Assessing the ability of people with a learning disability to give informed consent to treatment.

BACKGROUND: People with a learning disability are increasingly being encouraged to take a more active role in decisions about their psychological and medical treatment, raising complex questions concerning their ability to consent. This study investigates the capacity of people with a learning disability to consent in the context of three treatment vignettes, and the influence of verbal and memory ability on this capacity. METHODS: Measures of verbal ability, memory ability and ability to consent to treatment (ACQ) were administered to 40 people with a learning disability. The ACQ consisted of three vignettes depicting a restraint, psychiatric or surgical intervention. These were followed by questions addressing people's ability to understand the presenting problem; the nature of the proposed intervention; the alternatives, risks and benefits; their involvement in the decision-making process; and their ability to express a clear decision with a rationale for treatment. RESULTS: Five people (12.5%) could be construed as able to consent to all three vignettes; 26 (65%) could be construed as able to consent to at least one. The questions that were most difficult to answer concerned a participants' rights, options and the impact of their choices. Verbal and memory ability both influenced ability to consent. CONCLUSIONS: This study introduces a measure that may enable clinicians to make more systematic assessments of people's capacity to consent. A number of issues surrounding the complex area of consent to treatment are also raised.

Stress, coping, and disturbed eating attitudes in teenage girls.

OBJECTIVE: This study explored the relationship between stressors and disturbed eating attitudes among adolescent females, assessing the moderating role of coping and the mediating influence of poor self-esteem. METHOD: Two hundred eighty-six teenage girls were recruited from local schools, and completed standardized measures of stressors, coping, self-esteem, perfectionism, and disturbed eating attitudes. Regression analyses were used to test for moderating and mediating effects. RESULTS: Stressors and emotion-focused coping were found to be associated with low self-esteem, which in turn was strongly associated with disturbed eating attitudes. Stressors were also directly related to disturbed eating attitudes. DISCUSSION: The findings provide partial support for existing models of the etiology and maintenance of eating psychopathology, but have wider implications for our understanding of the eating disorders and their treatment.