Autism & Developmental Disorders Lab
Department of Psychology, Simon Fraser University RCB 5213, 8888 University Drive, Burnaby, BC, V5A 1S6
Consent Form: Social interaction among children and parents
Study Team
Principal Investigator: Mandeep Gurm Faculty Supervisor: Dr. Grace Iarocci
Research Personnel: Teagan Chambers, Katelyn Baertsch, Marieke Vandenhende, & Dominic Trevisan
Introduction: The proposed study investigates how children develop social skills for communication and interaction.
Study Procedures: If you and your child choose to participate in this study, you and your child will play games together, things like building Lego and discussing stories. Your child will also talk about cartoons with the experimenter and do other things like answering questions and playing with blocks. You will complete several questionnaires. The study will take 3 hours in total. You will receive $30 and parking for your time and effort.
You and your child will be video recorded during these tasks. These video recordings will be maintained on a password-protected computer in the Autism & Developmental
Disorders Lab until 2025, at which time the video files will be erased. Videos will only be used in research and never published or made public.
We cannot provide you or your child with information about your child’s performance on questionnaires or computer tasks, as results are for research purposes only. However, you or your child may request a summary of the overall findings. If you or your child would like to obtain information about the overall findings, please contact the Autism and Developmental Disorders Lab.
Voluntary Participation: Your participation and your child’s participation are voluntary.
You or your child has the right to refuse to participate in this study. If you and your child decide to participate, you and your child may still choose to withdraw from the study at
Confidentiality: If you and your child choose to participate, confidentiality of your data and your child’s data will be assured. Only the principal investigator and research assistants will have access to it. All research assistants have signed confidentiality agreements and have undergone research training and criminal record checks. Confidentiality will be maintained by linking data with a code number, rather than your child’s name. Although online responses will be collected through secure and encrypted software hosted on a secure SFU server, absolute confidentiality cannot be assured for data being collected electronically. Hardcopy responses will be stored securely in a filing cabinet and computer at the ADDL. Data will be stored until 2025. Your privacy and your child’s privacy will be protected in any scientific publications or presentations resulting from this study and your individual identity will not be revealed.
Withdrawal: You and your child may withdraw from this study at any time without giving reason. If you and your child choose to enter the study and then decide to withdraw at a later time, all data collected about you and your child during your enrolment in the study will be destroyed.
Contact for information about the study: If you or your child have any questions about this study or would like more information, please contact Dr. Grace Iarocci.
Contact for concerns about the rights of research participants: If you or your child has any complaints about your rights or the rights of your child as a research participant and/or your experiences while participating in this study, you may contact Dr. Jeffrey Toward, Director, Office of Research Ethics.
Consent: Participation in this study is entirely voluntary. If at any point you or your child wishes to withdraw from the experiment, before or after agreeing to participate, there will be no penalty and there will be no adverse effects on your ability to participate in future studies. Please feel free to ask the experimenter any additional questions you may have about the study.
I consent to participating in this study with my child, including video recording. The video will never be made public, and only used for research purposes. Entering my name and the date indicates that I consent to participate with my child in this study.
Printed Name (First and Last)
Signature
Sometimes we will contact participants after they have participated in order to clarify information (e.g. if there is a part of the data that is missing or unclear such as a missed item on a questionnaire). I allow the ADDL to contact me in the future if such an instance arises:
YES
NO
If yes, please enter your phone number and email:
Phone number
The ADDL would like to be able to show how participants completed this study during research presentations by playing short sections of the video recording of you and your child. This video will not be linked to your questionnaire responses nor made available to non-research audiences. You and your child may still participate in this study if you answer no.
I allow the ADDL to show short sections of the video recording of my child and I during research presentations.
YES
NO
Printed Name (First and Last)
Signature