Children’s house-tree-person drawings as a window into mental health: Links to internalizing behaviors, externalizing behaviors and trauma

In the present study, the newly developed House-Tree-Person (H-T-P) Scoring Manual was utilized to quantitatively assess children’s drawing characteristics in relation to internalizing problems, externalizing problems, and traumatic experiences. A total of 93 children aged 6–16 participated, and their caregivers completed the Child Behavior Checklist (CBCL) and Adverse Childhood Experiences (ACE) questionnaire, while the children completed The House-Tree-Person Drawing task, the Children’s Depression Inventory (CDI), the Screen for Child Anxiety Related Emotional Disorders (SCARED). Drawing features were evaluated under seven categories such as line distortions, size irregularities, location, level of detail, bizarre items, distortions and negative feelings. Controlling for age, gender, and intelligence, correlational and regression analyses were conducted to evaluate predictive relationships. While none of the regression models significantly predicted psychological symptoms overall, partial correlations showed that externalizing behaviors were positively associated with greater drawing details, and trauma symptoms were linked with more problematic person drawings. The findings suggest that while specific H-T-P features may hold clinical relevance, overall predictive power was limited in this sample. These results contribute to the psychometric investigation of projective drawing assessments and highlight the need for further validation studies in diverse child populations. Clinical implications, limitations, and directions for future research are discussed.