decide if I want to be in the study? - Social Information Processing and Working Memory Followi

Nobody will be angry or upset if you do not want to be in the study. We are talking to your parent/legal guardians about the study and you should talk to them about it too.

Sponsorship

Funding for this study was provided by March of Dimes of Canada and Ontario’s Ministry of Training, Colleges, and Universities.

If you have any questions, please ask. If you would like to continue, please write your name on the line below.

I was present when _____________________________________ read this form and said that he or she agreed, or assented, to take part in this study.

_____________________________________ __________________________________ Printed Name of person who obtained assent Signature & Date

Appendix E Debriefing Script

The goal of this study is to explore the relationship of complex cognitive processes and social information processing in children with and without histories of stroke. We are testing children from the ages of 6 through to 14 years old. We are interested in how children's memory for verbal and visual information affects their socially adaptive behaviour. This is important because children are presented with a significant amount of information every day that they must

remember and interpret. This information is important for learning and we want to know how children remember and manipulate this information. The brain is constantly changing throughout childhood, and new connections are being formed while others are being strengthened.

Working memory is important in a social context. Children and adolescents must go through a process of encoding, interpreting and responding to situations that are presented to them. They must look at incoming information and decide how they will respond. This interpretation and response system is thought to involve a ‘database’ of information from previous social interactions that can be used in the current situation. Because social interaction is often a constant exchange of both verbal (words) and nonverbal (gestures) information, a child may be interpreting, encoding and responding to many things at the same time. Therefore, they may need to keep a lot of information ‘online’ while interacting.

We used many different types of tasks to assess your working memory and social information processing. We also have to control for certain things that may also affect social behaviour, such as language skills. These tasks will help us better understand how working memory is related to social information processing. We expect that children who have significant difficulties with these higher order cognitive processes will have more difficulty in social situations.

Thank you for being a part of an original research project. Please feel free to ask any other questions you may have at this point, or in the future by contacting Amanda Fuentes

([email protected]), Mary Desrocher (416-736-5115 ext. 33111), or Robyn Westmacott (416- 813-6376). Once again, thank you for your time and consideration.

Appendix F

Demographic Questionnaire SECTION 1: GENERAL INFORMATION

In your own words, describe any concerns that you might have pertaining to your child’s physical or cognitive development, academic achievement, behavior, or social/emotional development:

1. _______________________________________________________________ 2. _______________________________________________________________ 3. _______________________________________________________________ 4. _______________________________________________________________ 5. _______________________________________________________________ SECTION 2: DEVELOPMENTAL HISTORY

Has this child ever had or been diagnosed with (if yes, please provide further information):

ADD [ ] no [ ] yes – explain:________________

ADHD [ ] no [ ] yes – explain:________________

Allergies [ ] no [ ] yes – explain:________________ Anxiety [ ] no [ ] yes – explain:________________ Autism Spectrum Disorder [ ] no [ ] yes – explain:________________ Chronic sinusitis [ ] no [ ] yes – explain:________________ Depression [ ] no [ ] yes – explain:________________ Diabetes [ ] no [ ] yes – explain:________________ Epilepsy [ ] no [ ] yes – explain:________________ Febrile convulsion [ ] no [ ] yes – explain:________________ Gifted and Talented [ ] no [ ] yes – explain:________________ Head Injury [ ] no [ ] yes – explain:________________ Hearing problems [ ] no [ ] yes – explain:________________ Hospitalization [ ] no [ ] yes – explain:________________ Language difficulties [ ] no [ ] yes – explain:________________ Language disorder [ ] no [ ] yes – explain:________________ Learning Disability [ ] no [ ] yes – explain:________________

Multiple ear infections [ ] no [ ] yes – explain:________________ Operations [ ] no [ ] yes – explain:________________ Other chronic illness [ ] no [ ] yes – explain:________________ Other psychiatric illness [ ] no [ ] yes – explain:________________ Sensory difficulties [ ] no [ ] yes – explain:________________ Vision problems [ ] no [ ] yes – explain:________________ Other [ ] no [ ] yes – explain:________________ SECTION 3: FAMILY HISTORY

1. Parents’ Marital Status:

Single ______ Married ______ Separated ______ Divorced ______ Common-Law ______ Legal Guardian ______ 2. Number of children in the family:

Name Age Sex Grade Health?

1. ________________ _______ ____ ______ __________________ 2. ________________ _______ ____ ______ __________________ 3. ________________ _______ ____ ______ __________________ 4. ________________ _______ ____ ______ __________________ 5. ________________ _______ ____ ______ __________________ 6. ________________ _______ ____ ______ __________________ 3. Does any member of the family have a history of academic, learning, or attention difficulties? If yes, please indicate who and the nature of the difficulties.

______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

4. Does anyone in the family have a history of emotional or psychiatric illnesses? If yes, please indicate who and the nature of the difficulties:

What is your child’s native (first) language? _________________________________________ If not English, at what age did your child start speaking English? _________________________ What is the mother’s native language? _________________________________________ What is the father’s native language? __________________________________________ What other languages are used in your home? _______________________________________ Which language is used most with your child? ________________________________________ 6. MOTHER’S EDUCATION:

What is the highest educational level of the mother?

 Some elementary school (grades completed): _____________________________

 Finished elementary school

 Some high school (grades completed):___________________________________

 Finished high school

 Some college (No. of years): ____________________________________

 Finished college

 University

 Postgraduate degree (i.e., M.A., Ph.D.)

What diploma, degree, or certificate did you receive? __________________________________ Where did you study, if not in Canada? ______________________________________________ What kind of work do you do? ____________________________________________________ What is your job title? ___________________________________________________________ Age when child was born _________________ Current age ____________________

7. FATHER’S EDUCATION:

What is the highest educational level of the father?

 Some elementary school (grades completed):_____________________________

 Finished elementary school

 Some high school (grades completed):___________________________________

 Finished high school

 Some college (No. of years): __________________________________________

 Finished college

 University

 Postgraduate degree (i.e., M.A., Ph.D.)

 Under $20,000  $20,001 - $30,000  $30,001 - $40,000  $40,001 - $50,000  $50,001 - $80,000  Over $80,000

9. What is your child’s ethnicity? Please circle.

 African Origin

 Asian Am./Asian Pacific Islander

 Latino-a/Hispanic

 Aboriginal Canadian/Am. Indian/Alaska Native

 European Origin/White

 Bi-racial/Multi-racial

In document Social Information Processing and Working Memory Following Pediatric Stroke (Page 145-150)