Informed Consent Form I

 

Study Title: Physiological Linkage: A New Construct for Studying Social Reciprocity in Autism

Investigators: Angela Scarpa, Ph.D., Martha Ann Bell, Ph.D., Julie Dunsmore, Ph.D., Richard Ashley, Ph.D., Jonathan Waldron, M.S.          

 

I.               Purpose of this research

 

As the first part of a two-part study, the purpose of this study is to examine how people with and without Autism Spectrum Disorder talk about emotional situations with people they know compared with strangers. Results will be used in the development of a grant, with the potential for publication and/or use in presentations.

 

II.             Procedures

 

You will be asked to complete a questionnaire about your background, mood, and health. If you decide to participate, you will be asked to respond to an online questionnaire expected to last between 30 to 45 minutes. Based on your responses to the measures, you may or may not be contacted for participation in the second portion of the study, where you would be in a lab with another participant of the same gender. In the event that you are eligible for the second part of the study, you will be contacted by email and will be eligible for additional compensation. If any stressful or difficult issues arise at any time during the completion of the questionnaires, emergency contact phone numbers will be listed on the main webpage.

 

III.           Risks

 

There will be minimal discomfort associated with the completion of the questionnaires.

 

IV.           Benefits

 

Your participation in this study will help advance the understanding of the effects of mood recall in social settings in college students and for understanding social reciprocity in individuals with an Autism Spectrum Disorder.

 

V.             Confidentiality

 

Any information you provide will be confidential. You will be asked to provide your name, phone number, PID, and e-mail address solely for the purpose of obtaining extra credit and being contacted for the second study. A participant number will be assigned to your responses and only this number will be associated with your information for purposes of data analyses and writing of results. Please note that although the responses to the questionnaire require a password for entry and completion for the questionnaire, this does not guarantee complete confidentiality in the event the responses are intercepted inappropriately from the Internet.

 

At no time will the researchers release identifying information from this study to anyone other than those working on the study and the one additional participant (should you be eligible and participate in the second part) without your written consent. However, confidentiality may be broken if you express intent to harm yourself or someone else, in which case the researchers are legally obligated to inform the appropriate authorities. In such a case, you will be informed of the need to do so, and are encouraged to contact the Cook Counseling Center (231-6557) or the Psychological Services Center (231-6914). Research findings may be published or presented for scientific purposes, but your identity will not be revealed in the description or publication of this research.

 

VI.           Compensation

 

You may receive extra credit point for the psychology class you are currently enrolled in. If you are not currently enrolled in a psychology class, please speak with your professor about alternative methods of receiving extra credit.

 

VII.         Freedom to Withdraw

 

You are free to withdraw from this study at any time.

 

VIII.       Participant Responsibilities

 

I voluntarily agree to participate in this study and complete the questionnaires associated with this phase of the current research study.

 

IX.           Participant Permission

 

I have read and understand the informed consent and conditions of this project. I have had my questions answered. I hereby acknowledge the above and give my voluntary consent for participation in this project. If I participate, I may withdraw at any time. I agree to abide by the rules of this project.

 

By entering your personal information and completing the online questionnaire, you are giving consent to participate in this study. If you do not wish to participate, simply exit the survey now.

 

Should I have any further questions about this research or its conduct specifically related to appointments, payments, or credit, I will contact:

 

 

________________________                                                            ________________________

Angela Scarpa, Ph.D.                                                                          Martha Ann Bell, Ph.D.

ascarpa@vt.edu                                                                                  mabell@vt.edu           

540-231-2615                                                                                     540-231-2546

 

 

________________________                                                            ________________________

Julie Dunsmore, Ph.D.                                                                        Richard Ashley, Ph.D.

jdunsmor@vt.edu                                                                               ashleyr@.vt.edu  

540-231-4201                                                                                     540-231-6220

 

________________________                                                           

Jonathan Waldron      

jwaldron22@vt.edu

540-231-2594                                                

                       

 

Should I have any further questions about this research or its conduct specifically related to ethical concerns or human subjects protection, I will contact:

                                                                                                           

________________________

David Moore, Ph.D.

IRB Chair

mooredv@vt.edu

540-231-4991

 

________________________

David Harrison, Ph.D.

Psychology Human Subjects Committee Chair

dwh@vt.edu

540-231-4422