Attachment E3 SC Child Assent age 7-8 3-13-07

Attachment E3: South Carolina Assent age 7-8

South Carolina PLAY
Project to Learn about ADHD in Youth

SC PLAY ASSENT FORM for RESEARCH

(For 7-8 Year Old Participants)

Your parent has said that it is okay for us to talk to you about a project that the University of South Carolina is doing. The study is about attention, hyperactivity and impulsive problems and how these affect kids and their families. We would like for you to help us by answering some questions. We want to find out how children your age feel about certain things like school and about how you get along doing everyday things. We would also like to ask your parent and teacher about these things.

We will ask you questions and show you some cards to help you answer. This is not a test. I won’t show your answers to anyone, but I will tell your parent if there is a serious problem. We will write down your answers and use a code number, so your name won’t be on the paper. It will take about one hour or a little more to do all of these things, and we can take some breaks if you want to. I will ask you some sensitive questions about smoking and alcohol

You do not have to be in this study; it is your choice. It will not affect how you are treated at school or anywhere else if you say no. If you decide to help us with our study, we will give you a $15 gift card after we finish, even if you do not answer all the questions. You don’t have to answer any questions if you don’t want to, and you may stop anytime just by telling me that you do not want to continue.

Do you have any questions? Is this okay with you? If this is okay with you, please sign your name below. You will get a copy of this to keep.

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Sign Your Name Date

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ADHD Staff or Investigator Date

Study Principal Investigator: Robert E. McKeown, PhD

Dept. of Epidemiology & Biostatistics · Arnold School of Public Health · Columbia, SC 29208

Phone: (803) 777-1124 · Fax: (803) 777-2524

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