to the Information and Consent/Permission Form (ages 11

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How Does Emotion Regulation Relate to Well-being in Youth?
Date:
Dear Participants and Parents,
Youth in the KW community are invited to participate in a University of Waterloo research project
conducted by researchers with the Child and Adolescent Neuropsychology Laboratory in the
Department of Psychology.
About This Project
As a society, part of getting along with others requires that we control how we express our
emotions. The strategies that we use to control our emotions can affect our psychological health.
The purpose of this study is to explore how different emotion regulation strategies relate to mental
health in youth. This research will lead to a better understanding of the relationship between
emotion regulation and psychological well-being in young people.
What You Will Be Asked To Do
If you decide to participate, it will take about one hour to complete the study. During the study, you
will be asked to complete eight computerized questionnaires that ask questions about how you try
to control emotions (e.g. "No matter how upset I am, I try to look calm”), your thinking skills (e.g., “I
can keep important information in my mind), your self-esteem (e.g. "I feel that I am a person of
worth"), your psychological well-being (e.g. "I have confidence in my opinions"), your emotions, (e.g.
“Over the past week I felt happy”), and your personal background (e.g. age, general health). In
appreciation for your time and participation, you will receive a $15.00 gift card.
Confidentiality
All of the information we collect is considered confidential and your results will not be shared with
anyone, nor will your name be written on any data. All paper data will be marked with an ID number
and kept in locked filing cabinets. Responses to all questionnaires will be provided on Qualtrics
(www.qualtrics.com), which is a secure online survey server. All information you provide over the
course of the study will remain confidential and will be stored indefinitely on a secure, password
protected computer in Dr. McAuley’s lab, to which only her research team will have access.
We hope that the results of this study may be published and/or presented at academic conferences.
If findings from the study are published or presented at academic conferences, no reference will be
made in verbal or written reports which could link you to the study. Presentation and distribution of
results will occur only at the group level, and no individual participant’s results or information will be
identified.
Benefits and Risks of Participation
There are no known personal benefits to participating in this study. As a participant, you will be
asked to think about ways that you handle emotions. So, you may find yourself thinking about some
negative emotions (for example, sadness or anger) when completing the questionnaires. If you feel
uncomfortable answering any questions is this study, you may skip the questions. If you are
distressed by anything in this study please tell the researcher. You may also end the study at any
time without penalty by telling the researcher you want to stop.
Contact Information
If you have any questions or concerns regarding your participation in this study, please contact the
Research Coordinator, Siobhan Sutherland, at storrie@uwaterloo.ca or 519-888-4567 ext. 32953 or
the Principal Investigator, Dr. Tara McAuley, at tara.mcauley@uwaterloo.ca.
This study has been reviewed and received ethics clearance through a University of Waterloo
Research Ethics Board and the Waterloo Region District School Board has given approval for
approaching schools regarding this study. Should you have any concerns or comments, please
contact Dr. Maureen Nummelin in the Office of Research Ethics at 519-888-4567 ext. 36005 or email
at maureen.nummelin@uwaterloo.ca.
Sincerely,
Dr. Tara McAuley
Principal Investigator
Child and Adolescent Neuropsychology Lab
University of Waterloo
tara.mcauley@uwaterloo.ca
Participant Consent/Assent
I have read the information sheet concerning the research project being conducted by Dr. Tara
McAuley of the Department of Psychology at the University of Waterloo. I have had the opportunity
to ask questions and receive any additional details I wanted about the study.
I acknowledge that all information gathered on this project will be used for research purposes only
and will be considered confidential. I am aware that permission may be withdrawn at any time
without penalty by advising the researchers.
I realize that this project has been reviewed by, and received ethics clearance through the Office of
Research Ethics (ORE) at the University of Waterloo. I also realize that I may contact Dr. Maureen
Nummelin in the Office of Research Ethics at 519-888-4567 ext. 36005 or email at
maureen.nummelin@uwaterloo.ca, if I have any comments or concerns about my involvement in this
study.
Participant name (Printed): _______________________________
Participant signature: ____________________________________
Date: ____________________________________________
Permission Form
Youth between the ages of 11 to 15 years who wish to participate in the study entitled “How Does
Emotion Regulation Relate to Well-being in Youth?” must provide this permission form, signed by a
parent or guardian, to the Child and Adolescent Neuropsychology Lab researchers in order to
participate in the study.
Parent/Guardian:
I have read the information sheet concerning the research project being conducted by researchers in
the Child and Adolescent Neuropsychology Lab of the Department of Psychology at the University of
Waterloo. I have had the opportunity to ask questions and receive any additional details I wanted
about the study.
I acknowledge that all information gathered on this project will be used for research purposes only
and will be considered confidential. I am aware that my permission to have my child participate in
this study may be withdrawn at any time without penalty by advising the researchers.
I realize that this project has been reviewed by, and received ethics clearance through the Office of
Research Ethics (ORE) at the University of Waterloo and the Waterloo Region District School Board. I
also realize that I may contact Dr. Maureen Nummelin in the Office of Research Ethics at 519-8884567 ext. 36005 or email at maureen.nummelin@uwaterloo.ca, if I have any comments or concerns
about my child’s involvement in this study.
Permission Decision: ____ Yes - I would like my child to participate in this study
Child's name: _______________________________
Parent / Guardian name (print): __________________________
Parent / Guardian signature: _____________________________
Date: ______________________________
Permission to be Re-contacted for Future Studies
Professor Tara McAuley in the Department of Psychology at the University of Waterloo plans to
conduct a number of studies similar to the one in which your child is planning to participate. With
your agreement, we would like to contact you at a future point to invite your child to consider taking
part in one of those studies.
Agreeing to be contacted does not obligate you to take part in any future study; you may decide if
you are interested in a specific study at the time of each contact. Your name and contact details will
be available only to members of our research team. This information will be securely stored in
Professor McAuley’s Child and Adolescent Neuropsychology Lab on a password-protected computer
for a period of five years at which point the information will be deleted. You may change your mind
at any time and request that your name and contact details be deleted from our records. Please
note that before any of our studies are conducted, they are reviewed and receive ethics clearance
through a University of Waterloo Research Ethics Committee.
I agree to be contacted about my child’s possible participation in future studies associated with
Professor Tara McAuley’s Child and Adolescent Neuropsychology Lab. I am aware that my
agreement now does not obligate my child to take part in any studies, and that at any time I may
request that my child’s name and contact information be deleted.
Parent/Guardian Name: ________________________
Student Name: ________________________
Student Date of Birth: _______________________
Contact Telephone Number: ______________________
Email:
Best time to be contacted: _________________________
Parent/Guardian Signature: _______________________________
Student Signature: _______________________________
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