ADULT PERSONALITY DEVELOPMENT LAB, CANISIUS COLLEGE

and

INSTITUTE FOR AUTISM RESEARCH, CANISIUS COLLEGE

Self-Concept in Individuals with High Functioning Autism Spectrum Disorders



CONSENT FORM FOR PARTICIPANTS



This consent form explains the research study. Please read it carefully. Ask questions about anything you do not understand. If you do not have questions now, you may ask later.



PURPOSE: You are being invited to participate in a study evaluating self-concept in individuals with or relatives of individuals with Asperger's, high-functioning autism, or PDDNOS (hereafter referred to as high-functioning autism spectrum disorders; HFASDs). Self-concept refers to beliefs that an individual has about themselves including aspects of personality traits, goals, self-esteem, empathy, and clarity. The current study seeks to broaden the knowledge about self-concept in individuals with HFASDs.



PROCEDURES: In this study, you will be asked to complete approximately 30 minutes of internet based questionnaires. The questionnaires cover a variety of topics such as personality traits, goals, well-being, self-esteem, and self-concept clarity. In addition to completing these questionnaires, you will be asked to provide personal accounts of different memories that you have. As this study only involves group level analyses, we cannot provide you with individualized feedback on your responses to any of the questionnaires. However, many of the questionnaires are in the public record and we are happy to share these with you if you contact us.



TIME COMMITMENT: These questionnaires will take approximately 30 minutes to complete.



RISKS AND BENEFITS: A potential risk is associated with the unlikely event that data could be lost or stolen. In order to reduce the potential negative effects of such an event, electronic data will be stored on secure servers hosted at the Institute for Autism Research at Canisius College. In addition, each protocol contains only a code number and no identifying information.



CONFIDENTIALITY: This consent form will be will be stored on secure servers hosted at the Institute for Autism Research at Canisius College. All participant information collected for the study will be kept confidential and secure in our secure servers at the Institute for Autism Research, Canisius College. All protocols will be assigned a code number such that no individual or family names will be on any protocol or in the database.



Your individual privacy will be maintained in all published and written data resulting from this research project. Study results will not involve the reporting of any personally identifying information about individual participants. All open-ended data collected with this protocol will be deidentified by trained research assistants before undergoing any further analysis. All data will be retained for a minimum of 3 years after collection.



Study Oversight and Inspection of Records: In order to monitor this research study, representatives from the Canisius College IRB may inspect the research records to assure compliance with appropriate standards. This process may reveal your identity to those performing the inspection.



VOLUNTARY PARTICIPATION: Your participation is completely voluntary. Your refusal to participate in the study will involve no penalty or loss of benefits to which you are otherwise entitled. You have the right to refuse to answer particular questions for any reason during the study. You also have the right to remove yourselves from participation in the study at any time.



If you have any questions about your rights as a participant in a research project, or questions, concerns or complaints about the research and wish to speak with someone who is not a member of the research team, you should contact (anonymously, if you wish) the Institutional Review Board at Canisius College (KC 211, Canisius College, 2001 Main Street, Buffalo, NY 14208, e-mail mdolan@canisius.edu, phone 716/888-8468).



FOR QUESTIONS, CONCERNS, OR COMPLAINTS ABOUT THIS RESEARCH, CONTACT:



Jennifer Lodi-Smith, Ph.D.

Assistant Professor

Health Science 209B

Adult Personality Development Lab, Canisius College

716-888-2513, lodismij@canisius.edu



Christopher Lopata, Psy.D.

Professor

Science Hall 1016C

Institute for Autism Research, Canisius College

716-888-2861, lopatac@canisius.edu



SUBJECT STATEMENT: I have read the explanation provided to me. I have had all my questions answered to my satisfaction, and I voluntarily give my permission to participate in this study. BY CLICKING THE BUTTON BELOW, I AFFIRM THAT I AM WILLING TO PARTICIPATE IN THIS RESEARCH.



PLEASE PRINT A COPY OF THIS CONSENT FORM FOR YOUR RECORDS NOW.



PLEASE DO NOT COMPLETE THIS SURVEY IF YOU ARE UNDER 18 YEARS OF AGE. If you do complete this survey and are under 18 years of age please do so with your parents' consent. However, please know that if you are under 18 years of age your data will be deleted from the database and not used.

* must provide value I AM OVER 18 YEARS OF AGE AND CONSENT TO PARTICIPATE IN THIS STUDY I AM NOT OVER 18 and/or I DO NOT CONSENT TO PARTICIPATE IN THIS STUDY reset