Consent Form

Study Title: Disparities in Autism Diagnostic Assessment Among Korean and Latino Children in California
I am a student at The Chicago School of Professional Psychology. This study is being conducted as a part of my dissertation requirement for the Applied Clinical Psychology program.
I am asking you to participate in a research study about your experience during the autism diagnostic assessment process of your child. You will be asked to complete a survey of 23 multiple choice questions online. This will take approximately 5 minutes.  This may cause you some frustration when trying to recall information about your experience.  To minimize this risk, questions which may require you to recall information has the option of “Don’t remember”.
Although you may not benefit, it will help to understand if autism diagnostic assessments are being conducted in the preferred language. 
Please take your time to read the entire description before clicking on the consent . You can contact me at the e-mail address at the end of the consent if you have questions before agreeing to participate.
Purpose:  The purpose of this study is to examine the percentage of parent and child dyads of Korean and Latino families in California that underwent the diagnostic process in their preferred language when their child was being diagnosed with ASD.
Procedures:  During this study, you will be asked to complete a survey of 17 multiple choice questions.  This will take approximately 5 minutes.
Risks to Participants:  The risk of study participation is frustration when trying to recall information about your experience.  To minimize this risk, questions which may require you to recall information has the option of “Don’t remember”.
Benefits to Participants:  You will not benefit from this study.  However, we hope the information learned from this study may benefit society in our understanding of the disparities in autism assessment among Koreans and Latinos.
Alternatives to Participation:  Participation in this study is voluntary. You may withdraw from study participation at any time without any penalty.
Confidentiality:  During this study, no identifying information will be collected about you for the purpose of this research. 
This research will be requesting ASD diagnostic information.  All data collected will be secured in a password protected computer and will be retained for 5 years. 
It is possible that your data may be used for future research or distributed to another researcher without your consent. However, information that could identify you will not be available.
Your research records may be reviewed by federal agencies whose responsibility is to protect human subjects participating in research, including the Office of Human Research Protections (OHRP) and by representatives from The Chicago School of Professional Psychology Institutional Review Board, a committee that oversees research.
Questions/Concerns: If you have questions related to the procedures described in this document please contact the primary researcher, Joanne Choi at jchoi@ego.thechicagoschool.edu) and the dissertation chair, Dr. Kim Dell’Angela at kdellangela@thechicagoschool.edu)
If you have questions concerning your rights in this research study you may contact the Institutional Review Board, The Chicago School of Professional Psychology, 325 N. Wells, Chicago, Illinois, 60654.
Completing the questionnaire indicates that I have read the description of the study and I agree to participate in the study. 

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* 1. Do you currently reside in California?

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* 2. Are you a parent or caregiver of an individual diagnosed with autism spectrum disorder (ASD)?

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* 3. Are you between the ages of 18 through 65?

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* 4. Are you from a dual or multi language home in which Korean or Spanish is spoken in the home?

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* 5. Is the individual with ASD between the ages of 2 through 19?

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* 6. Did the individual with ASD receive the diagnosis from a trained professional in the state of California?

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* 7. Did you attend school in the U.S. between the ages of 3 -17 years old for more than 5 years?

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* 8. Is your child’s primary language English?

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* 9. Do you speak your preferred language more with your child in comparison to English?

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* 10. How many children do you have diagnosed with ASD? (please complete this questionnaire about one child only. Additional questionnaires may be completed for additional children.)

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* 11. How old is the child with ASD right now?

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* 12. How old was the child when the child was first diagnosed?

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* 13. Was your child diagnosed with autism in the state of California?

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* 14. How long ago was the child first assessed for autism? (in year/s, if less than 11 months choose 1 year)

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* 15. Which service location was your child assessed/diagnosed at?

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* 16. What professional assessed/diagnosed your child?

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* 17. Did you have an interpreter provided by the assessor for the parent interview during the assessment?

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* 18. Who interpreted the interview with the assessor?

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* 19. Were the questionnaires you filled out during the assessment in your preferred language?

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* 20. Was your child assessed in English?

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* 21. Did your child have an interpreter?

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* 22. When the assessment for ASD was completed did you receive the evaluation report, feedback, treatment planning, educational resources in your primary language?

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* 23. Was your child diagnosed with additional delays or disorders? (e.g., ADHD, ODD, Language delay, intellectual disability, genetic conditions, etc.)

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* 24. What is your preferred language?

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