INFORMED CONSENT

My name is Lynn M. Dalton. I am a student from Dominican College in Orangeburg, New York pursuing my graduate degree as a Family Nurse Practitioner. I am conducting research to explore the relationship between the medication Ritalin (used to treat Attention Deficit Hyperactivity Disorder) and the reduction and/or elimination of inappropriate aggressive behaviors (physical and verbal) in Attention Deficit Hyperactivity Disorder (ADHD) Elementary school aged children. The length of this study will be 2 months starting May 1, 2013 July 1, 2013. As a parent, you are being invited to participate in this study because you have a child diagnosed with ADHD. Participation is voluntary and confidential. There are no risks to participate. Names of participants will be held in confidence. Any information obtained relating to this study will be kept within the offices of Gergely Pediatrics, and be kept in a locked file drawer. This questionnaire will not be shared or used by anyone other than myself for research purposes only. Any demographic data will be used exclusively for this study and will not be shared nor will your identity be revealed. The consent form and any other collected information will be destroyed after 3 years. Your time and input is valuable and is an important contribution to this study. I hope to gain insight into the effects of Ritalin on ADHD patients and how this can affect aggression in elementary school aged children. If you decide to participate, I will ask that you complete the attached Vanderbilt ADHD Diagnostic Parent Rating Scale questionnaire. You will need to complete the questionnaire twice: once, before your child starts Ritalin, and again after your child is on the medication for one month. The results being gathered will ultimately be reported in my Capstone Project, which is a requirement for completion of my Masters Degree as a Family Nurse Practitioner at Dominican College . All data will be summarized and reported as a complete set of work only. Your name will not appear in any work associated with this research and there is no compensation for your participation. Please drop the completed questionnaire off at the front desk in the patient questionnaire box. This indicates you have read this consent and have elected to participate. A copy of this form will be provided for you to reference, should you have any questions or concerns. Please feel free to contact me with any questions or concerns related to this research project. I can be reached at (845) 548-1299 or Louisette@optonline.net. My Professor, Maureen Creegan can be reached at (845) 848-6027 or Maureen.Creegan@dc.edu. Thank you in advance for your participation. Sincerely,

Lynn M. Dalton RN, FNP Student

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Participants Signature

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