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Consent Form


Thank you for your interest in participating in the research study titled Validation of a Social, Communication, Interaction and Play Screener.
Researchers at the Kennedy Krieger Institute (KKI) are conducting a study to learn whether a new screening tool provides a good way to tell whether young children are showing signs of social and/or communication delays, or autism spectrum disorder (hereafter “social-communication delays”).
Right now, there are no existing video-guided screeners that are able to predict if children should receive further developmental evaluation.  If our new video-guided screener, called the Social, Communication, Interaction, and Play Screener (SCIPS), is able to identify children who may have a social-communication delay, then we hope to make it available for use around the country.
Parents of children with and without developmental concerns about their children may join.

What is involved?

  • Completing a series of questions about your child and you (i.e., age, race, gender, etc.) followed by questions about any concerns you may have about your child’s development and history of treatment. The questions will take about 10 minutes to complete. 
  • You will then receive a link to a secure website. You will be asked to complete three online developmental screening tools including the.
    • When completing the SCIPS, you will be asked to watch videos of children with and without social-communication delays, and answer questions about your child’s behavior based on what you see in the videos. 
    • To examine the success of the SCIPS in correctly telling whether a child does or does not have a social-communication delay, we will be comparing the results of the SCIPS to results of two other screeners currently used by professionals. 
    • All three developmental screeners will take approximately one hour to complete in total.
  • After you complete the online developmental screeners, you and your child will be invited to receive a follow-up virtually administered developmental assessment.
    • This assessment includes observation of your child, direct assessment of your child, and parent interview questions you will answer about your child. 
    • This assessment will take about 1-1.5 hour(s) to complete, including breaks for your child.
    • Following completion of this assessment you will receive feedback of your child’s development with the clinician who administered the assessment. 
There are minimal risks or discomforts for this study. Placing your information into a research database is a potential security and privacy risk. All data are stored at Kennedy Krieger Institute in a protected database and we will take every step to minimize risks. There are no costs or payments for participation. There are also no direct medical benefits of participating. If you take part in this study, you may help others in the future.
We suggest you read the full Informed Consent Form. This form includes more detailed information about the study. We recommend you print a copy for your records as well. 

 To retrieve the full consent form, please  click this link.

By checking this box, I agree to participate in the online survey and to participate in the follow-up development assessment in the research study titled Validation of a Video-Guided Screening Instrument for Social and Communication Delays in Toddlers and have read and understood the Informed Consent and Privacy Authorization Form.
By checking this box, I agree to participate in the virtually administered developmental assessment of my child.
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  • Read and understand the information given to you on the consent form provided at the link
  • You accept the provisions in the form.
  • You confirm your selections above regarding your decision to join the study.
You will not give up any legal rights by signing this form. 
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So that a member of our research team may contact you to schedule the assessment, please provide us with the following information:

Your name

Child's name

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What is your relation to :
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 Contact information:

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Preferred contact time: