Welcome to the Autism Risk Survey
You are invited to take part in a research study about a mother’s risk factors for autism spectrum disorders in her children. This form is part of a process called “informed consent” to allow you to understand this study before deciding whether to take part.

New research suggests that about 1 in 8 children may be diagnosed with an autism spectrum disorder (ASD) in the United States. This could be due to several reasons which remain unknown. This study invites mothers who have given birth to children in the United States to share their experiences with diet and supplementation during pregnancy.

Findings from this study can be used to help identify risk factors for ASD risk.

About the study:
-- One 15–20-minute survey for each child you've given birth to
-- To protect your privacy, the published study would not use any identifying information

Volunteers must meet these requirements:
-- Mothers 18 years or older with a child aged 3-12 years who has an official ASD diagnosis from a clinician
-- Mothers 18 years or older of children aged 3-12 years who do not have an ASD diagnosis so comparisons can be made between groups

This survey is part of the doctoral study for Michael M. Haniff, a Ph.D. student at Walden University.

Study Purpose:
The purpose of this study is to understand the role of a mother’s diet, social standing, and supplementation with folate or folic acid may have on her child’s future development of autism. Comparisons will be made between mothers of children who have a child with an official ASD diagnosis from a clinician to mothers of children without an ASD diagnosis.

Procedures:
This study will involve you completing the following steps:
An online survey that will take approximately 20 minutes

Here are some sample questions:
1) How many people are currently living in your household, including yourself?
2) Do you drink caffeinated beverages daily (such as coffee, tea, colas)?
3) Did you use any folate/folic acid supplements during pregnancy?
4) What percentage of your diet consisted of meat or meat products?
5) Was your pregnancy planned?
6) Does your child have a confirmed ASD diagnosis by a physician?

Voluntary Nature of the Study:
Research should only be done with those who freely volunteer. So, everyone involved will respect your decision to join or not.
If you decide to join the study now, you can still change your mind later. You may stop at any time.

Risks and Benefits of Being in the Study:
Being in this study could involve some risk of the minor discomforts that can be encountered in daily life such as sharing sensitive information. With the protections in place, this study would pose minimal risk to your wellbeing. Because this study touches your child’s health, if you need assistance, please call the National Helpline at 1-800-662-HELP (4357).

This study offers no direct benefits to individual volunteers. The aim of this study is to benefit society by understanding what risk factors related to diet and supplementation during pregnancy are correlated with ASD risk. Once the analysis is complete, the researcher will share the overall results by posting them to this website.

Payment:
This study is completely voluntary. No compensation will be given for participation.

Privacy:
The researcher is required to protect your privacy. Your identity will be kept confidential, within the limits of the law. The researcher will not ask for your name at any time or link your responses to your contact info. The researcher will not use your personal information for any purposes outside of this research project. If the researcher were to share this dataset with another researcher in the future, the dataset would contain no identifiers so this would not involve another round of obtaining informed consent. Data will be kept secure by removing any identifying information and storage of email addresses in a password-protected cloud drive (Google Sheets). Data will be kept for a period of at least 5 years, as required by the university.

Contacts and Questions:
You can ask questions of the researcher by phone at (954) 999-2466 or email at michael.haniff@waldenu.edu. If you want to talk privately about your rights as a participant or any negative parts of the study, you can call Walden University’s Research Participant Advocate at 612-312-1210. Walden University’s approval number for this study is 06-16-22-0412467. It expires on June 15, 2023.

You might wish to retain this consent form for your records. You may ask the researcher or Walden University for a copy at any time using the contact info above.

Obtaining Your Consent:

If you feel you understand the study and wish to volunteer, please click next to begin the survey.
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