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Language and communication disruptions in schizophrenia are at the center of a large body of investigation. Yet, the remediation of such disruptions is still in its infancy. Here we targeted what is known to be one of the most damaged language domains in schizophrenia, namely pragmatics, by conducting a pragmatics-centered intervention with a randomized controlled trial design and assessing also durability and generalization. To the best of our knowledge, this is the first study with these characteristics.Inspired by the Gricean account of natural language use, we tailored a novel treatment addressing the pragmatics of communication (PragmaCom) and we tested its efficacy in a sample of individuals with schizophrenia randomized to the experimental group or to an active control group. The primary outcome with respect to the efficacy of the PragmaCom was measured by changes in pragmatic abilities (as evaluated with the global score of the Assessment of Pragmatic Abilities and Cognitive Substrates test) from baseline to 12 weeks and at 3-month follow-up. The secondary outcome was measured by changes in metaphor comprehension, abstract thinking, and global functioning from baseline to 12 weeks and at 3-month follow-up.Relative to the control group, at post-test the PragmaCom group showed greater and enduring improvement in global pragmatic skills and in metaphor comprehension. At follow-up, these improvements persisted and the PragmaCom exerted beneficial effects also on functioning.Despite the limited sample size, we believe that these findings offer initial yet encouraging evidence of the possibility to improve pragmatic skills with a theoretically grounded approach and to obtain durable and clinically relevant benefits. We argue that it is time that therapeutic efforts embrace communicative dysfunctions in order to improve illness outcome.

Although metaphors are essential tools in everyday communication and educational settings, the literature lacks evidence of effective training tools to promote metaphor comprehension in typical development. Grounding in theoretical pragmatics, we developed a novel metaphor comprehension training (MetaCom) for school-age children that focuses on inferential and contextual aspects of metaphors. The effects of the MetaCom were tested against a control training focusing on text comprehension in a randomized controlled trial involving 55 children aged between 8;8 and 9;8. Only children in the MetaCom group improved in the ability to verbally explain the meaning of a metaphor. Moreover, only the MetaCom showed transfer effects to reading comprehension. These findings suggest that targeting inference and attention to context is key to promote metaphor understanding, and that the benefits might extend to linguistic and communicative skills at large. The MetaCom training can thus represent a promising tool for educational programs, possibly also in atypical populations.

Difficulties in the pragmatic aspects of language are considered a hallmark of Traumatic Brain Injury (TBI). However, this claim is mostly based on assessments of discourse production, neglecting a...

When we speak, we often say things that are different from what we actually mean. For example, at a ballet, we might say that the dancers are butterflies. Dancers are not really butterflies, but this statement is not a lie; it is a metaphor. A metaphor is a figure of speech quite common in our everyday language and in books. In this article, we explain what metaphors are, why we use them, and what happens in our brains when we must understand a metaphor. Understanding metaphors requires a lot of brain work, which is why it is not always easy. Some people might find metaphors particularly difficult to understand, for example, very young children and people who are autistic. At the end of the article, we suggest things that teachers and speech and language therapists can do to help those who have difficulty understanding metaphors.

Background A pragmatic disruption is observed in several clinical conditions and especially in schizophrenia. It is estimated that over 75% of patients affected by schizophrenia present a pervasive and wide impairment of pragmatic abilities, encompassing both comprehension and production abilities, thus confirming the hypothesis of a wide Pragmatic Language Disorder in schizophrenia. More specifically, the comprehension of figurative languages, such as metaphors, idioms, and irony, is the most compromised domain in schizophrenia. Poor pragmatics has a relevant impact on daily functioning, by contributing to social isolation and lower quality of life. Only few pragmatic treatments have been developed and tested in schizophrenia, focusing only on specific pragmatic features and without using a Randomized Controlled Trial (RCT) design. This study aimed at investigating the efficacy of PragmaCom Training (PT), a novel 12-weeks intervention specifically developed to enhance pragmatics in schizophrenia. Methods 30 patients with schizophrenia, according to DSM 5, were randomly assigned to PT to an active control group (ACG). All patients were assessed for global pragmatics with the Assessment of Pragmatic Abilities and Cognitive Substrates test, APACS), metaphor comprehension (Physical and Mental Metaphors task, PMM), executive functions (Brief Assessment of Cognition in Schizophrenia, Tower of London score, BACS), abstract thinking (Positive and Negative Syndrome Scale for Schizophrenia, N5 score, PANSS), and daily functioning (Quality of Life Scale, QLS). To quantify the magnitude of changes after the PT, effect sizes were estimated using Cohen’s d (Cohen, 1988) for APACS, PMM, PANSS N5 Score, and QLS only in PT Group. The effect of PT in enhancing pragmatic abilities, the abstract thinking and daily functioning was tested between groups by means of several ANCOVA, entering post-training measures as dependent variables, measures at the baseline and executive functions as covariates, and treatment (PT vs ACG) as grouping variables. Results Patients treated with PT showed small to medium-large effect-sizes in global pragmatics (0.25), metaphors comprehension (0.72), functioning (0.23), and abstract thinking (-0.18). ANCOVAs revealed a significant effect of PT in enhancing global pragmatic abilities (F=5.4, p=.03), metaphor comprehension (F=8.94, p=.007) and abstract thinking (F=8.1, p=.01). No significant effect was found for functioning. Discussion This is the first study using a RCT design to test the efficacy of a pragmatic training. PT is a novel training specifically developed to target the pragmatic impairments that characterize schizophrenia. This study confirms the efficacy of PT in improving multiple domains, encompassing global pragmatics, the comprehension of figurative language, and abstract thinking in schizophrenia. Impact on functioning is also expected. However, in line with literature, it is likely to occur at later time points, since it requires the chance to apply the enhanced abilities in ecological contexts.

Among all aspects of the linguistic and communicative competence, pragmatics seems especially vulnerable in aging, due also to cognitive decline. However, pragmatics has never been considered as an intervention target in healthy aging. Here we tested the effects of a novel training program to improve pragmatics (PragmaCom) in older adults, compared with an active cognitive control group in a randomized-controlled-trial design. Both the PragmaCom group and the control group improved in pragmatic skills such as understanding metaphors and avoiding off-topic speech, indicating that it is possible to improve pragmatics in aging both with a specific training and with a cognitive training. Individual cognitive factors predicted pragmatic improvement in the control group, while in the PragmaCom group benefits were less dependent on individual characteristics. We discuss the results in terms of pragmatic plasticity, highlighting the importance of these findings for promoting older adults' social communication and well-being.

Financial capacity is the ability to manage one's own finances according to self-interests. Failure in financial decisions and lack of independence when dealing with money can affect people's quality of life and are associated with neuropsychological deficits or clinical conditions such as mild cognitive impairment or Alzheimer's disease. Despite the importance of evaluating financial capacity in the assessment of patients with neuropsychological and psychiatric disorders, only a few tools have been developed. In the present article, the authors introduce the Numerical Activities of Daily Living - Financial (NADL-F) test, a new test to assess financial capacity in clinical populations. The NADL-F is relatively short, yet it encompasses the most common activities involving financial capacities. The NADL-F proved to have satisfactory psychometric properties and overall good validity for measuring financial abilities. Associations with performance on basic neuropsychological tests were investigated, in particular focusing on mathematical abilities as cognitive correlates of financial capacity. Results indicate that the NADL-F could be a useful tool to guide treatments for the enhancement of financial capacities. By sharing all materials and procedures, the authors hope to promote the development of further versions of the NADL-F in different languages, taking into account the necessary adjustments related to different socio-cultural contexts.