Considering the realities of salivary research with young children:

What’s spit all about?

Christine O’Farrellya and Eilis Hennessya

aSchool of Psychology, University College Dublin, Dublin, Ireland

Corresponding Author: Eilis Hennessy, School of Psychology F208, University College

Dublin, Newman Building, Belfield, Dublin 4, IRELAND.

E-mail: eilis.hennessy@ucd.ie

Phone: 00353 1 716 8362

Christine O’Farrelly is a PhD candidate at the School of Psychology at University

College Dublin. Her PhD research is investigating children’s experiences of transitions

to new rooms in early childhood care and education settings.

Eilis Hennessy is senior lecturer in developmental psychology at the School of

Psychology at University College Dublin. Her research interests include children’s

experiences in day care and out-of-school care.

O’Farrelly, C. & Hennessy, E. Considering the realities of salivary research with young children: What’s spit all about? International Journal of Social Research Methodology

Considering the realities of salivary research with young children:

What’s spit all about?

Over the last two decades interest in salivary research in the social sciences has

grown rapidly. Salivary research is appealing as a quick, inexpensive, and

noninvasive means of determining a range of biological markers, which offer

insight into a variety of human responses, for example, stress. To the social

researcher these advantages provide exciting possibilities for new transactions

between social, behavioural, and biological models of development. Salivary

research is especially attractive to those working with children. Indeed, as well as

being noninvasive, saliva also provides an opportunity to measure variables with

young children where self-report measures may be inappropriate. Yet, for all its

appeal the reality of saliva collection with younger populations appears far from

straightforward. This article draws on two research examples to illustrate some of

the methodological, ethical, and practical issues pertinent to salivary research

with young children. Specifically, it considers barriers to participation and

possible strategies for promoting the methodological and ethical basis of salivary

research. In doing so it provides starting points for discussion in what has become

a critical methodological debate.

Keywords: salivary research; young children; biobehavioural research; assent;

play

Introduction

Saliva, previously the purview of clinical science, has become a common feature of

research in the social and behavioural sciences. The enthusiasm is palpable, with some

suggesting that salivary markers may be key in facilitating the integration of biological,

behavioural, and social models of development (Granger & Kivlighan, 2003). Interest in

saliva is driven in large part by the ever-increasing catalogue of information that can be

determined in small samples. These biomarkers offer insight into a variety of human

responses such as stress levels and immune function. Saliva’s appeal is also built on its

inherent advantages as a means of collecting biological specimens. Indeed, next to

blood or urine sampling saliva collection is cheap, convenient, and noninvasive

(Hofman, 2001). This makes saliva both affordable and amenable to collection in the

field. Consequently, saliva collection has become a feasible option for social scientists

seeking to integrate biological markers into their research.

Saliva’s advantages are especially attractive to social and developmental

researchers working with children. Firstly, unlike blood draw, which can be acutely

painful, saliva collection is relatively noninvasive. Consequently, saliva is likely to

reduce the risk of distress to children, an ethical necessity in research contexts.

Secondly, saliva offers information on variables, such as stress, that young children may

have difficulty describing verbally (Jessop & Turner-Cobb, 2008). Moreover, as

children’s stress levels cannot always be reliably determined by their behaviour,

researchers are increasingly turning to physiological measures, such as salivary cortisol,

as an index of children’s stress response (Vermeer & van IJzendoorn, 2006).

By virtue of this versatility saliva has enabled researchers to tackle questions

that were previously only theoretical. For example, salivary cortisol has been employed

to indicate the pattern of infants’ stress reactivity during enrolment in Early Childhood

Care and Education (ECCE) settings for the first time (Ahnert, Gunnar, Lamb, &

Barthel, 2004). Others have used salivary biomarkers of immune function to investigate

the relationship between children’s mental health and their immunity (Keller, El-Sheikh,

Vaughn, & Granger, 2010). In many ways the possibilities for insight seem limitless.

However, as Granger and colleagues (2007) point out, the reality of saliva collection

with younger populations is often far from straightforward.

This article considers some of the barriers to salivary research with young

children (2-6 years), including children and caregivers’ resistance to saliva collection,

the absence of a superior saliva collection method, and a lack of reporting on assent

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procedures. It draws on two research examples to further explore these issues and offers

practical suggestions as to how they might be addressed.

Saliva collection with young children: A confounding situation?

Perhaps the most challenging aspect of salivary research with young children is the

tendency for some children to resist saliva collection. This pattern is particularly

problematic for research investigating children’s stress response. Here it is possible that

some children may react stressfully to the collection process itself, which undermines

the validity of the data collected (Gunnar & White, 2001). In this way the method itself

risks operating as a confounding variable. This concern has received some support from

a recent study, which found that young children who resisted, but did not outright refuse

to participate in saliva collection, showed higher levels of the stress hormone cortisol

(Kaitz, Sabato, Shalev, Ebstein, & Mankuta, 2012). To complicate matters it appears

that some children may be more likely to resist saliva collection than others.

Consequently, missing data is unlikely to be random, but rather related to individual

characteristics such as children’s temperament (Granger et al., 2007; Kaitz et al., 2012).

This resistance has various repercussions. Ethically, this pattern suggests that

saliva collection may pose a risk of distress for some children. Practically, resistance

can reduce both the amount of saliva and the number of participants available, a

frequently reported scenario (e.g., de Haan, Gunnar, Tout, Hart, & Stansbury, 1998).

Where stress hormones are of interest resistance may introduce sampling bias because

the children who resist may be the ones who are most stressed by their experiences.

From a methodological perspective this resistance ultimately stands to undermine the

validity of the very data it seeks to collect (at least in the case of stress hormones).

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Saliva collection as noninvasive - do children agree?

One possible explanation for children’s resistance to saliva collection is that their

perceptions of saliva collection may differ from those of adults. This is illustrated by a

surprising research report suggesting that children’s preferences for saliva collection did

not dramatically outweigh their preferences for blood draw, despite parents choosing

saliva collection in the vast majority of cases (Gorodischer, Burtin, Hwang, Levine, &

Koren, 1994). Unfortunately, these results are difficult to interpret due to

methodological inconsistencies in how saliva and blood were collected. Nonetheless,

others assert that children can respond anxiously to medical procedures irrespective of

their invasiveness (Gold, Kim, Kant, Joseph, & Rizzo, 2006). Thus, it is possible that

children do not see saliva collection as being noninvasive in the same way that adults

appear to.

The search for an acceptable saliva collection method

Difficulties with children’s participation are further exacerbated by the absence of a

gold standard saliva collection method. This is because collection methods that work

well with adults and older children often prove ineffective when used with younger

participants (e.g., Watamura, Donzella, Kertes, & Gunnar, 2004). A variety of methods,

from drooling to absorbent oral devices, have been employed with young children with

varying success. These methods typically involve children drooling into a cup or vial or

mouthing a device for one to two minutes. In particular, cotton-based devices seem to

be especially unpalatable and their use has been linked to poor participation (Clements,

Parker, Dixon, & Salley, 2007). Collection methods can prove so ineffective with some

children that some researchers have been forced to change or revise their collection

methods to encourage greater participation (e.g. Watamura et al., 2004). Yet, in spite of

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these frustrations, the value of investigating the acceptability of these collection

methods from children’s own point of view has been completely overlooked.

Assent procedures in salivary research with young children

Another feature of salivary research that may well relate to challenges with participation

is the absence of reporting on assent procedures. It is possible that this omission reflects

word limits rather than practices, as manuscript length is believed to constrain reporting

on methodological issues (Brannen, 2005). However, it is similarly conceivable that

assent procedures are one example of the dissonance between qualitative and

quantitative research paradigms (Brannen, 2005). Although accounts of assent

procedures are often omitted from salivary research with young children, reports from

research with infants are far from encouraging. Here authors concede to attempting to

coax infants into participation (Goldberg et al., 2003). Others report only stopping short

of insisting that infants participate because of the confound with stress levels (van Bakel

& Riksen-Walraven, 2004).

Seeking children’s assent regarding their research participation is critical for two

reasons. Firstly, such procedures are an ethical necessity. Secondly, negotiating assent

on children’s terms, using meaningful information, benefits all parties including the

researcher (Lindeke, Hauke, & Tanner, 2000). For example, meaningful assent may

help promote children’s sense of ownership in the research, which in turn may boost

participation rates. Some may take the view that assent procedures are unnecessary or

ineffective with younger children because of misconceptions regarding young children’s

cognitive competencies (Morrow & Richards, 1996). However, Hill (2005) holds that it

is wrong to assume that young children lack the competency to make decisions about

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their research participation. Indeed, even simple explanations can help young children

make sense of what their research participation will involve (Fine & Sandstrom, 1988).

Parental and caregiver resistance to salivary research

A further issue with saliva collection arises from how the collection of biological

samples is perceived by parents and other caregivers. Aside from being gatekeepers,

parents and other caregivers are increasingly being recruited to collect samples with

young children. For example, parents and practitioners have been asked to collect

samples in research investigating what appears to be evidence of atypical stress patterns

in some children attending full-day ECCE settings (see Vermeer & van IJzendoorn,

2006). However, participation in such research is often low, a trend one study suggested

may be due to parents and ECCE providers’ dislike of saliva samples being collected

from children (Groeneveld, Vermeer, van IJzendoorn, & Linting 2010).

What is it about saliva collection that parents and caregivers might dislike?

Saliva collection may be disagreeable to caregivers because of concerns that

participation will encourage children to drool or spit. In fact there are reports of children

refusing to participate because of their parents’ rules about spitting (Kaminski, Pellino,

& Wish, 2002). But evidence from epidemiological salivary research suggests that

resistance goes beyond this explanation. Here reports have demonstrated that adults

often refuse their participation based on a variety of concerns ranging from the

plausible, such as drug testing, to the unlikely, such as cloning (Adam & Kumari, 2009).

In cases where parents are being asked to consent to sample collection on behalf of their

child, these uncertainties may be heightened and concerns and misconceptions may

operate more intensely. It is also possible that parents may feel that the use of a clinical

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method for research that promotes an understanding of social rather than medical

phenomena is unjustified.

Playful alternatives to saliva collection

One possible means of promoting the methodological, ethical, and practical basis of

salivary research with young populations could be to employ collection approaches that

are enjoyable for and attractive to children. Adopting techniques that respond to how

young children naturally engage with their worlds has a strong tradition in participatory

research. Yet such attempts are rare in salivary research with young children.

Exceptions include reports of ‘tasting games’ that involve children guessing the flavour

of various powdered drink mixes (Watamura, Sebanc, & Gunnar, 2002), and presenting

saliva collection as a ‘tea-party game’ (Legendre & Trudel, 1996). Perhaps, the most

detailed and notable example is Zimmermann’s (2008) ‘feed the frog’ collection

method. This technique involved asking children to drool saliva into a model of a

‘hungry’ frog. Utilising a playful rationale for saliva collection appeals to children’s

natural competencies and in doing so may reduce the likelihood that children will react

stressfully to the collection method itself.

Salivary research in action

In order to further unravel the issues outlined above two research examples are

considered. The authors arrived at these research examples unexpectedly, based on the

findings of a mixed-method exploratory study suggesting that some children may find

transitions to new rooms in ECCE settings stressful. To further explore this stress we

decided to investigate children’s salivary cortisol patterns during transitions. However,

saliva collection seemed almost the antithesis of participatory research. And so we

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found ourselves at the intersection of two seemingly incompatible research paradigms:

the social and natural sciences. A clash of research cultures was evident, most notably in

how children’s participation was positioned in the respective approaches. In salivary

research accounts of children’s active participation were often invisible. And yet in the

social sciences there is a long-established reflective discourse on children’s research

participation. Overall, we found that there were few signposts to indicate how best to

provide meaningful opportunities for assent, what collection methods would be

acceptable to children and parents, and how children were likely to respond to salivary

research activities.

To help address these gaps the objective of the first research example was to

explore the acceptability of different saliva collection methods to young children, their

parents, and ECCE practitioners using a play-based approach. Social scientists have

long been aware of the need to communicate effectively with young children in order to

avoid misunderstanding and potentially uninterpretable findings (e.g., Donaldson,

1978).  This is repeated here with a new data collection method, because if the

collection method for saliva causes stress this will render the findings uninterpretable.

The findings of the first research example informed the methodology of the second

study, which investigated the cortisol patterns of preschool children as they moved to

new rooms in ECCE settings. These research examples are included in this paper to

springboard discussion on issues related to saliva collection with young populations.

Research example 1: An investigation of saliva collection methods

The saliva collection study was designed to compare the acceptability of three saliva

collection methods to 17 preschool-aged children (2-5 years) children, their parents, and

ECCE practitioners. This convenience sample of preschool children and their families

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was recruited from two centre-based ECCE settings. The parental response rate in each

centre was 43.33% and 35.29%. In addition to background literature, parents and

practitioners were given a short illustrated booklet as a tool to discuss the research

activities with the children. As well as comparing collection methods the study served

as a pilot for a larger study investigating children’s cortisol patterns. Because of this

consent was sought to run cortisol analysis on the samples collected.

Saliva samples were collected using three methods:

Sorbettes (BD Visispear™ Eye Sponge distributed by Salimetrics): Children

mouthed two Sorbettes for 90 seconds. Once wet Sorbettes were placed in

storage tubes.

Salimetrics Children’s Swab: Children mouthed the swab for 90 seconds. Once

wet swabs were cut at the wet/dry section using a scissors and the saturated end

was placed in storage tubes.

Passive Drool: Children tilted their head forward and drooled either through

straws or funnels into vials.

A timer was used to record the 90 seconds required for the Sorbette and swab methods.

The pilot also included the use of a play-based collection technique that was

purposefully designed to make the saliva collection fun and meaningful for the children.

This involved a story about ‘Rocco the Astronaut’ who needed saliva, the secret

ingredient in rocket fuel, to fix his spaceship, along with a commercially available hand-

sized astronaut puppet. Children were also given the opportunity to choose a sticker as a

thank you for their participation. Stickers were provided to children irrespective of

whether they chose to participate and children were not told about the stickers before

being invited to take part. Two practitioners and parents collected saliva samples with

children in each ECCE setting and at home respectively. The first author assisted the

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saliva collection in the ECCE settings. It was emphasised to both parents and

practitioners that saliva collection should only be carried out where children were

willing to participate.

Short semi-structured interviews were carried out with 2 practitioners and 9

parents and participatory interviews were carried out with 15 children to investigate

saliva collection experiences. Participatory interviews involved a variety of methods

including large puppet, drawing, smiley-face rating-scale, and recommendations for

hypothetical peers activities. Interviews focused on the relative acceptability of the

collection methods to participants, but also explored participants’ research experiences

more generally. Interviews were transcribed verbatim and analysed using the principles

of thematic analysis (Braun & Clarke, 2006). The findings most relevant to the present

paper’s purpose are presented here.

First impressions: Lost for words

Of the parents who chose to take part in the study the majority reported having no

concerns about saliva collection, following consideration of the background literature.

At the same time one parent did highlight that she could ‘see why some people might

find it a little invasive or something’. Similarly, a practitioner reported that ‘the idea of

it seem[ed] maybe a little bit invasive’. This practitioner went on to comment that

measuring biological markers such as cortisol would cause ‘question marks in your

head’. Interestingly, she added ‘I don’t even know why. I can’t actually justify it’.

Another parent referred to similar reticence: ‘I didn’t really want to do it at first...it was

just ‘cause it was saliva or whatever’.

This difficulty in articulating specific concerns could indicate the unfamiliar

place of biobehavioural research in the day-to-day lives of the general public.

11

Nonetheless, these reactions, be they nonverbal or even unconscious, appear to be

negative in nature. In other words, participants may not be quick to identify their

concerns about biobehavioural research, but it appears that they exist. It is important to

note that we did not have the opportunity to consult with parents who decided not to

take part in the study. It is likely that such data would have further illuminated parents’

perceptions of salivary research.

Making saliva collection child’s play

Feedback on the play-based approach was very positive with many parents and both

practitioners reporting that its inclusion made a ‘huge difference’. According to one

parent the story was ‘really helpful, I mean I don’t know how it would have been

without it’. Both the parents and the practitioners highlighted that it would have been

difficult to explain the saliva collection to the children otherwise: ‘that could be very

difficult if you are trying to explain to a child that they need it for a test, a medical test,

they would be looking at you, you know, “what are you talking about mum?”’.

According to some parents the play approach helped better prepare children so that they

‘knew what was coming’. Encouragingly, reports suggested that the medium of play

appealed to the children: ‘she started talking about it as soon as she got in the car on

Friday… She was just talking about it all night, she took [the storybook] to bed with

her’. Children also described the process as ‘fun’ and frequently asked to take part in

saliva collection during their interview. Nearly all of the children recounted the play-

based narrative in their interviews and drawings: ‘It run out of petrol…we got the petrol

out of here…then we put it in the rocket…it goes on the moon again’. However, some

parents did add that the book became less important and sometimes was not necessary:

‘once she knew the story then it was less important’.

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The positive appraisals of the play-based method suggest that play may help to

offer children an enjoyable and attractive saliva collection experience. Together with the

children’s information booklet these attempts at promoting ethical partnerships may

have afforded children greater control in the research process. This in turn may have

optimised participation as reflected by children’s full participation rates. Indeed, failing

to acknowledge the active way in which children try to make sense of their research

participation (Westcott & Littleton, 2005) not only discredits children’s competency,

but also is likely to incur practical consequences for participation. At the same time it

could be argued that a fictitious rationale bypassed the provision of a more

comprehensive account of the study’s purpose. Although this criticism is valid, the

objective was not to convince the children to participate for false ends, but rather to play

to their natural ability to simultaneously engage in, and makes sense of, their

imaginative encounters (Harris, 2000). In hindsight, however, greater efforts should

have been made to explain to the children how their saliva would be used, in line with

recommendations that children should be informed about the full implications of

research (Kellett, 2010).

The medium of play seemed more important than its actual content. In fact one

parent suggested that a second story, more specifically targeted towards girls, would be

a useful revision to the procedure. Either way saliva collection is most likely to be a

credible play activity for children when endorsed by an engaging and responsive sample

collector. Indeed, in the second study a practitioner reported incorporating the story into

other activities whereby the children designed and built a large spaceship themselves.

This coincides with the notion that participatory techniques derive their success not

from the use of specific methods, but rather from the spirit and process in which they

are employed (Gallacher & Gallagher, 2008).

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Children as saliva collection experts

The interview data also indicated children’s expertise in saliva collection. Several

parents noted that their children often showed them what to do: ‘he tells me “I know,

don’t read, let me tell you this, we do that, we do this”’. The children themselves also

referred to their competency, informing the researcher: ‘I’m very good’ and ‘I just did it

all myself’. For several of the children this meant that they were confident in taking the

lead in the collection process, telling the researcher ‘I’ll show you’ and ‘you don’t know

it, we know it’. Interestingly, the children frequently made perceptive observations about

the saliva collection process. For example, some of the children commented on

materials, such as the timer and the scissors, that were employed in the saliva collection

but had not been included as interview props: ‘where’s the beeper though?’, and ‘the

cap can’t cut it’. These findings support arguments that children actively construe their

research participation. Moreover, they demonstrate children’s capacity as competent

research participants.

Sensitive collection strategies

Parents and practitioners also shared insight on other factors that they suggested might

influence participation. In line with caveats in the literature, practitioners and parents

spoke about how personality and age might play a part in participation. ‘I guess it

depends on [the child’s] personality, but I thought that [my daughter] would protest to

something being put on her tongue’. Similarly, one of the practitioners commented that

‘[younger children] would just be a little bit more reluctant’. In these cases respondents

emphasised the importance of familiarity: ‘the most important thing is knowing the

children’. Ensuring that a familiar adult carried out the sample collection was seen as

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being particularly important in helping younger children feel at ease: ‘[Younger

children] would just be a little bit more reluctant so just making sure that they have a

carer that they are confident in doing it with them’. Where children were more reticent,

practitioners commented that having another child go first might help children feel more

comfortable: ‘[watching another child] just gives them a boost of confidence so it’s not

so bad like’. Alternatively, practitioners could demonstrate themselves when a child

hesitated: ‘just a bit of encouragement and care, just showing him and trying to help

him’. Similarly, one parent noted that participating in both the play and the sample

collection with her daughter worked quite well.

Research Example 2: An investigation of children’s cortisol patterns during

transitions to new rooms in ECCE

The Transitions Study was designed to investigate children’s cortisol patterns as they

moved to new rooms in their ECCE setting. Twenty-six preschool-aged children were

recruited from thirteen ECCE settings. A short-term longitudinal design was employed

whereby salivary cortisol was collected before and following transitions. In addition to

background literature, parents and ECCE centres were given a short illustrated booklet

as a tool for discussing the research process with the children. Parents and practitioners

collected samples with Sorbettes, along with the ‘Rocco the Astronaut’ play-based

technique, using the procedures outlined in the previous research example.

Biobehavioral research: A hard sell

Like many social and behavioural studies, recruitment for the Transitions study was

difficult. Recruitment efforts included written invitations to 74 centres, the distribution

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of invitation letters by a local ECCE quality-coordinator, and an advertisement in the

Ezine of a leading professional organisation. The low participation rate of 29.69% (of

the 64 suitable settings who received written invitations) was discouraging but

somewhat higher than rates reported in similar studies (Groeneveld et al., 2010). In a

considerable number of cases centres cited concerns over how parents would receive the

study as an explanation for their refusal. Others pitched the study to parents first and

refused on the basis that parents had expressly sounded their objections to research

involving saliva collection. Of the 19 centres who agreed to take part, five were unable

to recruit any of the 28 families invited to take part in the study. Overall parental

interest in the study was somewhat low with 37.83% of eligible parents deciding to take

part in the study.

Promoting children’s participation

More positively, and counter to the greater number of similar studies, all of the children

in the Transitions Study chose to participate in the majority of the saliva collection

occasions. However, as the authors were not present during saliva collection it was

difficult to determine with certainty that missing samples were not due to children’s

refusal. The study’s successful participation rates may be related to a number of factors.

Firstly, we chose to include practice occasions, whereby practitioners were given extra

collection equipment and encouraged to introduce children to the materials and

collection process. This may have helped normalise the collection process and perhaps

went some way in empowering children’s decision making about their participation.

Certainly, practitioners reported that several children were initially hesitant before

practice sessions or until the practitioner had demonstrated the process.

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A further factor may have been the play-based approach, a possibility endorsed

by many of the centres’ reports. Yet, as can be expected, in some cases practitioners

commented that certain children seemed less interested in the technique. Interestingly,

in a small number of instances practitioners reported that children were most fascinated

by the timer or the selection of stickers they could choose from as a thank you.

Another possible explanation for the participation rates may be the skill of the

data collectors themselves. Entrusting the saliva collection to the practitioners was a

complex decision. On the one hand, research assistants offer maximum protocol fidelity.

This compliance is imperative because, depending on the analyte, even small deviations

from procedures can affect sample validity. Nonetheless, building trust with young

children takes time. Without this investment, young children, especially those with an

inhibited temperament style, may find the presence of a novel researcher stressful.

Again this is likely to reduce children’s participation and confound biomarkers of stress.

Certainly, the first author quickly learnt that her mere presence was enough to elicit

reticence from some children. Consequently, the decision for saliva collection to be

carried out by practitioners who were familiar with the children’s personalities and well

versed in reading their nonverbal cues of interest/disinterest, may have offered

advantages for this study. However, it is important to note that this partnership

sometimes incurred a trade off as practitioners either forgot, or were unable, to observe

certain aspects of the collection protocols.

Discussion

The reality of saliva collection with younger populations is clearly more complicated

than it appears at first blush. Yes, saliva may be inexpensive and easy to collect, but

only when considered next to blood and urine sampling techniques. To the social

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researcher saliva collection may well prove cumbersome, expensive, and time

consuming. As O’Connor (2011) warns biobehavioural research of this kind is not for

‘the faint-hearted or under-resourced’ (p.109). Perhaps more critically, under certain

circumstances the validity of the data collected may be compromised. Unfortunately,

technical research aimed at increasing saliva’s applications seems to be outpacing

efforts to address some of the methodological issues associated with younger

participants. Consequently, although a sophisticated technique is now at our disposal, its

efficacy remains limited without careful consideration of the social context of data

collection. That said, the issues with saliva collection with young children are difficult,

but not intractable. As these examples illustrate, reflective treatments of the pitfalls of

this research may be helpful in contributing to more effective research efforts. However,

these examples draw on limited samples and are not intended to be indicative of salivary

research in general. Nonetheless, they offer a useful starting point to stimulate much

needed discussion and debate. To this end, the most salient discussion points are

summarised below.

Difficulties with participation may well take root where there is public

uncertainty concerning biobehavioural research. Certainly, the examples in this paper

demonstrate that biobehavioural research with young children is a gated process.

Successful research is likely to hinge on trust and well-informed parents and caregivers.

Understanding how best to galvanize such trust requires research on where caregivers’

uncertainty and concerns regarding biobehavioural research lies, irrespective of its

basis. Additionally, at a broader level, greater efforts from the scientific community are

needed to engage with the media and public education on the uses of

psychophysiological measures (Wardlaw et al., 2011).

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Barriers to participation may also stem from children’s perceptions of saliva

collection procedures. Firstly, in deciding which methods (e.g., Sorbettes) are

appropriate for collection attention should be given not only to technical performance,

but also to their acceptability to the given population. Secondly, to counter

misconceptions, and as an ethical priority, greater attention is needed in considering

effective assent procedures. For this purpose those practices that have emerged from

qualitative research may offer a valuable resource. Although the booklets we employed

were useful, they may have been limited in their impact. After all they require the

cooperation of an enthusiastic caregiver who is well acquainted with the saliva

collection procedures. An alternative approach could be to provide a video clip of a

model engaging in saliva collection as a more comprehensive tool for parents,

practitioners, and children to utilise together. This approach offers more scope to

explain the full implications of the research project and may help in minimising

children’s anticipatory stress responses to saliva collection. Indeed, modelling

techniques are commonly used in paediatric practice to reduce procedural anxiety

(O’Byrne, Peterson, & Saldana, 1997). Finally, efforts should also be made to provide

children with ongoing opportunities for consent. In the case that the participants are

very young children (< 3 years) it may be appropriate to employ ‘circles of consent’

(Kellett & Nind, 2001). Here individuals who know the child well are enlisted to help

interpret the ongoing consenting status of the child and prevent potentially distressing

activities.

The value of play-based techniques also deserves greater attention, given their

potential in normalising saliva collection. Play may prove particularly valuable for those

working with younger children with whom resistance has seemed to be more likely

(e.g., de Bruijn, van Bakel, Wijnen, Pop, & van Baar, 2009). Both our own and

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Zimmermann’s (2008) approach offer viable templates for use with preschool-aged

populations. In designing play approaches for use with biomarkers of stress care should

be taken to choose techniques that are not over-stimulating, so as to avoid eliciting a

potentially confounding excitation response. In large-scale studies the availability of the

required materials should be considered. Also, where practitioners and parents are being

recruited, consideration should be given to how easily the technique can be incorporated

into daily routines. Researchers should avoid insisting that play is implemented where

interest has waned. It may also be appropriate to suggest that play protocols can be used

flexibly, where changes are likely to increase children’s ease. Finally, care should be

taken to balance the provision of play with accurate information on the research process.

Deciding who is best to collect saliva with young children requires careful

consideration. Researchers should avoid attempts to fast track relationships with young

children. Where research assistants are necessary, taking time to teach children how to

provide saliva samples, ahead of data collection (e.g., Lisonbee, Mize, Payne, &

Granger, 2008), may maximise the amount of data available whilst simultaneously

increasing children’s familiarity with the research team. Where ECCE practitioners are

recruited to collect samples it is important that the activities are not overburdening.

Decisions on what level of involvement is appropriate should be taken in line with the

study’s design and the profile of its participants. Overall, it is important that the drive

for data does not take precedence over adequate supports for participants. Of course

such a balance carries implications for a research method that requires strong protocol

fidelity to ensure its reliability. These ethical and practical decisions need to be weighed

carefully as too little attention to either will destabilise the research effort as a whole.

Conclusion

20

The potential of biobehavioural salivary research continues to hold exciting promise for

developmental and social researchers. Realising this potential hinges on improving

public knowledge of biobehavioural research. Moreover, further work is needed towards

the development of sensitive saliva collection methods that are ethically sound,

practically effective, and methodologically reliable. Ultimately a reflective discourse is

needed if a method that is clinical in its appearance, perception, and administration is to

be successful in field settings. To this end the value of a more concerted

methodological debate, one that acknowledges and draws on the expertise of the

participants themselves, should not be overlooked.

21

Acknowledgements

We would like to thank all of the participants who shared their perspectives. We

gratefully acknowledge funding from the Department of Children and Youth Affairs

and the University College Dublin Seed Funding Scheme. We are also grateful to

Carmel Smith for her thoughtful suggestions.

22

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