CONSENT TO PARTICIPATE IN RESEARCH

         QUANTITATIVE EEG CORRELATES OF NORMAL CHILDREN

You are asked to participate in a research study conducted by ________________. 
Your child has been asked to participate in this study as a control subject.
His or her participation in this study is entirely voluntary. You should read the 
information below and ask questions about anything you do not understand before 
deciding whether or not to participate.

PURPOSE OF THE STUDY

I understand that this project is designed to create a normative database of Quantitative
EEG activity in baseline and challenge conditions. I understand that the entire process will 
involve a recording session of up to two hours, which will include reading and math problem 
completion tasks.

PROCEDURES

If I volunteer to participate in this study, I will be asked to have my child undergo 
19-channel topographic EEG acquisition for approximately 30 minutes. During this time 
s/he will be asked to relax, to read age- and skill-appropriate material and to solve 
a series of math problems.

POTENTLAL RISKS AND DISCOMFORTS

I understand that EEG acquisition requires the placement of electrodes on the scalp 
for the purpose of recording an EEG. There are few risks associated with this procedure. 
There is a remote possibility of skin irritation from the electrode cream used to attach 
electrodes. Techniques used to attach electrodes have been used at numerous research 
institutions for many years with no significantly negative side effects reported.

I understand that I and my child can remove the electrodes at any time if I or s/he so 
desires and there is no risk of electroshock from this procedure. We do not expect any 
psychological, legal, or financial risks for participating in the research, but as always, 
there may be possible unforeseeable risks that have not been identified.

No information about my child or provided by me during the research project will be disclosed 
to anyone outside the project's team members (local clinician and Sterman-Kaiser Imaging 
Laboratory scientists), without written permission, except if necessary to protect my child's 
rights or welfare. For example, if s/he is injured and needs emergency care or required 
by law. When the results of the research are published and discussed in conferences, no 
information will be included that reveals his or her identity. Any photographs, videos, or 
audiotape records will be used for educational purposes. His or her identity will be 
protected or disguised. All personal information collected during this study will be stored 
in the research database at the Sterman-Kaiser Imaging Laboratory. Records will be coded to 
prevent access by any authorized personnel. 

RIGHTS OF RESEARCH SUBJECTS

I may withdraw my consent at any time and discontinue my child's participation without 
penalty. I am not waiving any legal rights or remedies because of my child's participation 
in this research study. 

SIGNATURE OF RESEARCH SUBJECT OR LEGAL REPRESENTATIVE

I have read and understand the information provided above. I have been given an opportunity 
to ask questions and all of my questions have been answered to my satisfaction.

BY SIGNING THIS FORM, I WILLINGLY AGREE TO ALLOW MY CHILD TO PARTICIPATE IN THE RESEARCH IT 
DESCRIBES.

Name of Subject

____________________________________________         


Name of Subject's Parent or Guardian


____________________________________________         _____________________
Signature of Subject's Parent or Guardian             Date


SIGNATURE OF INVESTIGATOR

I have explained the research to the subject of his/her legal representative, and answered 
all of his/her questions I believe that he/she understands the information described in this 
document and freely consents to participate.

Name of lnvestigator

____________________________________________         _____________________

Signature of lnvestigator                             Date