Background

People with schizophrenia process language in unusual ways, but the causes of these abnormalities are unclear. In particular, it has proven difficult to empirically disentangle explanations based on impairments in the top-down processing of higher-level information from those based on the bottom-up processing of lower-level information.

Methods

To distinguish these accounts, we used visual world eye-tracking, a paradigm that measures spoken language processing during real-world interactions. Participants listened to and then acted out syntactically ambiguous spoken instructions (e.g., “tickle the frog with the feather”, which could either specify how to tickle a frog, or which frog to tickle). We contrasted how 24 people with schizophrenia and 24 demographically-matched controls used two types of lower-level information (prosody and lexical representations) and two types of higher-level information (pragmatic and discourse-level representations) to resolve the ambiguous meanings of these instructions. Eye-tracking allowed us to assess how participants arrived at their interpretation in real time, while recordings of participants’ actions measured how they ultimately interpreted the instructions.

Results

We found a striking dissociation in participants’ eye movements: the two groups were similarly adept at using lower-level information to immediately constrain their interpretations of the instructions, but only controls showed evidence of fast top-down use of higher-level information. People with schizophrenia, nonetheless, did eventually reach the same interpretations as controls.

Conclusions

Background: Schizophrenia is characterized by abnormalities in referential communication, which may be linked to more general deficits in proactive cognitive control. We used event-related potentials (ERPs) to probe the timing and nature of the neural mechanisms engaged as people with schizophrenia linked pronouns to their preceding referents during word-by-word sentence comprehension.

Methods: We measured ERPs to pronouns in two-clause sentences from 16 people with schizophrenia and 20 demographically-matched control participants. Our design crossed the number of potential referents (1-referent, 2-referent) with whether the pronoun matched the gender of its preceding referent(s) (matching, mismatching). This gave rise to four conditions: (1) 1-referent matching (“…Edward took courses in accounting but he…”), (2) 2-referent matching (“…Edward and Phillip took courses but he…”), (3) 1-referent mismatching (“…Edward took courses in accounting but she…”), and (4) 2-referent mismatching (“…Edward and Phillip took courses but she…”).

Results: Consistent with previous findings, healthy controls produced a larger left anteriorly-distributed negativity between 400-600ms to 2-referent matching than to 1-referent matching pronouns (the “Nref effect”). In contrast, people with schizophrenia produced a larger centro-posterior positivity effect between 600-800ms. Both patient and control groups produced a larger positivity between 400-800ms to mismatching than to matching pronouns.

Conclusions: These findings suggest that proactive mechanisms of referential processing, reflected by the Nref effect, are impaired in schizophrenia, while reactive mechanisms, reflected by the positivity effects, are relatively spared. Indeed, patients may compensate for proactive deficits by retro-actively engaging with context to influence the processing of inputs at a later stage of analysis.