The effect of medical/therapeutic clowns on the playfulness of children with intellectual disabilities.
Rinat Feniger-Schaal, Amitai Stern, Einat Elizarov
PMID 36409006WHAT IT FOUND
Children with intellectual disabilities showed increased observed playfulness after weekly medical clown sessions.
Those who received the intervention for six months improved more than those who received it for three months. Teachers reported children initiating play and engaging more with peers.
Key findings
01Observed playfulness scores significantly increased from baseline to post-intervention in both the six-month and three-month groups.
02The improvement in playfulness was significantly larger in the group that received the six-month intervention compared to the three-month group.
03Teachers reported that the clowns' work led to children initiating interactions, engaging in group play, and continuing to ask for the clowns' games months later.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
There was no control group that received no intervention. Both groups received the clowns, so it is impossible to know if the improvement was due to the clowns specifically or simply the passage of time and regular interaction. The study did not measure outcomes outside the clown sessions, so it is unclear if the improved playfulness transferred to other settings or interactions. The Test of Playfulness was adapted for this study, removing some items and changing scoring for skillfulness, which may affect the validity of the comparisons. The sample size was smaller than the calculated requirement (52 participants vs the planned 52 per group or total 52? Text says 'sample of 26 participants per group' for power calculation, total 52. Wait, text says 'we were expecting... using a sample of 26 participants per group.' Total 52. So power was met? But text says 'pioneering study' and 'limited'. Actually, the limitation is the lack of control group and the naturalistic setting. The authors note the absence of a robust control group makes it impossible to pinpoint the unique contribution of the clowns compared to other treatments.
Declared interests
The paper does not explicitly state a conflict of interest declaration in the provided text, but it notes ethical approval from the University of Haifa and the Israel Ministry of Education. The clowns were graduates of the same university's program.
The easy way to misread this
Do not assume this proves medical clowns are superior to other play interventions. Without a control group, the improvement in playfulness could be due to any consistent, engaging adult interaction, not specifically clowning.