UNIVERSITY OF
VICTORIA
OFFICE OF THE VICE-PRESIDENT,
RESEARCH
Participant Consent
Form
HUMAN RESEARCH ETHICS COMMITTEE
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 nikks@uvic.ca
or contact Dr. Ryan Rhodes at 721-8384 or email at rhodes@uvic.ca,
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.
Sincerely,
Nicole E. I.
Smith, B.Sc.
Graduate
Student & MSFHR Scholar
Behavioral
Medicine Laboratory
School of
Physical Education
University of
Victoria
(250) 472-5488,
nikks@uvic.ca
Dr. Ryan
Rhodes
Associate
Professor & MSFHR Scholar
Behavioral
Medicine Laboratory
School of
Physical Education
University of
Victoria
(250) 721-8384,
rhodes@uvic.ca
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
