{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T02:09:55Z","timestamp":1769825395683,"version":"3.49.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,2]]},"abstract":"\n Objectives:<\/jats:title>\n Can an innovative projective drawing test assist children in disclosing their bullying exposure? Bullying leads to recurrent emergency department visits for physical or emotional trauma, hindered by children\u2019s reluctance to verbalize. Identifying patterns, referred to as graphic indicators, can characterize forms of trauma linked to bullying.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Sixty-four children aged 7 to 18 years with psychosomatic complaints at a pediatric hospital emergency department were asked to draw themselves on paper. Drawings were scored blindly by counting the frequency of 22 graphic indicators on self-figure drawings used to assess various forms of child abuse. Children were categorized using the Illinois Bully Scale score. Discriminant analysis evaluated the relative weighting of the 22 graphic indicators, aiming for optimal discrimination between the bullied and non-bullied groups. ROC analysis was utilized to maximize the diagnostic accuracy of the drawing test.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Four graphic indicators emerged as potential markers of bullying: (1) missing legs or feet, (2) dots, hollowed or crossed eyes, (3) double line, hollowed, or shaded facial contours, and (4) asymmetric or horizontal arm positions. Discriminant scores ranged from 0.00 (indicating no bullying) to 4.76 (indicating bullying). The criterion separating the two groups was a discriminant score >1.90. The resulting area under the curve was 0.88 (\n P<\/jats:italic>\n < 0.001), indicating good predictive ability. The test demonstrated a sensitivity of 69% and a specificity of 91%.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Identifiable drawing cues in children may signal bullying, highlighting the need for further research to develop a standardized tool for early identification of bullying exposure before it can be applied in practice.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/pec.0000000000003497","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T12:00:07Z","timestamp":1760702407000},"page":"e30-e36","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Sketching Silence"],"prefix":"10.1097","volume":"42","author":[{"given":"Daniel L.","family":"Mongillo","sequence":"first","affiliation":[{"name":"School of Medicine, St. George\u2019s University, St. George, Grenada"},{"name":"School of Graduate Studies, St. George\u2019s University, St. George, Grenada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8720-955X","authenticated-orcid":false,"given":"Muhammad","family":"Waseem","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Weill Cornell Medicine, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul J.","family":"Fields","sequence":"additional","affiliation":[{"name":"School of Graduate Studies, St. George\u2019s University, St. George, Grenada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"issue":"suppl 2","key":"R2-20260130","doi-asserted-by":"crossref","first-page":"S216","DOI":"10.1007\/s00038-009-5413-9","article-title":"A cross-national profile of bullying and victimization among adolescents in 40 countries","volume":"54","author":"Craig","year":"2009","journal-title":"Int J Public Health"},{"key":"R3-20260130","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1007\/s00787-020-01647-9","article-title":"Effects and moderators of the Olweus bullying prevention program (OBPP) in Germany","volume":"30","author":"Ossa","year":"2021","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"R4-20260130","doi-asserted-by":"crossref","first-page":"60","DOI":"10.5498\/wjp.v7.i1.60","article-title":"Consequences of bullying victimization in childhood and adolescence: a systematic review and meta-analysis","volume":"7","author":"Moore","year":"2017","journal-title":"World J Psychiatry"},{"key":"R5-20260130","doi-asserted-by":"crossref","first-page":"2586","DOI":"10.1007\/s10826-019-01484-8","article-title":"Effects of bullying victimization on internalizing and externalizing symptoms: The mediating role of alexithymia","volume":"28","author":"Prino","year":"2019","journal-title":"J Child Fam Stud"},{"key":"R6-20260130","doi-asserted-by":"crossref","first-page":"105720","DOI":"10.1016\/j.childyouth.2020.105720","article-title":"Bullying victimization and muscle dysmorphic disorder in Italian adolescents: the mediating role of attachment to peers","volume":"120","author":"Fabris","year":"2021","journal-title":"Child Youth Serv Rev"},{"key":"R7-20260130","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jpeds.2003.09.025","article-title":"Bullying behavior and associations with psychosomatic complaints and depression in victims","volume":"144","author":"Fekkes","year":"2004","journal-title":"J Pediatr"},{"key":"R8-20260130","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1136\/bmj.319.7206.344","article-title":"Bullying behaviour and psychosocial health among school students in New South Wales, Australia: cross-sectional survey","volume":"319","author":"Forero","year":"1999","journal-title":"Brit Med J"},{"key":"R9-20260130","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1177\/14034948010290011001","article-title":"Psychosomatic complaints in schoolchildren: a Nordic comparison","volume":"29","author":"Berntsson","year":"2001","journal-title":"Scand J Public Health"},{"key":"R10-20260130","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1111\/j.1440-1754.2007.01155.x","article-title":"Associations between bullying behavior, psychosomatic complaints, emotional and behavioral problems","volume":"44","author":"Gini","year":"2008","journal-title":"J Paediatr Child Health"},{"key":"R11-20260130","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1348\/000709999157590","article-title":"Peer victimization at school and the health of secondary school students","volume":"69","author":"Rigby","year":"1999","journal-title":"Br J Educ Psychol"},{"key":"R12-20260130","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1093\/her\/cyg100","article-title":"Bullying: Who does what, when, and where? 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