Benefits of medical clowning in the treatment of young children with autism spectrum disorder

Humor in rehabilitation professions: a scoping review

PURPOSE

Studying humor in the rehabilitation professions is important given its positive effects on health and well-being. We conducted a scoping review to understand how the use of humor has been explored in the existing literature in four rehabilitation professions. The rehabilitation professions included audiology, speech-language pathology, physical therapy, and occupational therapy.

MATERIALS AND METHODS

The five-stage method identified by Arksey and O'Malley was used to conduct this review. Six databases were searched. We included 57 articles in our final review, summarized in a narrative synthesis.

RESULTS

We generated seven themes in our analysis: (1) humour as a management strategy in therapy; (2) humour as a power establisher vs. equalizer; (3) humour as a coping mechanism in rehabilitation; (4) conceptualizations of non-verbal humor cues in therapy; (5) Is humour trainable? (6) Humor used to foster group cohesion; and (7) Attitudes and beliefs surrounding humor practice.

CONCLUSIONS

Our findings emphasize the importance of using humor in the rehabilitation professions, and the ways in which humor is conceptualized in a multitude of ways for both clinician and client. Future work is needed to further understand the presence and use of humor in rehabilitation professions.IMPLICATIONS FOR REHABILITATIONIn a scoping review of the literature, this study showed that humor was used mainly positively in rehabilitation by the included professions of audiology, speech-language pathology, physical therapy, and occupational therapy and contributed to a sense of belonging.Humor may be an effective way to improve management of client/clinician relations as well as improving group cohesion in rehabilitation settings.In the rehabilitation professions of audiology, speech-language pathology, physical therapy, and occupational therapy, non-verbal humor cues were used in instances where communication was difficult or impaired for clients.

Play therapy in children with autism: Its role, implications, and limitations

Play is a pleasurable physical or mental activity that enhances the child’s skills involving negotiation abilities, problem-solving, manual dexterity, sharing, decision-making, and working in a group. Play affects all the brain's areas, structures, and functions. Children with autism have adaptive behavior, adaptive response, and social interaction limitations. This review explores the different applications of play therapy in helping children with autism disorder. Play is usually significantly impaired in children with autism. Play therapy is mainly intended to help children to honor their unique mental abilities and developmental levels. The main aim of play therapy is to prevent or solve psychosocial difficulties and achieve optimal child-healthy growth and development. Play therapy helps children with autism to engage in play activities of their interest and choice to express themselves in the most comfortable ways. It changes their way of self-expression from unwanted behaviors to more non-injurious expressive behavior using toys or activities of their choice as their words. Play therapy also helps those children to experience feeling out various interaction styles. Every child with autism is unique and responds differently. Therefore, different types of intervention, like play therapy, could fit the differences in children with autism. Proper evaluation of the child is mandatory to evaluate which type fits the child more than the others. This narrative review revised the different types of play therapy that could fit children with autism in an evidence-based way. Despite weak evidence, play therapy still has potential benefits for patients and their families.

The effect of medical/therapeutic clowns on the playfulness of children with intellectual disabilities

BACKGROUND

Play is an essential component of children's development. Children with intellectual disability tend to have poor socioemotional abilities and impaired play. This study examined the effects of a medical/therapeutic clowning play intervention on the playfulness of children with intellectual disability.

METHOD

Two medical clowns facilitated a play intervention in a preschool classroom setting with a total of 52 children with intellectual disability. We compared before and after two groups that received the intervention: group 1 met the medical clowns once a week for 6 months (long-intervention group) and group 2 for 3 months (short intervention group). Children's functioning was assessed using the Vineland Adaptive Behaviour Scales. Children's playfulness was scored using the Test of Playfulness observational assessment. A teachers' focus- group was used to gather additional information on the clowns' work.

RESULTS

Children's playfulness increased significantly at the end of the intervention, whereas the improvement in the playfulness scores of group 1 was significantly larger than those of group 2 (t₅₀  = -4.82, p < .001). The teachers' focus group revealed additional benefits of the medical clowns' work.

CONCLUSION

The results shed light on the play and playfulness of children with intellectual disability and the possible contribution of a clowning play intervention to their development.

Motivations and Personal Traits Can Predict Self-Efficacy of the Clown Therapist: A Descriptive Study

The individual and collective perception of self-efficacy in clown therapists is fundamental in order to be able to be active, restrained, energetic and defocused, if necessary, without being overwhelmed by any problems patients might have. The present study evaluated both the incidence of motivational and dispositional functions on the level of perceived self-efficacy with a sample of 259 Italian clown therapists who were administered The Volunteer Self-Efficacy Scale, the Volunteer Process Model and the Italy Personality Inventory. The significance of a hierarchical linear regression model of perceived self-efficacy was tested. The results showed that the value orientation of the operators mainly influenced the level of perceived self-efficacy, that is, the search for actions with a high social meaning, rather than the orientation towards situations and experiences that allow one to expand one's knowledge and promote one's own person. Profiles with higher perceived self-efficacy were associated with the trait of dynamism and conscientiousness, while a person's vulnerability was found to be a significant negative predictor of self-efficacy. An additional significant predictor was the experience of the clown therapist. The results of the study also showed a positive and functional role of the synergy conferred by teamwork. The group mitigates the emotional difficulties of the individual and supports him/her by orienting him/her technically and compensating for any inexperience in the field of animation in sensitive contexts, such as hospital wards with serious and vulnerable patients, such as children.

Pediatric Tuina in children with autism spectrum disorder: a study protocol for a randomized controlled trial

Background

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by repetitive stereotypical behavior and communication deficits. Currently, it lacks a specific clinical treatment method. Pediatric Tuina is a recent therapy in traditional Chinese medicine (TCM) and has been used to treat children with ASD. Nonetheless, it remains uncommon given the lack of large-scale evidence-based medical studies. This study aims to compare the efficacy of Tuina and conventional treatment in children with ASD.

Methods

Eligible children will be randomly assigned to either the pediatric Tuina plus conventional treatment group or to the conventional treatment alone group based on a random table at a ratio of 1:1. The effectiveness of the Tuina intervention for ASD will be evaluated by a third-party organization. The pre- and post-intervention scores on the Childhood Autism Rating Scale comprised the primary outcome, whereas pre- and post-intervention scores on the Autism Treatment Evaluation Checklist were the secondary outcomes to assess improvement in symptoms. Baseline values of the participants will be determined at the time of registration. Outcomes will be evaluated after the 30th treatment session. The follow-up period will last for 6 months after treatment.

Discussion

This study will evaluate the effectiveness and safety of Tuina in the treatment of ASD. The results of this study could provide reliable evidence to improve the management of patients with ASD.

Trial registration

Chinese Clinical Trial Registry (CHICTR), ChiCTR2000040452. Registered on 28 November 2020.