Study Interest Form

Thank you for your interest in the "Comparative Effectiveness of EIBI and Adaptive ABA for Children with Autism" study!

Please read and complete the information below in order for someone from our study team to get in touch with you.

This information sheet tells you about a research study being conducted at several different sites, including the Cleveland Clinic, May Institute, Nationwide Children's Hospital, and Vanderbilt University Medical Center. The study is called Comparative Effectiveness of EIBI and Adaptive ABA for Children with Autism and is for young children with autism spectrum disorder (ASD) and their families.

What is this study about?
We are comparing two different interventions for young children with autism. The interventions are similar in many ways. Both:
- Use strategies that have been shown by research to help young children with autism learn skills
(that are evidence based)
- Teach children how to better communicate and socialize
- Teach children important skills like self-help or how to not have problem behavior
- Can be modified to meet the needs of your child and your family

The interventions are different in a few ways, too:
- One intervention will have a therapist working with your child for about 20 hours per week. The other intervention has your child working with a therapist for less hours per week.
- In one intervention the therapist will work with your child on many different goals throughout the study. In the other more focused intervention, the therapist will begin by focusing on teaching your child ways to communicate better, and then may add goals to address other areas such as disruptive behaviors, sleep problems and repetitive behaviors.

Next Steps
If you want to learn more about this study, please fill out the information below and someone from the research team will contact you. You can also contact the research team directly at the phone and email listed at the bottom of this page. Writing your name on this form or contacting us will not mean that you are participating in the study, it will only mean that you are interested in learning more about the study.

It is important to know that this letter is not to tell you to join this study. It is your decision, and your participation is voluntary. If you do not wish to learn any more about the study or have someone from the research team contact you, please exit out of this internet window.

Parent/Caregiver Name

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Child Name

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YES, I do want to be contacted to learn more about this project. You can contact me through (please mark only those that you would like us to use):

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Phone

Text

Mailing Address

Phone Number:

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Text Number:

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Carrier for text messaging:

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Email Address

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Mailing Address

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Best days/times to contact me:

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If you would like to contact someone from the research team directly:

Research Coordinator: Destiny Kaznoch
(216) 448-6392 or autismresearch@ccf.org

Principal Investigator: Dr. Cynthia Johnson, Cleveland Clinic

Has this subject information been addressed?

Yes

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Date Addressed

M-D-Y

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Additional Research Team Notes

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