Thank you for your interest in COUNT: The Precision Autism Project, Phase 1. This study is being conducted by the
Snyder Lab at Stanford University.
The purpose of this survey is to see if you meet the criteria for taking part in our research study and the survey will
take about 10 minutes.
| Legally authorized representatives ( e.g., parents, guardians, or conservator) may sign up for the following potential participants: • children: 4-17 years of age
• adults (18+ years of age): where legally authorized representatives may be providing consent on their behalf |
You may choose not to answer these questions. You may also choose to stop participating in this survey at any time;
if you want to stop, just close your browser window. Information you provide will be kept as confidential as possible
as required by law. It is possible that the Food and Drug Administration, and other federal and state authorities, may
inspect this record.
You can choose if you want or do not want to take part in this research screening procedure - it is up to you. If you
refuse to answer the questions or stop answering them at any time, there will be no penalty and you will not lose any
benefits to which you otherwise would be entitled.
The risk of taking part in this survey is very small. Information about you that you give in this survey will be kept as
confidential as possible. You may choose not to answer these questions - it is up to you.
If you have any questions, concerns, or complaints about this study, its procedures, risks, and benefits, please contact us at: autism_snyderlab@stanford.edu .
Independent Contact: If you are not satisfied with how this study is being conducted, or if you have any concerns, complaints, or general questions about the research or your rights as a participant, please contact the Stanford Institutional Review Board (IRB) to speak to someone independent of the research team at 650-723-2480 or toll free at 1-866-680-2906. You can also write to the Stanford IRB, Stanford University, 1705 El Camino Real, Palo Alto, CA 94306.
You are being asked to consider being in this research study and your participation is completely voluntary.
PURPOSE: The goal of this study is to better understand autism spectrum disorder (ASD) symptoms, comorbidities, and the biology of ASD. We will do this by analyzing samples and data from you.
WHAT YOU WILL DO: We will ask you for samples that will include the following: blood microsample, stool, saliva and air filter samples. We will ask you to wear a smartwatch and share the wearables data with the study team. We will ask you to carry a Personal Exposure Monitor (PEM) to measure the particles in the air around you. We will ask you to answer surveys about things such as symptoms and track your diet through Cronometer. We will also ask you to share your electronic medical records with the study team.
The study team will provide you with the supplies needed for this study.
TIME INVOLVED: Taking part in this study will take about 10 hours each month, for 3 months (90 days).
RISKS: The risks of participating in this study are minimal and foreseeable risks are similar to what you might encounter during routine clinical care and daily life. We do not expect you to be harmed by taking part in this study.
BENEFITS: The main benefit of being in this study is that you will help better the understanding of ASD in the medical community and help shape future phases of COUNT: The Precision Autism Project. We cannot and do not guarantee or promise that you will receive any benefits from this study.
PAYMENT: You will not receive payment for your participation but if you would like to, you can keep the smartwatch after your participation concludes.
COST: There is no cost to you for taking part in this study, other than the personal time it will take to collect samples and ship samples to the lab.
Completing this survey and successfully submitting your responses does not mean that you have been enrolled in the study. Additionally, you are not in any way obligated to participate even if this form has been submitted.
This survey is only to see if you may be eligible. If you are eligible and you choose to leave your contact information, a member of the study team will reach out to verify eligibility by requesting clinical records of ASD diagnosis from you.
