OFFICE OF THE VICE-PRESIDENT, RESEARCH                      Participant Consent Form





Physical Activity and ADHD Survey



You are being invited to participate in a study entitled “Investigating the Effects of Physical Activity on the Behavioral Symptoms of ADHD in Children” that is being conducted by Nicole Smith and the Learning Disabilities Association (LDA) – South Vancouver Island Chapter. Nicole Smith is a graduate student at the University of Victoria in the School of Physical Education, and is required to conduct research as part of the requirements for a master’s degree in the area of Behavioral Medicine. This research is being conducted under the supervision of Dr. Ryan Rhodes. You may contact Nicole Smith at 472-5488 or email at or contact Dr. Ryan Rhodes at 721-8384 or email at, if you have further questions.


The purpose of this research project is to evaluate whether the use of physical activity decreases the behavioral symptoms of Attention-Deficit Hyperactivity Disorder (ADHD) in children. If you are a parent of a child, who is between the ages of 7 – 12 years old, and currently has ADHD, we are interested in your participation within this study.


As you may be aware, ADHD is one of the most frequently diagnosed psychiatric disorders of childhood. Little research exists on the effect of exercise on the behavioral symptoms of ADHD in children. It is hoped the knowledge that you provide will be useful to educators, health care practitioners, administrators and policy makers who wish to learn more about the effects of physical activity on the behavioral symptoms of ADHD.  There is also potential to make a significant contribution in the areas of child mental health, ADHD health promotion, school classroom management and ADHD intervention.


What do I Have to do to Participate?

It is actually quite simple. If you agree to voluntarily participate in this research, your participation will include one 10 - 15 minute session completing the attached survey. You may refuse to answer any questions in the survey. If you fill out the survey and return it to us, you have consented to participate.  We have provided instructions on the front of the survey. There are no further surveys or contact associated with this study. 


Inconvenience, Risks & Benefits

Participation in this study may cause some inconvenience to you, including asking you to think about your child’s previous exercise experiences. However, there are no known or anticipated risks to you by participating in this research. The potential benefits by participating in this research include providing you with information concerning your child's health and disruptive behaviors. This study will also provide preliminary information on which to build future physical activity intervention programs catered to children with ADHD.


Anonymity and Confidentiality

You will not be required to put your name on the survey. The survey will be strictly anonymous as no names will be mentioned and all results will be interpreted and displayed as group data only. Once the completed surveys are returned to the researcher (Nicole Smith), all data will be kept in a locked cabinet in the Behavioral Medicine Research Laboratory at the University of Victoria. The researcher will not know which survey is yours because we do not ask for your name and, as a result, any information that we gather from you cannot be withdrawn from the study once you return the survey.


A Token of Appreciation:

The Learning Disabilities Association - South Vancouver Island Chapter (LDA – SVIC) has agreed to participate in this research project. As a token of appreciation for your time, we will provide a donation of five dollars for every returned and completed survey to the LDA - SVIC in Victoria, BC. The LDA - SVIC is a not for profit organization that educates, supports and advocates for children and youth with Learning Disabilities and or Attention Deficit Disorders and their families. This organization does not currently receive government funding for operations and there is a continual demand and outreach for community support. This association raises, invests and stewards funds to provide support of the physical, mental and social well-being of children, youth and families primarily on Vancouver Island and British Columbia.


Sharing of the Results

Upon consultation with the LDA-SVIC Director and executive committee, it is anticipated that the results of this study will be shared in the following ways:


·                    As a visual presentation, a research report and written recommendations to the LDA - SVIC Director and Executive Commitee, as well as members at large

·                    As a report to the BC Ministry of Health, as well as other BC ADHD societies

·                    As a part of the researcher’s Master’s Thesis

·                    As a report to be presented at scholarly conferences

·                    As a published article in a professional peer reviewed journal


Do I have to participate?

No, your participation is completely voluntary.  However, it is only through voluntary participation in research projects that we increase our knowledge about issues that are important to health.  We hope you can spare the 15 minutes to help the research community out! 


In addition to being able to contact the researcher at the above numbers, you may verify the ethical approval of this study or raise any concerns you might have, by contacting the Associate Vice-President, Research at the University of Victoria (250-472-4545).


By returning the enclosed survey, you have indicated that you have read the above information and agree to participate in this research.




Nicole E. I. Smith, B.Sc.                                                                                               

Graduate Student & MSFHR Scholar                                                                             

Behavioral Medicine Laboratory                                                                        

School of Physical Education                                                                            

University of Victoria                                                                                                     

(250) 472-5488,  


Dr. Ryan Rhodes

Associate Professor & MSFHR Scholar

Behavioral Medicine Laboratory

School of Physical Education

University of Victoria

(250) 721-8384,                                                                       



If you agree to participate, please complete the online survey and print this consent form for your records



This research is being funded by the Michael Smith Foundation for Health Research