Paper Reading #4: Supporting Face-To-Face Communication Between Clinicians and Children with Chronic Headaches Through a Zoomable Multi-Touch App

Introduction

In their paper "Supporting Face-To-Face Communication Between Clinicians and Children with Chronic Headaches Through a Zoomable Multi-Touch App," Juan Pablo Hourcade, Martha Driessnack, and Kelsey E. Huebner explored how zoomable drawing applications can be used to enhance the already existing Draw-and-Tell Conversation (DTC) method. DTC is used to allow children to communicate with adults their feelings or thoughts through drawings first before they use verbal descriptions. The drawings allow them to better show that they may find difficult to articulate well with words. This was presented at CHI 2012 in May of 2012 in Austin, TX. All three authors are from the University of Iowa. Hourcade is an associate professor and is interested in technology that supports creativity, collaboration, and information access for a variety of users. Driessnack is an assistant professor who finds interest in researching children's perspectives and art-based assessment and intervention methods. Finally, Huebner is interested in 3D modeling and graphic design.

Summary

The authors simply wanted to know if using a multitouch tablet would be a better tool to use than regular pencil and paper when implementing the DTC method. In particular, they were trying to figure out whether children with chronic headaches were able to more effectively show and describe how they felt through drawings. Hourcade, et al. used three different media through which the children used to draw and describe their pain. They used (1) two sheets of paper, one with the outline of a human head and one with the outline of a human body, and colored pencils and markers, (2) a zoomable drawing application on a tablet, and (3) Photogoo. Photogoo allows the user to manipulate a picture shown on the screen and draw on top of the picture. In this case, the picture was of the child's head. Each child tried every method, but in different orders.

Figure 1: A child using the zoomable drawing application of a tablet

Related Work Not Referenced in the Paper

The authors talked in depth about the related work. Driessnack had developed the DTC method. I do not think the work was incredibly novel; they were only exploring a different medium through which DTC could be used.

1. Bradding, Angela, and Marie Horstman. "Using the write and draw technique with children." European Journal of Oncology Nursing. 3.3 (1999): 170-5. Web. 6 Sep. 2012.

The paper by Bradding and Horstman provides background information on how drawing and writing can help adults understand what children are thinking, feeling, and perceiving in the medical field. Driessnack probably had done similar research.

2. Horstman, Maire, Susie Aldiss, et al. "Methodological Issues When Using the Draw and Write Technique With Children Aged 6 to 12 Years." Qualitative Health Research. 18.7 (2008): 1001-11. Web. 6 Sep. 2012.

Horstman, et al. explain how draw and write techniques need to be done in a responsible way in order to effectively and sensitively acquire information from children. Hourcade, et al. were aware of this and made sure someone who had experience with these techniques worked with the children.

3. Wesson, Michaela, and Karen Salmon. "Drawing and showing: helping children to report emotionally laden events." Applied Cognitive Psychology. 15.3 (2001): 301-19. Web. 6 Sep. 2012.

Wesson and Salmon offer another way for allowing children to express themselves: through reenactment. Hourcade, et al. could probably also try this technique in future work and compare it to the zoomable drawing application.

4. Butler, Sarnia, Julien Gross, and Harlene Hayne. "The effect of drawing on memory performance in young children." Developmental Psychology. 31.4 (1995): 597-608. Web. 6 Sep. 2012.

Butler, et al.'s work shows that children had a more accurate memory when they were allowed to draw versus when they only verbalized their memory. This has implications in the work of Hourcade, et al. because it reveals how much more accurate and therefore reliable the children's descriptions of their headaches were.

5. Maytal, Joseph, Robert S. Bienkowski, et al. "The Value of Brain Imaging in Children with Headaches."PEDIATRICS. 96.3 (1995): 413-16. Web. 6 Sep. 2012.

MRIs or CT scans could have been used to give a medical perspective on children with chronic headaches. They could be used to link the descriptors with the medical diagnosis.

6. Shinnar, S., and B.J. D'Souza. "The diagnosis and management of headaches in childhood." Pediatr Clin North Am.. 29.1 (1982): 79-94. Web. 6 Sep. 2012.

Shinnar and D'Souza examined headaches in children. They described how they can be diagnosed and managed. Hourcade, et al. probably used information like this as a different perspective in how children were examined for chronic headaches.

7. De Carlo, L., B. Cavaliere, et al. "EEG evaluation in children and adolescents with chronic headaches."European Journal of Pediatrics. 158.3 (1999): 247-48. Web. 6 Sep. 2012.

De Carlo, et al. explored the use of EEGs to help diagnose headaches in children and adolescents. This is yet another way Hourcade, et al. could use medical technology to help decipher children's chronic headaches.

8. Gladstein, Jack, and E. Wayne Holden. "Chronic Daily Headache in Children and Adolescents: A 2-Year Prospective Study." Headache: The Journal of Head and Face Pain. 36.6 (1996): 349-51. Web. 6 Sep. 2012.

Gladstein and Holden offer very distinct differences between adult and childhood chronic headaches. This goes with Hourcade, et al.'s emphasis on needing to distinguish difference between diagnosing adult chronic headaches and children chronic headaches.

9. Mikail, Samuel F., and Carl L. von Baeyer. "Pain, somatic focus, and emotional adjustment in children of chronic headache sufferers and controls." Social Science & Medicine. 31.1 (1990): 51-9. Web. 6 Sep. 2012.

Mikail and von Baeyer's work could offer Hourcade, et al. another perspective for children with chronic headaches. The images drawn by children could reflect a family history of chronic pain descriptors. This is because there is a trend of other family members having chronic pain, too.

10. Gascon, GG. "Chronic and recurrent headaches in children and adolescents." Pediatric Clinics of North America. 31.5 (1984): 1027-51. Web. 6 Sep. 2012.

Gascon gives a general overview of chronic headaches in children and adolescents. This can give more background information about chronic headaches and their different diagnoses for children.

Evaluation

Hourcade, et al. evaluated the work through both qualitative and quantitative means. The results were largely qualitative because they used the detail in the children's descriptions and what they observed to evaluate the effectiveness of the media used. They measured part of the DTC system: the medium on which the drawings took place. Interestingly, most of the children did not like Photogoo because they did not like to manipulate their own face or they did not know what they looked like when they had headaches. Therefore, the authors only focused on the other two media. The quantitative data they collected was the phrases that the children used to describe their pain, where the pain was, and how they felt and what they did when they had the headache. From this data, the authors saw that if the paper was used first, then there was an increase in descriptors when the tablet was used; however, when the tablet was used first, there was no increase nor decrease in the amount of descriptors when the paper followed. Time-wise, both methods were completed within a short amount of time, the longest being over 10 minutes. The children spent slightly more time on the tablet than on the paper, indicating that they had more to add to it. The subjective qualitative data included the drawings themselves and what the authors interpreted from them. They saw that children could provide more detail because they could zoom into the area of pain. They also observed that the zooming allowed the children to provide more context; they linked their headaches to pain or discomfort in other parts of the body, like the stomach and neck. Finally, they observed that the children used many more colors on the tablet with pen and paper, which baffled the authors; they could only speculate why that might be the case.

Discussion

I personally think this work and contribution was slightly interesting, but not really profound. The evaluation seemed appropriate for what they wanted to measure: effectiveness in description. The contribution was not spectacularly novel. I would like to see more work like this done because children tend to be less emphasized when it comes to chronic headaches. I did not like how the authors included a section on how many children with chronic headaches tend to be treated through adult methods. I think that did not have anything directly to do with their research.