Effectiveness of cognitive-behaviour therapy for hoarding disorder in people with mild intellectual disabilities

Evaluations of cognitive behavioural interventions for hoarding for those with intellectual disabilities (ID) have not been previously attempted. This investigation therefore examined the acceptability and effectiveness of cognitive-behavioural therapy (CBT) in a sample of N = 14 adults with mild ID. All participants had hoarding as their primary problem and received twelve individual CBT sessions, all conducted via domiciliary visits. The primary outcome measure was an environmental measure (Clutter Image Rating Scale), which was scored at baseline, end of treatment and at six-month follow-up. Acceptability of CBT was measured via the treatment refusal and dropout rate. Secondary self-report outcomes included measures of hoarding, depression and anxiety. Results demonstrate that hoarding significantly reduced following treatment on both self-report and environmental assessment. No participants refused or dropped out of treatment and that there was no evidence of relapse over the follow-up period. No adverse treatment incidences were reported. This open trial suggests that CBT may be a safe and effective intervention for hoarding difficulties in people with ID, but that the evidence base in this population needs urgent and detailed attention

On the limits of genetic responsibility: Communication and consent for tumour testing for Lynch syndrome

Testing cancers for mismatch repair (MMR) gene defects assists selection of families for genetic testing for cancer predisposing Lynch syndrome. Performing MMR tumour testing without consent is debated, though little empirical work has been undertaken. We address this by examining the significance of testing for those who have consented without prior genetic counselling, particularly their ‘accounts’ of testing via displays of knowledge and responsibility. Semi-structured interviews were conducted with participants recruited from a UK genetics service. Participants had difficulties in formulating the benefits of testing when consent was facilitated by a relative or by mail. Discourse analysis revealed that in the absence of specific or accurate understandings of tumour testing, participants displayed responsibility towards themselves and others by generalising and diminishing the implications of testing. Within the framework of ‘genetic responsibility’, MMR tumour testing seems less important in participants’ accounts compared to more definitive genetic testing. If facilitating genetic knowledge and responsibility are goals of genetic testing then developing appropriate consent procedures for MMR tumour testing is an important consideration. Further research is required to differentiate whether genetic counselling is a precondition for enacting genetic responsibility or whether intrinsic differences between types of testing make the concept less relevant