1. Running head: NONVERBAL COMMUNICATION 1
Nonverbal Communication and Autism; the Role and
Importance of Affection Exchange Theory
Indiana University-Purdue University at Indianapolis
April Priest
December 10, 2015

2. NONVERBAL COMMUNICATION 2
Abstract
This study looks at the relationship of cortisol to nonverbal communication in the form of
touch. The hypothesis is that nonverbal behaviors will prove to be more efficacious to
calm and comfort an upset autistic child who has extremely limited verbal abilities. The
primary investigator believes that Affection exchange theory (AET) will be the reason
that nonverbal communication is able to affect cortisol levels. AET is based upon three
premises; that humans have an inborn need and ability to feel affection, that expressing or
feeling affection do not always occur together, and that affectionate communication is of
great importance for human survival and reproduction (Floyd, Hesse, & Generous,
2015). So receiving affection can influence an autistic child’s physiological traits which
will positively impact the child’s health and ultimately their survival.

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This paper will discuss how nonverbal communication in the form of touch
affects the stress levels of autistic children with severe communication difficulties as
measured by cortisol levels in their saliva samples.
Autism
Autism spectrum disorder (ASD) is a complex developmental disability that can
cause individuals large communication, social, and behavioral impairments. The latest
prevalence rates estimated by the Centers for Disease Control are that 1in 68 children
have some form of ASD (Baio, 2014). This growing population is in desperate need of
communication treatments that move beyond mere speech.
Applied Behavioral Analysis
Applied behavioral analysis (ABA) is one of the most effective treatments for
autism, teaching daily living skills through a carefully thought out schematic that breaks
down every skill into individual discrete elements. ABA is, however, a very intense
program that works best when applied religiously for 8 hours a day, 5 days a week
(Hammond, 2000). The child typically works with the same therapists each day which
necessitates an excellent relationship between the child and the therapists. Before an
ABA therapist can work with a client, there is typically a time when the child and
therapist get to know each other and develop a bond called a “pairing”.
Pairing is important to establish a relationship of mutual affection and trust and
with a child who lacks speech capabilities, the mode of communication utilized most
frequently is nonverbal in the form of hugs, tickling, and lots of smiling. Many of these
children have sensory disorders as well, often completely avoiding touch, which in turn

4. NONVERBAL COMMUNICATION 4
creates difficulties in their ability to communicate or receive affection. Having severe
language deficits further limits an autistic child’s ability to establish relationships.
Alexithymia is the inability to communicate or experience emotions. Although
autism and alexithymia are separate conditions, children with autism are also unable to
communicate their emotions due to their poor communication skills. Utilizing the
affection exchange theory, Colin Hesse & Kory Floyd (2008) propose that affectionate
communication can mediate the relation of alexithymia to various key metal health
characteristics.
Affection Exchange Theory
Affection exchange theory is a communication theory that has its roots in neo-
Darwinian philosophy. In fact, AET posits that communication is necessary for our
survival and procreation, the two main goals for all human beings. AET is based upon
three premises; that humans have an inborn need and ability to feel affection, that
expressing or feeling affection do not always occur together, and that affectionate
communication is of great importance for human survival and reproduction (Floyd,
Hesse, & Generous, 2015). So giving and receiving affection influences physiological
traits which impact our health. Thus humans are physically rewarded for communicating
and receiving affection.
Affection exchange theory can account for our investment in relational bonds
through affectionate communication. The results of a study done by Horan and Booth-
Butterfield (2010) indicated that affectionate communication can strengthen pair bonds
between romantic partners. This study provides evidence that affectionate
communication is a matter of survival. Although my study involves children too young

5. NONVERBAL COMMUNICATION 5
to be involved in a romantic relationship, the pair bond between autistic children and
their therapists is equally important for survival.
Floyd (2014) conducted a study consisting of a battery of self-report
questionnaires completed by over 200 women and nearly 300 men. Nine different scales
were used to assess both positive and negative mental health traits. The resulting
correlations showed that affection deprivation is positively associated with alexithymia,
depression, loneliness, and stress, as well as mood disorders, personality disorders, and
immune deficiencies. Happiness, social support, general health, and relationship
satisfaction were negatively correlated with affection deprivation. These research results
once again demonstrate support for affection exchange theory.
Although therapeutic touch has been utilized in an Alzheimer’s unit to calm the
patients’ agitated behaviors, which resemble the agitated behaviors of autistic children
(Woods & Dimond, 2002) and a study done by Cullen and Barlow (2002) demonstrated
an increase in nonverbal communication through touch for 12 autistic children and their
parents, there have been no studies done between autistic children and their therapists.
Factors affecting saliva collection
There are many variables that could create problems in any study that utilizes
salivary cortisol as a variable. Gender, age, body mass index, and sampling conditions
are just a few of the factors that are especially relevant to a study of autistic children
(Jessop & Turner-Cobb, 2008). All of these factors should be kept in mind when
designing a research study. Since autistic children already show abnormalities in their
cortisol response, the research study should start with a baseline cortisol level for each
participant.

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According to Granger et al. (2007), choosing the material for collecting the
salivary samples is especially important. Cotton rolls, the most common collection
material used, tend to hold onto saliva, even after it has been centrifuged and squeezed.
This makes collecting an adequate saliva sample for assaying, somewhat problematic. In
addition the sensory issues of autistic children may make compliance difficult unless the
process is quick.
Although numerous studies have been done on the relationship between nonverbal
behavior and cortisol levels none have asked the question “How does non-verbal
communication, in the form of comforting touches by therapists, affect stress in agitated
autistic children with severe communication deficits, as measured by their cortisol
levels?” This leaves an important gap in the current research literature which the
proposed study hopes to fill.
Method
Participants
This study would be conducted by recruiting 3-4 year old nonverbal autistic
children and their ABA therapists from local applied behavior analysis centers. The
inclusion criteria requires a diagnosis of autism, Asperger syndrome, or pervasive
developmental disorder-not otherwise specified. Additionally an ABA therapy student
would act as an observer and collect the saliva samples for each child/therapist dyad. A
signed consent form would be required for each child and therapist participating in the
experiments.
Instruments

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The student observers will use the E.M.P.A.T.H.Y. checklist (Riess & Kraft-
Todd, 2012) to guide their observations and notes of the nonverbal behaviors used by
therapists. For the study to be as quantitative as possible, all therapists will be trained to
notice and focus on their own use of nonverbal behavior with participants in a similar
fashion through the use of an acronym devised by Riess, Kelley, Bailey, Dunn, & Phillips
(2012). The acronym E.M.P.A.T.H.Y. stands for eye contact, muscles of facial
expressions, posture, affect, tone of voice, hearing the whole patient, and your response.
This system will be used to create uniform records and descriptions of all nonverbal
interactions.
This study will use the Touch Therapy program developed by Cullen and Barlow
(2002). This program will be utilized to increase the use of nonverbal comforting
measures by therapists once the child has become upset during the final day of the
experiment.
Experiment process
This study will consist of two testing days separated by a week during which the
ABA therapists will take part in a Touch Therapy Program.
All data will be collected during the morning one-to-one training sessions. One
therapist will be conducting the ABA therapy, and the ABA student will act as an
observer and collect saliva samples.
Both the ABA therapist and ABA student will take part in a training session
designed around the E.M.P.A.T.H.Y. protocol established by Reiss et al. This session
will highlight the importance of nonverbal communication and will familiarize the

8. NONVERBAL COMMUNICATION 8
student with the design of the field notes sheet that they will be using. This session will
include familiarizing the student and therapist with the saliva collection protocol as well.
The first saliva sample will be collected on a day when the child is in a good
mood, approximately one hour after the morning drop-off time. This sample establishes
the base rate cortisol level for each child and will serve as a comparison to the subsequent
levels.
The second sample will be obtained after the child has become frustrated and
upset by a stressful task to be determined by the ABA therapist. What each child
perceives as stressful is unique to the child and the ABA therapist will have working
knowledge of the type of task that is likely to elicit a frustration response.
At that time each therapist is to engage in comforting measures that are language-
based only for fifteen minutes. Thirty minutes after the frustration and comforting
measures are employed the ABA student will collect a second saliva sample to determine
how well the child has responded to language-based comforting. At that point each child
will return to their usual therapy tasks for the day.
The therapists will then attend a week-long training session to teach them how to
conduct Touch Therapy through a program designed by Cullen and Barlow (2002). This
will standardize the nonverbal comforting measures to be used at the second employment
of the frustration task.
On the day after the Touch Therapy sessions are completed, the therapist will
once again employ a stressful task for each child to attempt. Once the child has become
frustrated and upset, the ABA student will take the first saliva sample of that day. The
ABA therapist will then use the nonverbal behaviors learned previously to comfort the

9. NONVERBAL COMMUNICATION 9
child. Thirty minutes after the comfort measures are employed, the ABA student will
take the second saliva sample of the day.
All saliva samples and field notes will be collected by the primary investigator
and the saliva samples will be delivered to a local lab for testing.
Saliva collection equipment
The device to be used for saliva collection will be an eye sponge (BD Visispear)
that is sold as the saliva-collecting device Sorbette bySalimetricsLLC. It has a total length
of 7 cm and consists of a 5.5 cm longplasticshaft with a 1.7 cm long 1mm thick arrowhead
made of absorbing sponge material.
Saliva collection procedure
The saliva sampling procedure will involve holding the plastic shaft and placing
the sponge into the mouth. The sponge can be simply moved around in the mouth or may
be placed under the tongue. Once in contact with saliva, the sponge will swell and
expand fully until it is 1.9 cm long and 6mm thick. This process will take approximately
20-30 seconds. A fully expanded sponge contains 200–250 ml of saliva. For storage and
later centrifugation, the eye sponge is to be placed with the sponge end up (facing the
cap) into a screw topped tube and stored in a freezer until it is ready to be transported to a
local lab. The saliva will then be extracted from the eye sponge by centrifuging the tube.
Data analysis
The information on cortisol will be collected from the lab and analyzed and
graphed to determine whether nonverbal communication behavior is superior to, equal
with, or less successful than verbal communication in comforting an autistic child with
severe communication deficits.

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Due to the severe communication deficits experienced by children with autism, it
is hypothesized that nonverbal communication behaviors will be more effective in
lowering the children’s stress level as measured by their cortisol levels.

11. NONVERBAL COMMUNICATION 11
References
Cullen, L., & Barlow, J. (2002). ‘Kiss, cuddle, squeeze’: The experiences and meaning of
touch among parents of children with autism attending a touch therapy
programme. Journal of Child Health Care, 6(3), 171-181.
Baio, J. (2014). Prevalence of Autism Spectrum Disorders: Autism and Developmental
Disabilities Monitoring Network, 14 Sites, United States, 2010. Morbidity and
Mortality Weekly Report. Surveillance Summaries. Volume 63, Number
2. Centers for Disease Control and Prevention.
Dolin, D. J., & Booth‐Butterfield, M. (1993). Reach out and touch someone: Analysis of
nonverbal comforting responses. Communication Quarterly, 41(4), 383-393.
Floyd, K. (2014). Relational and health correlates of affection deprivation. Western
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Floyd, K., Hesse, C., & Generous, M. A. (2015) Affection exchange theory: A bio-
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Hesse, C., & Floyd, K. (2008). Affectionate experience mediates the effects of

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