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Evidence-Based Complementary and Alternative Medicine
Volume 2011, Article ID 732394, 10 pages
Original Article

Physiological and Emotional Responses of Disabled Children to Therapeutic Clowns: A Pilot Study

1Bloorview Research Institute, Bloorview Kids Rehab, University of Toronto, Toronto, Ontario, Canada
2Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
3Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
4Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
5SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada

Received 14 October 2009; Revised 5 January 2010; Accepted 7 January 2010

Copyright © 2011 Shauna Kingsnorth et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.