Dear Parent,
Will you help with our study on a new early childhood questionnaire? We are developing a new version of the Ages & Stages Questionnaires (ASQ), called the ASQ:Extended (ASQ:EX) to identify skills that children have learned and track their progress over time.
You are invited to participate if you are a parent/primary caregiver who is 18 years or older with a child in the ages of 1 month up to 7 years. You will answer a few questions that describe your child and family background, then the ASQ:EX will take about 5–15 minutes to complete. There are two other questionnaires offered if you are interested, including the ASQ. They may take about 10 minutes each to fill out. You can choose to skip any of the questionnaires that follow the ASQ:EX. You can quit the online session at any time.
Play and learning activities that fit your child’s age will be available by email and/or download at the end of the session. In addition, if you choose to complete the ASQ, then a copy of your ASQ and child’s results are available by email and/or download at end of the session. No personal names or addresses are needed or collected.
If you choose to enter or send an email address it will only be used to respond to your requests. It is not stored with the online data. There are no expected risks.
Researchers follow rules to make sure records and websites are secure and password protected. No names are asked or used in any type of report we write. Research records will be destroyed within 3 years. Only the researchers have access to the data.
Before you agree, please read this form. Please ask any questions you may have. If you have concerns at any time, you can contact one of the researchers by email.
There are benefits for participants and for humanity in general. Access to a free online way for parents to learn about their child's development may improve the quality of life for some children.
If you have any questions about the research, contact Jantina Clifford or Kimberly Murphy.
Thank you for your help.
I have read (or it was read to me) this consent form. I have been encouraged to ask questions. I have received answers to my questions. I am 18 years or older and give my consent to take part in this study.
Participation is voluntary and there is no penalty if you decide to withdraw. You may withdraw your consent at any time.
When you click Submit and Continue you give your consent to participate**. You may save this consent form and print for your records here.
Sincerely,
Jantina Clifford, Ph.D
*The principal investigator, Dr. Clifford, is one of the authors of the ASQ, and the assessment is commercially available and published through Brookes Publishing Company, Inc. **I give my consent to provide information as part of this study.