Parent Consent Form

Research Title: Exploring the Effects of a Parent Training Program on Executive Functioning
Skills in School-Aged Children Diagnosed with Intellectual Developmental Disorders (IDDs)
Student Researcher: Madison McMunn
Faculty Supervisor: Sarah Walmsley, M.A.D.S.
Name of Institution: St. Lawrence College
Name of Agency: Developmental Services of Leeds and Grenville

Invitation
You are being invited to participate in a research study. My name is Madison McMunn, and I am
a placement student in the Honours Bachelor of Behavioural Psychology Degree program
(BPSYC) at St. Lawrence College. I am currently on my fourth-year placement at
Developmental Services of Leeds and Grenville (DSLG). During my time on placement, I am
completing an applied thesis research project as part of the BPSYC program. The following
information in this form will help you understand my research. Please read the following
information carefully and ask all questions you might have before you decide if you want to
participate.

Purpose of this Research

My research project is an Executive Functioning Skills Training Program– a program designed
to teach parent’s and caregiver’s the importance of executive functioning skills and evidence-
based practices that can be applied to improve and support children’s executive functioning skills
during transitional stages in life. The research will explore parenting senses of competence,
parent-child relationships, and children’s executive functioning skills. In addition, parent’s will
be provided with psychoeducation focused on executive functioning skills and Behavioural
Skills Training (BST) to gain practical knowledge on evidence-based techniques designed to
improve children’s executive functioning skills. To assess the effects of the program, three brief
assessments will be used. The responses to the assessments will then be used to explore the
effects of this program on parenting senses of competence, parent-child relationships, and
children’s executive functioning skills.

What will you be asked to do if you participate?

If you choose to take part in this research study, you will be asked to participate in seven one-
hour sessions over the course of seven weeks. The sessions will be conducted at the DSLG’s
main office in Brockville on dates that are predetermined at the onset of the program. During the
initial session you will be asked to complete three self-reporting assessments that aim to gain
information on your own sense of parenting competence, your relationship with your child and
your perception of their executive functioning abilities. Two of the assessments will be
administered and interpreted by the student researcher, Madison McMunn, with support and
guidance from the manager of DSLG Specialized Services, Jeremy Sherstone, and/or the
psychometrist. Due to administration and scoring requirements, the third assessment, specifically
the Behaviour Rating Inventory of Executive Function; Second Edition, Parent Form will be
administered, scored, and interpreted only by the psychometrist. In addition, you will be asked to
schedule your sessions with the program facilitators. Psychoeducation on children's executive
functioning skills will be emphasized during the sessions. Each session will concentrate on one
or two of the executive functions, covering all 11 over the duration of seven sessions. (i.e.,
planning, time management, task initiation, organization, problem-solving, flexibility, work
memory, emotional control, impulse control, attentional control, and self-monitoring).
Additionally, evidence-based strategies for each executive functioning skill will be taught
throughout sessions using BST. BST is comprised of instructions, modelling, rehearsals, and
feedback. The sessions will be facilitated by myself and a supervisor from DSLG. At the end of
the program, you will be asked to complete the three brief-assessments again as part of a post
study measure.

Potential benefits associated with participation

By taking part in this study, you might learn more about executive functioning skills and how to
incorporate evidence-based executive functioning techniques with your child at home. Your
perception of competence or self-efficacy may improve as a result of learning positive strategies
and techniques. Furthermore, as you learn how to incorporate positive practices at home with
your child, the program may have a positive impact on your relationship with them.

Protentional risks associated with participation

The perceived risks and drawbacks of partaking in this research study are minimal to
nonexistent. However, there is a possibility that your child or adolescent may refuse to
participate in the activities at home. The risk of activity-refusal at home may affect program
results and yield negative effects on the parent-child relationship and executive function
development because the child is not appropriately engaged in program requirements (e.g.,
homework). If your child refuses to partake in activities at home, please contact the placement
student or Specialized Services manager for further information on navigating refusal and risk
reduction. Furthermore, All information provided will be used for research purposes and be kept
confidential. If concern arise in relation to your participation, please contact the placement
student or specialized services manager at DSLG.

Privacy and Confidentiality

Your confidentiality and privacy are valued by DSLG and St. Lawrence College. Unless
otherwise compelled by law, we will make every effort to keep any information that can be used
to identify you private. We will take out all information that could be used to identify you and
replace it with a false or fictitious name in order to safeguard your privacy.

Informed Consent Forms will be stored in a locked cabinet at St. Lawrence College for 10 years.
All additional research data will be safely kept at DSLG for six months following the conclusion
of the study, at which point it will be destroyed. The findings of the study are included in my
thesis, which will be made available in the St. Lawrence College library. The outcomes will also
be presented at the Behavioural Psychology poster gala at St. Lawrence College; however any
such presentations will be of general findings and never compromise individual anonymity. Any
information collected throughout the course of the research study will be secured at DSLG’s
main office. Digital files will be stored on a limited-access hard drive, on a password-protected
computer connected to DSLG’s encrypted server and deleted after 6-months. Hardcopy
information will be stored in confidential files in locked cupboards at DSLG’s main office.
Outside of business hours, this facility remains locked and armed with entry point and motion-
sensor security measures. Additionally, if this research project is presented at a professional
conference, all data will be deleted after 2-years.

The study is completely voluntary, as is participation. Your child will still be given the option
of whether or not they would like to participate in this research study regardless of whether their
parent has already provided consent on their behalf. In other words, for a child to participate, the
child's assent is necessary in addition to parental consent. The researcher will explain the goals of
this research, participant roles and responsibilities, potential risks, and benefits during a
scheduled and supervised phone conversation with the child or adolescent in order to acquire
their assent. At any time throughout the research, you have the choice to withdraw your consent
without giving a reason or incurring consequences. If at any moment you wish to withdraw from
the study, please notify Madison McMunn or Jeremy Sherstone in writing or by email
(MMcMunn@dslg.ca and JSherstone@dslg.ca). Choosing not to participate or withdrawing
consent at any time will not affect the services you receive from DSLG. Please inform Madison
McMunn, Jeremy Sherstone, or Sarah Walmsley if you also wish to have your data removed. Up
to two (2) weeks after the study's completion, you have the right to withdraw your data.

Contact for additional information

This research has received ethical clearance from the Research Ethics Committee for
Behavioural Psychology (REC-P) under the authority of the St. Lawrence College Research
Ethics Board (SLC-REB). The project was developed under the supervision of Sarah Walmsley,
M.A.D.S, my supervisor from St. Lawrence College. Thank you for your consideration. If you
have more questions, feel free to ask me, Madison McMunn at MMcMunn@dslg.ca. You can
also ask my college Supervisor, Sarah Walmsley at SWalmsley@sl.on.ca. Please contact the
SLC-REB Chair at reb@sl.on.ca if you have any concerns regarding the way this study is being
conducted or about your rights as a participant.

Consent
If you agree to participate in this research, please complete the following form and return it to me
as soon as possible. For your own records, you will be given a copy of this signed document. The
original copy will be retained at St. Lawrence College.

By checking the following statements and signing this form, I agree that:
 I understand the purpose of the research and what I am being asked to do.
 All of my questions were answered.
 The potential risks and benefits have been discussed and explained to me.
 I understand that I have the right to participate and withdraw my consent at any time.
  I understand who I can contact if I have any questions, comments, or concerns about the
research and how it is being conducted.
 I have been informed that my personal information will be kept confidential.
 I understand that I will receive a signed copy of this consent form.
 I understand that the data from this study will be presented at the St. Lawrence College
Behavioural Psychology Poster Gala and published in the St. Lawrence College Library.
No identifying information will be included in these reports or at any conferences.

I hereby consent to take part in the research study.

Parent/Guardian Name Signature of Parent/Guardian Date

Student Name Signature of Student Date

Supervisor Name Signature of Supervisor Date

Executive Director Name Signature of Executive Director Date