Effect of environmental clutter on attention performance in hoarding

Abstract

Clients with hoarding disorder (HD) frequently complain of problems with attention, and they are often easily distracted during decluttering efforts in the clinic or at home. In contrast, standardized tests of attention performance have not shown consistent impairment of attention. This study examined the role of a testing environment that simulated the disorganized visual array of a hoarded home. Participants (N = 162) completed neurocognitive tests (including a Continuous Performance Test), a diagnostic interview, and self-report questionnaires. Hoarding symptom severity correlated fairly strongly (r = 0.68) with self-reported ADHD symptoms. Participants who met criteria for HD (n = 61) reported substantially higher ADHD symptoms (d = 1.35) compared with 55 participants who were classified as healthy controls. Both hoarding diagnosis and symptom severity were associated with greater declines in vigilance during trials that involved longer (boring) pauses between stimuli, more frequent erroneous responses to non-targets (commission errors), and poorer performance on auditory attention and working memory, but these effects were quite small in comparison with the effect size for self-reported ADHD symptoms. The cluttered environment did not affect attention performance. Overall, findings suggest subsequent research should focus on the question of persistence in the context of boredom or negative affect.