Title of Study: The Impact of COVID-19 on the Symptoms of Children Diagnosed with Combined-type ADHD.
Please answer to the best of your ability.
Sign in to Google to save your progress. Learn more
Informed Consent
Title of Study: The Impact of COVID-19 on the Symptoms of Children Diagnosed with Combined-type ADHD. Investigator(s): Ali Idriss, Abbigail Rinard, M.S., Sarai Welch, Emily Buckley, Hayley Siegel, Jonathan Spaan, Tomer Zilbershtein, Lisa Finnegan, Ph. D. (Principal Investigator). Thank you for your interest in participating in our research study. The purpose of this study is to learn how the COVID-19 quarantine has affected the levels of symptomatology of hyperactivity, impulsivity, and inattention in children with ADHD. Potential benefits that you may receive from participation include expanding the knowledge of educators, medical professionals, and families who support children with combined-type ADHD in stressful situations such as the COVID-19 pandemic. This study is comprised of a brief survey. It should take you no more than 10 minutes to complete this survey. Your participation in this study is your choice. You may skip any questions that make you feel uncomfortable and you are free to withdraw from the study at any time without penalty. The risks involved with participating in this study are considered minimal and will nor more than that of everyday social activities.  Your responses will remain confidential and anonymous. Data from this research will be kept in a double password-protected file (computer & database) and reported only as a collective combined total. Your name will never appear on any survey or research instruments. No one other than the researchers will know your individual answers to this questionnaire. If you experience problems or have questions regarding your rights as a research subject, contact the Florida Atlantic University Division of Research at (561) 297-1383. If a non-English speaking guardian may be interested in participating in the study, we've provided contact information for the guardian to contact co-investigator, Ali Idriss, to provide an interpreter to read the survey. For other questions about the study, you should call the principal investigator: Lisa Finnegan at Lfinnegan@fau.edu; or Ali Idriss (co-researcher) aidriss2017@fau.edu. By completing and returning the attached survey, you give consent to participate in this study. If you choose, you can print a copy of the consent statement for personal records.
Clear selection
Q1. Relation to child (Please choose one):
Clear selection
Q2. Age of child:
Q3. Gender of child (Please choose one):
Clear selection
Q4. Ethnicity of child (Please choose one):
Clear selection
Q5. Please rate your current stress level as a guardian.
Clear selection
Q6. Are there members in the house that are currently working from home?
Clear selection
Q7. Is your child expected to complete school/homework?
Clear selection
Q8. Is there a sibling in the household?
Clear selection
Q9. Is your child on any medication?
Clear selection
Q10. If so, is your child on an ADHD medication?
Clear selection
Q11. If so, what ADHD medication does your child take? (Leave blank if your child is not on any ADHD medication or if you prefer not to answer):
Q12. What is the frequency of your child's ADHD medication consumption?  (For answer choice "Other" enter the # of days per week) (Leave blank if your child is not on any ADHD medication or if you prefer not to answer):
Clear selection
Q13. Before the COVID-19 quarantine, on average how many days per week did your child do physical activity (playing games outside, sports, bicycling, or any other physical activity)?
Clear selection
Q14. Since the beginning of COVID-19 quarantine, on average how many days per week does your child do physical activity (playing games outside, sports, bicycling, or any other physical activity)?
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report