The University of Mississippi Institutional Review Board
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The University of Mississippi
Institutional Review Board
Protocol «
Approval date c \OvrL
Expiration dater^rj t
Informed Consent Form Signature y
Title: The development of executive function and representation in a social context
Investigator: Dr. Stephanie Miller, Psychology, University of Mississippi, (662) 915-6541
Description: We want to know what helps children control their thoughts and behavior. In addition, we look
at how this control is related to things like getting along with friends, understanding others, and remembering
information. To answer these questions, we play games with children using toys, stories, videos, anc
computers. There are a many games your child could complete in this study, which are described in the
attached letter of information. These games help us understand how children solve problems and think about
other people. Children usually take between 20 minutes to an hour to finish our study, and we typically
videotape each session (see video consent form). We would work your child in their school, day care center,
organization, and/or at our University of Mississippi laboratory. By signing this consent torm you agree to
have your child participate in this study.
Risk and Benefits: Studies are presented as "games" that many children enjoy. The risk involved is no more
than one would experience in normal activities. The procedures have been developed to be safe and
comfortable to children. Participation in this study can contribute to general knowledge on children's
development, particularly what supports the development of higher thought processes. Children will receive a
toy for participation.
Right to Withdraw: Participation is completely voluntary, and you are free to refuse to allow your child to
participate or withdraw permission for your child to participate in this research without penalty or prejudice.
Whether or not you choose to participate or to withdraw will not affect your standing with the Department of
Psychology or with the University. In addition, your child will be asked if he or she wants to help us do the
study and can stop the study at any time without penalty.
Confidentiality: Your privacy will be protected, because your child will not be identified by name in this
project. If you give written permission to show a video of your child to professional audiences, it is possible
that someone may recognize your child. In any publication or reports of this project, only group results will be
described and no individual participants will be named or identifiable.
IRB Approval: This study has been reviewed by The University of Mississippi's Institutional Review Board
(IRB). The IRB has determined that this study fulfills the human research subject protections obligations
required by state and federal law and University policies. If you have any questions, concerns, or reports
regarding your rights as a participant of research, please contact the IRB at (662) 915-7482.
Statement of Consent
I have read the above information. I have been given a copy of this form. I have had an opportunity to ask
questions, and I have received answers. I consent to participate in the study.
Child's Name Date of Birth
Signature of Parent/Guardian Date Signature of Investigator Date
NOTE TO PARTICIPANTS: DO NOT SIGN THIS FORM
TF THE IRB APPROVAL STAMP ON THE FIRST PAGE HAS EXPIRED.Letter of Information The following studies are currently under way in the CUB Lab. By signing the attached consent form, your child may participate in any of these studies. If you have any questions about any of these studies, please contact the CUB Lab at (662) 915-2370 or cublab@olemiss.edu . Three Boxes Game: Children see three toys hidden in three distinct boxes (e.g., all a different color). Children are then encouraged to search for the toys until all three toys are found. Hidden Toy: Children will search for a toy that is hidden in one of five hiding locations. In another task, children will be asked to find a toy in one of two locations when it is hidden out of sight. Waiting Games. Children will be asked not to touch an appealing toy or wait to eat a snack. Parent or guardian permission is required before children receive a snack. In another game, children will be asked whether they want a small number of rewards now or if they would prefer to wait and get a larger amount. Imitation Games. Children will be asked to imitate an adult sorting objects into two buckets and the number of objects to sort will increase. In another game, an adult will show children how to imitate a sequence and children will be asked to reproduce the sequence. Categorization. Children are taught categorization rules for sorting objects (e.g., put baby animals in “baby box” and adult animals in “mommy box”). Helping Task. Children will observe a situation where the experimenter could benefit from help that children could provide (e.g., the child can reach a toy desired by the experimenter out of reach). Attention Task: Children’s attention to attractive toys will be monitored during play between a child and adult. Card Sorting Tasks. Children have to match cards on the computer based on one dimension (e.g., color) and then again by another dimension (e.g., shape). Thus, a blue boat goes in the “blue” pile in the color game, and later goes in the “boat” pile in the shape game. Backwards Memory. In these games, children are told to remember either a list of words or numbers and asked to repeat the list backwards (e.g., answering ‘ 4 6 2’ when told ‘2 6 4’). Friendship Stories. Children will hear hypothetical stories where a friend violates an expectation of friendship by being unreliable and will be asked what they think about these situations. Friendship Questionnaire: Children complete a questionnaire regarding how they feel about their interactions with their friends. Block Design- Children are asked to recreate a design the experimenter shows them from red and white blocks. Similarities- Children are asked to explain how two objects or concepts are similar (e.g., in what ways are an apple and banana alike?). Theory of Mind: In one task, children are asked to predict the beliefs of 2 characters that have different experiences and knowledge of a situation. In another task, children are read a story about character who makes a faux pas (e.g., a character insults a friends picture without knowing who it belongs to) and will be asked about the character’s intentions and knowledge of the situation. Memory for Categories. In this game, children are asked to remember a categorized list of pictures. Sometimes all pictures belong to the same category except for one (e.g., all pieces of clothing except for an apple). We will also ask children to forget some of the pictures we showed them. Language Task. Children will hear a word and point to one of four pictures that best describe the word.
Videotape)Consent)Form) ! We!videotape!the!testing!session!for!later!analysis!of!behavior!(e.g.,!response!time,! frequencies!of!behaviors).!The!videotaping!is!strictly!for!research!purposes!and!the! videotape!records!are!secured!in!a!locked!room!and!only!viewed!by!Dr.!Stephanie!miller! and!trained!researchers!associated!with!the!project.!Videotapes!will!be!kept!until!no! further!analysis!is!anticipated!(approximately!7!years,!after!which!videotapes!will!be! erased).!! ! Please!note!that!your!child!may!still!participate!in!the!study!even!if!you!do!not!wish!to!have! him!or!her!videotaped.!! ! If!you!DO!consent!to!have!your!child!videotaped!during!the!testing!session,!please!sign!and! date!here:!! ! ! _______________________________________________________!!!! _____________________________!! Parent/Guardian!Signature! ! ! ! ! Date! ! ! ! ! ! A!videotape!may!be!shown!to!a!professional!audience!in!the!course!of!a!scientific!lecture! solely!for!the!purposes!of!illustration.!In!this!instance,!the!person!appearing!on!the! videotape!will!not!be!identified!by!name!although!it!is!possible!that!someone!may! recognized!your!child.!! ! If!you!DO!consent!to!the!presentation!of!your!child’s!videotape,!please!sign!and!date!here:!! ! _______________________________________________________!!!! _____________________________!! Parent/Guardian!Signature! ! ! ! ! Date! !
If you are interested in receiving updates and/or hearing about opportunities for research in the CUB Lab at the University of Mississippi campus, please fill out the following information below. We respect your privacy and only use this information for the purposes that you select below: ☐ I would like to receive newsletter updates about the CUB lab and projects my child has participated in. ☐ I would like to hear about opportunities for participating in CUB Lab research on the University of Mississippi Campus. Parent and/or Guardian’s Name: ___________________________________________________ Child’s Name _______________________________ Child’s Birthday: ____________________ Home Phone: ________________________________Cell Phone: ________________________ Other Phone Number (s): ________________________________________________________ Email (s): _____________________________________________________________________ Good time to contact you/ Best way to reach you: _____________________________________ Address: ______________________________________________________________________ City_______________________________State____________________Zipcode_____________ If you are interested in having other children participate please list their information below: Children’s Names: ______________________________________________________________ Children’s Birthdays: ____________________________________________________________
ID# ____________
Parent Questionnaire
The American Psychological Association recommends that researchers report major demographic
characteristics of all research participants (e.g., children’s gender, parent’s educational background, etc.). To
assist us in collecting this information, we request that you complete this brief questionnaire for the
participating child. All data are confidential, and will not be used in any manner that identifies you or your
child. If you are uncomfortable responding to any of the items, feel free to disregard them.
Child’s Gender: Male Female Child’s Birth Date: (mm/dd/yyyy):______________________
Number of sibling: _________ Siblings’ Birth Dates: ________________________________
Level of Education (please write in the type of the highest degree earned for each biological parent):
Mother Father
__________________ __________________ High School diploma (e.g., GED, diploma)
__________________ __________________ Associates degree: (e.g., A.A., A.B.A.)
__________________ __________________ Bachelor’s degree: (e.g., B.S., B.A.)
__________________ __________________ Post-graduate degree: (e.g, M.A., Ph.D., J.D.)
Cultural identity (please check all that apply for each biological parent):
Mother Father
_____ _____ White (not of Hispanic origin)
_____ _____ Black/African American (not of Hispanic origin)
_____ _____ Asian or Pacific Islander
_____ _____ Hispanic
_____ _____ Other (please specify) __________________________________
Marital Status: __________________ Mother Birth Date:____________ Father Birth Date: ______________
Was your child adopted? ___________ If yes, at what age? ________________________
Father’s Occupation (check all that apply): Part time Full time Homemaker Unemployed Student
Mother’s Occupation (check all that apply): Part time Full time Homemaker Unemployed Student
Total Annual Household Income (check your best estimate):
_____ Less than $20 000 _____ $60,000 – $100,000
_____ $20 000-$40 000 _____ $100,000 – $150,000
_____ $40 000-$60 000 _____ Over $150,000
Language(s) spoken in the home:
Primary: _______________________ Secondary: ________________________
Average hours spent in caregiving activities each day. Mother:________________ Father:_______________You can also read
