Dear Parent,
Will you help with our study on a new early childhood questionnaire? We are developing a new version of the Ages & Stages Questionnaire (ASQ), to identify child's strengths and areas that may be at risk for delay.
Play and learning activities that fit your child’s age plus a copy of your ASQ and your child’s results are available by email and/or download at end of the session. No personal names or addresses are needed or collected.
This site is open to all parents of children ages 1 month up to 7 years. You will answer a few questions that describe your child and family background, then the ASQ will take about 10–15 minutes to complete. There are three other questionnaires offered if you are interested. They may take about 10 minutes each to fill out. You can choose to skip any of the questionnaires that follow the ASQ. You can quit the online session at any time.
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 or phone.
There are benefits for participants and for humanity in general. Access to a free online way for parents to check their child's development may improve the quality of life for some children. Results of the screening can help parents take steps to contact early intervention or community services for timely support of a child's early development.
If you have any questions about the research, contact Jane Squires 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 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,
Jane Squires, Ph.D.
Improving Early Identification: Renorming ASQ
*The principal investigator, Dr. Squires, is one of the authors of the ASQ, and the assessment is commercially available and published through Brookes Publishing Company, Inc.