Physiological and emotional responses of disabled children to therapeutic clowns: a pilot study.

Shauna Kingsnorth,Patricia Mckeever,Stefanie Blain

doi:10.1093/ecam/neq008

Abstract

This pilot study examined the effects of Therapeutic Clowning on inpatients in a pediatric rehabilitation hospital. Ten disabled children with varied physical and verbal expressive abilities participated in all or portions of the data collection protocol. Employing a mixed-method, single-subject ABAB study design, measures of physiological arousal, emotion and behavior were obtained from eight children under two conditions—television exposure and therapeutic clown interventions. Four peripheral autonomic nervous system (ANS) signals were recorded as measures of physiological arousal; these signals were analyzed with respect to measures of emotion (verbal self reports of mood) and behavior (facial expressions and vocalizations). Semistructured interviews were completed with verbally expressive children (n = 7) and nurses of participating children (n = 13). Significant differences among children were found in response to the clown intervention relative to television exposure. Physiologically, changes in ANS signals occurred either more frequently or in different patterns. Emotionally, children's (self) and nurses' (observed) reports of mood were elevated positively. Behaviorally, children exhibited more positive and fewer negative facial expressions and vocalizations of emotion during the clown intervention. Content and themes extracted from the interviews corroborated these findings. The results suggest that this popular psychosocial intervention has a direct and positive impact on hospitalized children. This pilot study contributes to the current understanding of the importance of alternative approaches in promoting well-being within healthcare settings.

Highlights

Since therapeutic clowning began in North America in 1986, it has become a popular practice in acute and rehabilitation hospitals worldwide [1,2,3,4,5] and increasingly is thought to play an important complementary role in healthcare [2, 6, 7]
Employing a mixed-method, single-subject ABAB study design, measures of physiological arousal, emotion and behavior were obtained from eight children under two conditions—television exposure and therapeutic clown interventions
Four peripheral autonomic nervous system (ANS) signals were recorded as measures of physiological arousal; these signals were analyzed with respect to measures of emotion and behavior

Summary

Introduction

Since therapeutic clowning began in North America in 1986, it has become a popular practice in acute and rehabilitation hospitals worldwide [1,2,3,4,5] and increasingly is thought to play an important complementary role in healthcare [2, 6, 7]. Studies of therapeutic clowning have shown that this intervention facilitates verbal and nonverbal communication [7, 10]; improves mood and attitude [6, 11, 12]; increases expressions of emotion such as laughter, joy and humor [7, 13,14,15,16]; supports empowerment and active role-reversal [13] and is perceived as a valuable complementary therapy by patients, families and care providers [12, 15, 16] While these results are encouraging, they must be interpreted with caution due to the limitations of their predominantly qualitative or evaluative study designs. Understanding of how Evidence-Based Complementary and Alternative Medicine therapeutic clowning affects the physical and mental wellbeing of hospitalized chronically ill and/or disabled children and their care providers is limited

Methods

Results

Discussion

Conclusion