, Tiedman ME. Child drawing: hospitalan instrument designed to measure the emotional status of hospitalized school-aged children. J Pediatr Nurs 1999 Feb;14(1):2-9.
  9. Mittal R, Sharma M. Assesment of psychological effects of dental treatment on children. Contemp Clin Dent 2012 Apr:3(Suppl 1):52-57.
  10. Stein LI, Lane CJ, Williams ME, Dawson ME, Polido JC, Cermak SA. Physiological and behavioural stress and anxiety in children with autism spectrum disorders during routine oral care. Biomed Res Int 2014;2014:694876. Available from:
  11. Noorani H, Joshi HV, Shivparkash PK. Salivary alpha amylase as a noninvasive biomarker for dental fear and its correlation with behavior of children during dental treatment. Int J Clin Pediatr Dent 2014;7(1):19-23.
  12. Sowjanya V, Tandon S, Tharian E. Physiological response to dental anxiety in Children. J Indian Soc Pedod Prev Dent 1995 Aug;13(1):13-17.
  13. Rayen R, Muthu MS, Chandrashekhar Rao R, Sivakumar N. Evaluation of Physiological and behavioural measures in relation to dental anxiety during sequential dental visits in children. Indian J Dent Res 2006 Jan-Mar;17(1):27-34. Available from:
  14. Stein, MT. Developmentally based office: setting the stage for enhanced practice. In: Dixon, Suzanne; Stein, Martin, editors. Encounters with children, pediatric behaviour and development. 4th ed. Philadelphia: Mosby Elsevier; 2006. p. 77.
  15. Welsh, JB; Susan, I; Stein, M. Use of drawings by children at health encounters. In: Dixon, Suzanne; Stein, Marvin. Encounters with children, pediatric behavior and development. 4th ed. Philadelphia: Mosby Elsevier; 2006. p. 100.
  16. Burkitt E, Barrett M, Davis A. Children's colour choices for completing drawings of affectively characterized topics. J Child Psychol Psychiatry 2003 Mar;44(3):445-455.
  17. Sheskin RB, Klein H, Lowental U. Assessment of children's anxiety throughout dental treatment by their drawings. ASDC J Dent Child 1982 Mar-Apr;49(2):99-106.
  18. Torriani DD, Goettems ML, Cademartori MG, Fernandez RR, Bussoletti DM Representation of dental care and oral health in children's drawings. Br Dent J 2014 Jun;216(12):E26.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.