Does clown therapy really help anxious kids?

Hospitals can be strange, foreboding places for young children. One idea to help reduce their anxiety is to invite clowns onto the ward to foster an atmosphere of light-heartedness and safety. This may seem like a harmless intervention – certainly preferable to anti-anxiety medication – but does it really work?

Alberto Dionigi and his team studied 77 children (aged 2 to 12, including 41 boys) at an Italian hospital. The children were awaiting otolaryngological surgery. They were accompanied by their parents, of whom there were 119, including 67 mothers. None of the children had a fear of clowns (coulrophobia).

Fifty-two of the children were allocated to the clown condition. In the waiting area before surgery, two clowns from the Clown Care Unit “I nasi rossi del dottor Jumba” of Cesena entertained these children, one child at a time, for about 30 minutes, using jokes, puppets, soap bubbles and magic. A control group of 25 children didn’t get to enjoy the clowns. A psychologist scored an observational anxiety scale for the children in the waiting area, and then again in the pre-operating room. The parents also completed a self-scored measure of anxiety in the waiting area and in the pre-operating room.

The encouraging result is that children in the clown group were less anxious in the pre-operating room after seeing the clowns, as compared with in the waiting area before they saw the clowns. The control group, by contrast, were more anxious in the pre-operating room than they had been earlier. Also, in the control group, the mothers’ anxiety increased once they were in the pre-operating room whereas the mothers of the children in the clown group did not show this increase in anxiety.

“These results support previous research that a clown doctor’s presence reduces the distress of the child preoperatively,” the researchers said. Clown therapy – now backed by science! Right? Maybe not. This study has a number of flaws that undermine the conclusions.

Because the control group received no intervention at all, we’ve no way of identifying the active ingredient of the clown intervention. Was it the jokes? The magic? Merely the distraction of meeting strangers? From a more technical perspective, an unfortunate detail was that children in the clown group started off a lot more anxious than children in the control group. Perhaps the clown group children showed a reduction in anxiety, not because of the clowns, but simply because acute anxiety can only be sustained for so long. No joke – we really need more robust research before concluding that clown therapy is beneficial.

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Dionigi A, Sangiorgi D, and Flangini R (2014). Clown intervention to reduce preoperative anxiety in children and parents: A randomized controlled trial. Journal of health psychology, 19 (3), 369-80 PMID: 23362335