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CONSENT FORM

STUDY NAME: Birth Order

RESEARCHERS: Simone Johnson, Kathleen Leonard, Tamir Maksimov, Vaunam

Venkadasalam

PURPOSE OF THE RESEARCH: To investigate the theory of Birth Order.

WHAT YOU WILL BE ASKED TO DO IN THE RESEARCH: Fill out a questionnaire in regards
to Birth Order that will take approximately 10-15 minutes.

RISKS AND DISCOMFORTS: We do not foresee any risks or discomfort from your
participation in the research.

BENEFITS OF THE RESEARCH AND BENEFITS TO YOU: The scope of undergraduate

research is not expected to benefit the public. You will be assisting the researcher in
his/her project

VOLUNTARY PARTICIPATION: Your participation in the study is completely voluntary and

you may choose to stop participating at any time.

WITHDRAWAL FROM THE STUDY: You can stop participating in the study at any time, for
any reason. There will be no consequences if you decide not to participate or withdraw
from the study.

CONFIDENTIALITY: All information you supply during the research will be held in
confidence and unless you specifically indicate your consent, your name will NOT appear in
any report or publication of the research.

QUESTIONS ABOUT THE RESEARCH? If you have questions about the research in general
or about your role in the study, please feel free to contact us:

Simone Johnson Y
 simoneaxo@yahoo.ca

Kathleen Leonard Y
 kleonardv03@hotmail.com
Tamir Maksimov Y
 tamir14@yorku.ca
Vaunam Venkadasalam Y
 vvenkada@yorku.ca

I_________________ (participantǯs name), consent to participate in the Birth Order Study

conducted by the researchers listed above. I have understood the nature of this project and
wish to participate. I am not waiving any of my legal rights by signing this form. My
signature below indicates my consent.

_______________________________ _____________________
Signature of Participant Date
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Instructions: For each question please write the appropriate NUMBER applicable to your
fatherǯs (F) and motherǯs (M) behaviour towards you. Answer each question separately
once for your mother and father. Be careful not to leave any questions unanswered unless
you have been raised by one parent only or do not have a sibling.

No/ Yes, but Yes, Yes, ost of

Never seo often the t e
1 2 3 4

1.c It happened that my parents were sour or angry with F

me without letting me know the cause M
2.c My parents praised me F
M
3.c It happened that I wished my parents would worry less F
about what I was doing M
4.c It happened that my parents gave me more corporal F
punishment than I deserved M
5.c When I came home, I then had to account for what I had F
been doing, to my parents M
6.c It think that my parents tried to make my adolescence F
stimulating, interesting and instructive (for instance by
giving me good books, arranging for me to go on camps, M
taking me to clubs)
7.c My parents criticized me and told me how lazy and F
useless I was in front of others M
8.c It happened that my parents forbade me to do things F
other children were allowed to do because they were
afraid that something might happen to me M
9.c My parents tried to spur me to become the best F
M
10.c My parents would look sad or in some other way F
show that I had behaved badly so that I got real feelings
M
of guilt
11.c I think that my parentsǯ anxiety that something might F
happen to me was exaggerated M
12.c If things went badly for me, I then felt that my F
parents tried to comfort and encourage me M
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13.c I was treated as the Ǯblack sheepǯ or Ǯscapegoatǯ of theF

family M
14.c My parents showed with words and gestures that F
they liked me M
15.c I felt that my parents liked my brother(s) and/or F
sister(s) more than they liked me M
16.c My parents treated me in such a way that I felt F
ashamed M
17.c I was allowed to go where I liked without my parents F
caring too much M
18.c I felt that my parents interfered with everything I did F
M
19.c I felt that warmth and tenderness existed between F
me and my parents M
20.c My parent put decisive limits for what I was and was F
not allowed to do, to which they then adhered
M
rigorously
21.c My parents would punish me hard, even for trifles F
(small offenses) M
22.c My parents wanted to decide how I should be F
dressed or how I should look M
23.c I felt that my parents were proud when I succeeded F
in something I had undertaken M
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Please choose any one (1) sibling to answer the following questions about (Please skip if
you are an only child)
Write the NUMBER that best responds to the question after the statement.

Hardly Not too Somewhat Very EXTREMELY

at all much much MUCH
1 2 3 4 5

1.c Some siblings do nice things for each other a lot, while other siblings do nice things
for each other a little. How much do both you and this sibling do nice things for each
other? _____
2.c How much do you show this sibling how to do things he or she doesnǯt know how to
do? _____
3.c How much does this sibling show you how to do things you donǯt know how to do?
_____
4.c How much do you tell this sibling what to do? _____
5.c How much does this sibling tell you what to do? _____
6.c Some siblings care about each other a lot while other siblings donǯt care about each
other that much. How much do you and this sibling care about each other? _____
7.c How much do you and this sibling go places and do things together? _____
8.c How much do you and this sibling insult and call each other names? _____
9.c How much do you and this sibling like the same things? _____
10.cHow much do you and this sibling tell each other everything? _____
11.cSome siblings try to out-do or beat each other at things a lot, while other siblings try
to out-do each other a little. How much do you and this sibling try to out-do each
other at things? _____
12.cHow much do you admire and respect this sibling? _____
13.cHow much does this sibling admire and respect you? _____
14.cHow much do you and this sibling disagree and quarrel with each other? _____
15.cSome siblings cooperate a lot, while other siblings cooperate a little. How much do
you and this sibling cooperate with other? _____
16.cHow much do you help this sibling with things he or she canǯt do by him or herself?
_____
17.cHow much does this sibling help you with things you canǯt do by yourself? _____
18.cHow much do you make this sibling do things? _____
19.cHow much does this sibling make you do things? _____
20.cHow much do you and this sibling love each other? _____
21.cSome siblings play around and have fun with each other a lot, while other siblings
play around and have fun with each other a little. How much do you and this sibling
play around and have fun with each other? _____
22.cHow much are you and this sibling mean to each other? _____
23.cHow much do you and this sibling have in common? _____
24.cHow much do you and this sibling share secrets and private feelings? _____
25.cHow much do you and this sibling compete with each other? _____
26.cHow much do you look up to and feel proud of this sibling? _____
27.cHow much does this sibling look up to and feel proud of you? _____
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28.cHow much do you and this sibling get mad at and get in arguments with each other?
_____
29.cHow much do both you and your sibling share with each other? _____
30.cHow much do you teach this sibling things that he or she doesnǯt know? _____
31.cHow much does this sibling teach you things that you donǯt know? _____
32.cHow much do you order this sibling around? _____
33.cHow much does this sibling order you around?
34.cHow much is there a strong feeling of affection (love) between you and this sibling?
_____
35.cSome kids spend lots of time with their siblings, while others donǯt spend so much.
How much free time do you and this sibling spend together? _____
36.cHow much do you and this sibling bug and pick on each other in mean ways? _____
37.cHow much are you and this sibling alike? _____
38.cHow much do you and this sibling tell each other things you donǯt want other people
to know? ____
39.cHow much do you and this sibling try to do things better than each other? _____
40.cHow much do you think highly of this sibling? _____
41.cHow much does this sibling think highly of you? _____
42.cHow much do you and this sibling argue with each other? _____

My sibling My sibling We get I often get I almost

almost always often gets treated treated always get
gets treated treated about the better treated
better better same 4 better 5
1 2 3

43. Who usually gets treated better by your mother, you or this sibling? _____
44. Who usually gets treated better by your father, you or this sibling? _____
45. Who gets more attention from your mother, you or this sibling? _____
46. Who gets more attention from your father, you or this sibling? _____
47. Who does your mother usually favor, you or this sibling? _____
48. Who does your father usually favor, you or this sibling? _____
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Please write a NUMBER in front of each statement to indicate the extent to which you agree
or disagree with that statement.
Disagree Disagree Neither agree Agree Agree
strongly a little nor disagree a little strongly
1 2 3 4 5
I See Myself as Someone Whoǥǥ

___1. Is talkative ___23. Tends to be lazy

___2. Tends to find fault with others
___3. Does a thorough job
___4. Is depressed, blue
___5. Is original, comes up with new ideas
___6. Is reserved
___7. Is helpful and unselfish with others
___8. Can be somewhat careless
___9. Is relaxed, handles stress well
___10. Curious about many different things
___11. Is full of energy
___12. Starts quarrels with others
___13. Is a reliable worker
___14. Can be tense
___15. Is ingenious, a deep thinker
___16. Generates a lot of enthusiasm
___17. Has a forgiving nature
___18. Tends to be disorganized
___19. Worries a lot
___20. Has an active imagination
___21. Tends to be quiet
___22. Is generally trusting
___24. Is emotionally stable, not easily upset
___25. Is inventive
___26. Has an assertive personality
___27. Can be cold and aloof
___28. Perseveres until the task is finished
___29. Can be moody
___30. Values artistic, aesthetic experiences
___31. Is sometimes shy, inhibited
___32. Does things efficiently
___33. Remains calm in tense situations
___34. Prefers work that is routine
___35. Is outgoing, sociable
___36. Is sometimes rude to others
___37. Gets nervous easily
___38. Likes to reflect, play with ideas
___39. Has few artistic interests
___40. Likes to cooperate with others
___41. Is easily distracted
___42. Makes plans & follows through with them
___43. Is considerate & kind to almost everyone
___44. Is sophisticated in art, music or literature

Please check: Did you write a number in front of each statement?

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The Self-Report Altruism Scale Instructions: Please read the following statements write a
NUMBER after each statement to indicate the frequency with which you have carried out
the following acts.
Never Once Often More th
n often Very often
1 2 3 4 5
1. I have helped push a stranger's car out of the snow. _____
2. I have given directions to a stranger. _____
3. I have made change for a stranger. _____
4. I have given money to a charity. _____
5. I have given money to a stranger who needed it (or asked me for it). _____
6. I have donated goods or clothes to a charity. _____
7. I have done volunteer work for a charity. _____
8. I have donated blood. _____
9. I have helped carry a stranger's belongings (books, parcels, etc.). _____
10. I have delayed an elevator and held the door open for a stranger. _____
11. I have allowed someone to go ahead of me in a lineup (at Xerox machine, in the
supermarket). _____
12. I have given a stranger a lift in my car. _____
13. I have pointed out a clerk's error (in a bank, at the supermarket) in undercharging me
for an item. _____
14. I have let a neighbour whom I didn't know too well borrow an item of some value to me
(e.g., a dish, tools, etc.). _____
15. I have bought 'charity' Christmas cards deliberately because I knew it was a good cause.
____
16. I have helped a classmate who I did not know that well with a homework assignment
when my knowledge was greater than his or hers. _____
17. I have before being asked, voluntarily looked after a neighbour's pets or children
without being paid for it. _____
18. I have offered to help a handicapped or elderly stranger across a street. _____
19. I have offered my seat on a bus or train to a stranger who was standing. _____
20. I have helped an acquaintance to move households. _____
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Please answer the following questions:

1.c Age: ____

2.c Male ____ Female ____

3.c What is your ethnicity? ________________

·

 
 
 

4.c What year of university are you currently in? ____

5.c Program of study: _______________

6.c If you are not a student, what is your occupation? __________________

7.c How many siblings do you have? ____

8.c What is the gender of all of your siblings? (In order from oldest to

youngest) _____________________________________________________________

9.c What is your birth order? (Example: are you a first-born, middle-born,
last-born etc.) ______________