Vertigo in children through drawing: an archetype?

The aim of this study is to evaluate whether drawing can be considered a complementary tool to identify the type of vertigo in children with balance disorders. The present study is based on the psycho-pedagogical analysis and parallel comparison of drawings made by pediatric patients, evaluated for balance disorders and collected in 15 years in three different Italian specialistic ambulatories (Audiology Department of Palermo, ENT Department - ASST Spedali Civili of Brescia, San Bernardino Outpatient Clinic of Salò). A total of 275 children’s drawings were collected and analyzed by two expert otoneurologists and two expert psycho-pedagogists in children with vestibular rotational vertigo (Benign Paroxysmal Positional Vertigo – BPPV; Acute unilateral Vestibular Loss – AUVL), migraine-related vertigo (Benign Paroxysmal Vertigo of Childhood - BPVC; Vestibular Migraine - VM) and psychogenic vertigo (Persistent Postural Perceptual Dizziness – PPPD). Correlations between graphic characteristics of drawings for each group of children were made. A close relationship between type of drawings’ graphic elements and clinical pictures was found, suggesting an unconscious and innate stereotyped archetype of children in representing their balance disturbances: Group 1 children diagnosed as rotatory vertigo (BPPV, AUVL) always draw themselves or arrows, and a clear perception of movement is perceived. Group 2 children, affected by migraine-related disorders (BPVC, MV), always draw closed circles, spirals or spots, representing their disabling symptom. In the Group 3 children (PPPD), no clear matter in their drawings was identified and they were always clinically diagnosed with psychogenic dysfunction or with a mix of other disorders (ocular, dental, hypotensive, metabolic, orthopedic, etc.). Drawing of dizzy children represents an interesting tool for diagnostic purposes in the pediatric vestibular field, laying the foundations for future more targeted treatments in the psycho-pedagogical field, in light of the scarcity of scientific evidence published on the topic.