N400 differences between physical and mental metaphors: The role of Theories of Mind.

Whether Theory of Mind (ToM) contributes to metaphor understanding has been largely investigated in language acquisition and decay. Yet we know very little about the role of ToM in real-time processing of metaphors in neurotypical adults. Here, we tested the relationship between ToM and metaphor through Event Related Potentials (ERPs) by capitalizing on the difference between metaphors inviting inferences on physical (Boxers are pandas) vs. mental aspects (Teachers are books). Physical metaphors involved a larger and sustained negativity compared to mental ones. This pattern resembled concreteness effects and suggests that physical metaphors may benefit from both verbal and perceptual information. Moreover, higher scores in the Reading the Mind in the Eyes Test (RMET), but not in the Animation task, were associated with a reduction of the N400 amplitude for both physical and mental metaphors. When exploring the ERP temporal trajectory with Generalized Additive Mixed Modeling, earlier differences between metaphors characterized individuals with higher RMET scores. Among the various ToM components, thus, emotion recognition seems to be involved in the processing of metaphors in general, with an earlier impact on the mental type. These findings highlight the multifaceted nature of metaphor, at the crossroad of language, social and perceptual experience.

What is the contribution of executive functions to communicative-pragmatic skills? Insights from aging and different types of pragmatic inference.

The role of executive functions in supporting the pragmatics of communication has been extensively examined in clinical populations, but is still under-explored in healthy aging. In this study we addressed the role of executive skills, including inhibition, working memory, and cognitive flexibility, in older adults' communicative-pragmatic abilities. Pragmatics was extensively assessed by measuring the understanding of figurative language, narrative texts, humor, and implicatures. A hierarchical regression analysis using composite scores evidenced a global effect of executive functions on communicative-pragmatic abilities, beyond demographic and theory of mind aspects. More fine-grained analyses showed that working memory was the strongest predictor of all pragmatic tasks. Specifically, comprehending narratives and humor seemed to capitalize primarily upon working memory, whereas figurative language and implicatures relied on working memory and to some extent cognitive flexibility. Conversely, inhibition did not stand out as a robust predictor of pragmatics. We argue that working memory allows for the simultaneous consideration of multiple pieces of information needed for pragmatic inferencing, and that only once working memory has played its role other executive aspects, such as cognitive flexibility and inhibition, might come into play. Overall, this study highlights the diverse role of executive skills in pragmatics in aging, and more generally contributes to shed light on pragmatic competence in older adults.

Beyond the motor account of amyotrophic lateral sclerosis: Verbal humour and its relationship with the cognitive and pragmatic profile.

BACKGROUND: Amyotrophic Lateral Sclerosis (ALS) was traditionally described as a disease restricted to the motor system. However, recent findings suggested that it also affects cognition, especially executive functions, social cognition, language and pragmatics. A relevant issue in current research is thus the description of the cognitive phenotype of ALS and the identification of the most vulnerable aspects. AIMS: The focus was on a communicative phenomenon placed at the crossroads of pragmatic and other cognitive domains, namely humour, which till now has been poorly explored in ALS. The first aim was to investigate whether ALS is associated with impairments in understanding and appreciating jokes. The second aim was to explore the predictors of humour comprehension and appreciation in patients, to confirm the involvement of pragmatic skills and to explore the role of other cognitive and clinical aspects. METHODS & PROCEDURES: A total of 30 non-demented patients with ALS and 27 controls were assessed with a task of verbal humour comprehension and appreciation, including two types of jokes: phonological and mental. We also administered a battery of pragmatic and other language tasks, and cognitive and socio-cognitive tasks. Mixed-effects models were used to test differences in the humour task between the two groups. Multiple regressions determined the best predictors of humour comprehension and appreciation in patients. OUTCOMES & RESULTS: Patients obtained lower comprehension accuracy scores than controls in the humour task, independently of the type of joke. Conversely, patients and controls did not differ in joke appreciation and both rated mental jokes as funnier than the phonological ones. Patients' comprehension accuracy was predicted by pragmatic skills and ALS severity, whereas appreciation was predicted by several clinical variables and, to a smaller extent, by language skills. CONCLUSIONS & IMPLICATIONS: The findings suggest that humour is a very vulnerable aspect in ALS, and that impairment in humour comprehension might be part of the larger cognitive impairment, being linked to pragmatic impairment. Clinical variables were also important, especially in relation to humour appreciation. More generally, these data speak in favour of pragmatics as a relevant aspect to sketch the cognitive phenotype of ALS. On the practical level, these findings point to the need of supporting communication at large, not only motor-related aspects such as dysarthria but also social-pragmatic aspects such as understanding jokes, to increase well-being in ALS. What this paper adds What is already known on this subject The literature of the last decades has shown that ALS comes with impairment in several cognitive domains, affecting especially executive functions as well as language. There is also initial evidence that the pragmatics of communication and humour comprehension are impaired, although non-serious talk has been documented in conversational interaction among people with ALS. What this paper adds to existing knowledge This study offers compelling evidence of an impairment in the comprehension of jokes in ALS, whereas the appreciation of joke funniness seems to be spared. The study also highlights the interplay of cognitive factors (especially pragmatics) and clinical factors (related to disease severity) in predicting the patients' performance in the humour task. What are the potential or actual clinical implications of this work? The study's findings call for the need of increased awareness among scholars as well as practitioners and caregivers of the profile of humour comprehension and appreciation in ALS. On a practical level, we highlight the need of assessing humour comprehension and adapting the communicative style accordingly. Second, we recommend that intervention programmes targeting communication in ALS go beyond speech-related difficulties and include pragmatic aspects such as humour. Considering the important communicative and social function of humour, as well as its use as a coping strategy, humour interventions are key to improve the quality of life of individuals with ALS.

Modulating "Surprise" with Syntax: A Study on Negative Sentences and Eye-Movement Recording.

This work focuses on a particular case of negative sentences, the Surprise Negation sentences (SNEGs). SNEGs belong to the class of expletive negation sentences, i.e., they are affirmative in meaning but involve a clausal negation. A clear example is offered by Italian: 'Enonmi è scesa dal treno Maria?!' (let. 'and not CLITIC.to_me is got off-the train Mary' = 'The surprise was that Maria got off the train!'). From a theoretical point of view, the interpretation of SNEGs as affirmative can be derived from their specific syntactic and semantic structure. Here we offer an implementation of the visual world paradigm to test how SNEGs are interpreted. Participants listened to affirmative, negative or expletive negative clauses while four objects (two relevant-either expected or unexpected-and two unrelated) were shown on the screen and their eye movements were recorded. Growth Curve Analysis showed that the fixation patterns to the relevant objects were very similar for affirmative and expletive negative sentences, while striking differences were observed between negative and affirmative sentences. These results showed that negation does play a different role in the mental representation of a sentence, depending on its syntactic derivation. Moreover, we also found that, compared to affirmative sentences, SNEGs require higher processing efforts due to both their syntactic complexity and pragmatic integration, with slower response time and lower accuracy.

'Honey, shall I change the baby? - Well done, choose another one': ERP and time-frequency correlates of humor processing.

We studied the electrophysiological correlates of verbal humor comprehension by comparing Event Related Potentials (ERPs) and time-frequency representations recorded while 50 participants read humorous and non-humorous passages. Using linear mixed models on single trials we showed that humorous target words elicited a larger Left Anterior Negativity (LAN), sustained in time and followed by a positive shift involving P600 and Late Positive Complex (LPC) components. In the time-frequency domain, humor was associated with a power decrease in the beta-band of the EEG. Furthermore, participants' Autism-spectrum Quotient correlated with the size of the LAN, suggesting that social skills may affect humor comprehension during the early processing phase. Our results describe a sequence of events where incongruity detection (associated with the LAN) precedes a composite set of mechanisms serving resolution and acting in parallel: the sustained LAN might reflect the search for an alternative script, while the P600 might index inferential processes arriving at the resolution and the updating of the discourse model. The processing differences associated with the LPC and the changes in beta power may reflect a later stage of more elaborative and reflective processing (where the receiver reflects upon the joke's solution) and the abandonment of the current discourse model.

Interpreting physical and mental metaphors: Is Theory of Mind associated with pragmatics in middle childhood?

We investigated the association between individual differences in metaphor understanding and Theory of Mind (ToM) in typically developing children. We distinguished between two types of metaphors and created a Physical and Mental Metaphors task, echoing a similar distinction for ToM. Nine-year-olds scored lower than older age-groups in ToM as well as in the interpretation of mental, but not physical, metaphors. Moreover, nine-year-olds (but not older children) who are better in ToM are also better in interpreting mental, but not physical, metaphors. This suggests that the link between metaphor and ToM is stronger when metaphorical interpretation involves mental aspects, and it is more evident in early rather than later childhood.

Pragmatic competence and its relationship with the linguistic and cognitive profile of young adults with dyslexia.

The study assessed the pragmatic skills of 19 well-compensated Italian-speaking young adults with dyslexia compared with controls. A comprehensive pragmatic assessment tool was employed, targeting production and comprehension (Assessment of Pragmatic Abilities and Cognitive Substrates [APACS]). Participants were also administered a series of standardized tests to assess verbal and non-verbal cognitive abilities, including executive functions and social cognition tests. Data were analysed with the aim of understanding whether pragmatic abilities are compromised in dyslexia and of exploring associations between pragmatic performance and other cognitive domains. The performance of the dyslexia group was poorer than that of the control group in both expressive and receptive modalities. Data showed diffuse problems across several domains, with the greatest challenge posed by inferring nonliteral meanings, which indicates that pragmatic inefficiency is an important aspect of the linguistic and communicative profile of dyslexia in adulthood. Explorative correlations highlighted a relation between pragmatic performance and reading and vocabulary abilities, as well as between pragmatics and working memory. This suggests that pragmatic difficulties are strongly tied to the most distinctive aspects of dyslexia, namely, phonological awareness, verbal short-term memory, pseudo-word repetition, whereas the link with high-level executive functions and Theory of Mind is negligible.

The contribution of surgical brain mapping to the understanding of the anatomo-functional basis of syntax: A critical review.

A wide range of studies on language assessment during awake brain surgery is nowadays available. Yet, a consensus on a standardized protocol for intraoperative language mapping is still lacking. More specifically, very limited information is offered about intraoperative assessment of a crucial component of language such as syntax. This review aims at critically analyzing the intraoperative studies investigating the cerebral basis of syntactic processing. A comprehensive query was performed on the literature, returning a total of 18 studies. These papers were analyzed according to two complementary criteria, based on the distinction between morphosyntax and syntax. The first criterion focused on the tasks and stimuli employed intraoperatively. Studies were divided into three different groups: group 1 included those studies that overtly aimed at investigating morphosyntactic processes; group 2 included studies that did not explicitly focus on syntax, yet employed stimuli requiring morphosyntactic processing; and group 3 included studies reporting some generic form of syntactic deficit, although not further investigated. The second criterion focused on the syntactic structures of the sentences assessed intraoperatively, analyzing the canonicity of sentence structure (i.e., canonical versus non-canonical word order). The global picture emerging from our analysis indicates that what was investigated in the intraoperative literature is morphosyntactic processing, rather than pure syntax. The study of the neurobiology of syntax during awake surgery seems thus to be still at an early stage, in need of systematic, linguistically grounded investigations.

The communicative impairment as a core feature of schizophrenia: Frequency of pragmatic deficit, cognitive substrates, and relation with quality of life.

BACKGROUND: Impairments in specific aspects of pragmatic competence, supporting the use of language in context, are largely documented in schizophrenia and might represent an indicator of poor outcome. Yet pragmatics is rarely included in clinical settings. This paper aims to promote a clinical consideration of pragmatics as a target of assessment and intervention. We investigated the frequency of the pragmatic deficit, its cognitive substrates, and the relation with quality of life. METHODS: Pragmatic abilities were compared in a sample of patients with schizophrenia and healthy controls based on a comprehensive pragmatic test (APACS). We assessed also for psychopathology, cognition, social cognition, and quality of life. We explored the co-occurrence of deficits in different domains, and we used multiple regressions to investigate the effect of cognition and social cognition on pragmatics, and of pragmatics on quality of life. RESULTS: Pragmatic abilities, especially comprehending discourse and non-literal meanings, were compromised in schizophrenia, with 77% of patients falling below cutoff. Pragmatic deficit co-occurred with cognitive or socio-cognitive deficits in approximately 30% of cases. Multiple regression analysis confirmed the interplay of cognition and social cognition in pragmatic behavior. Quality of life was predicted by symptoms and by pragmatic abilities. CONCLUSIONS: The high frequency of impairment suggests that the pragmatic deficit is a core feature of schizophrenia, associated with quality of life. Cognitive and socio-cognitive abilities might represent necessary though not sufficient building blocks for the acquisition of pragmatic abilities throughout development. Therefore, a more precise incorporation of pragmatics in the description of the pathology is of high clinical and translational relevance.

Word structure and decomposition effects in reading.

Theories on the processing of compound words differ on the role attributed to access to individual constituents. These theories are mostly based on empirical evidence obtained in experimental settings that could induce artificial effects normally not occurring in natural processing. In this study we investigated the processing of compounds as compared to noncompound complex words in Italian through a reading task with eye movement recording. We included both head-initial and head-final compounds, in order to test whether the position of the head may influence the reading process. After ruling out the effects of length and frequency, we observed that pseudocompounds (i.e., words with a segment homograph to a real word in the leftmost part) elicited longer total reading times than all other types of complex words, including compounds. Furthermore, head-final compounds elicited longer total reading times than head-initial compounds. The results suggest that a word structure resembling a compound may induce longer processing, presumably related to unexpected morphological structures. The results also converge with previous evidence that in some cases there is a higher processing costs for head-final as opposed to head-initial compounds, possibly indexing a reanalysis of the stimulus in order to correctly assign the constituent properties. However, a deeper analysis restricted to compounds revealed a more complex scenario where several variables interact with headedness (namely, first and second constituent frequency, compound frequency, and compound length), and future studies are needed to discriminate among possible interpretations. Overall, our findings suggest that longer reading times are related to solving incongruities due to noncanonical structures, rather than to morphologically complexity per se.

Weighing the role of social cognition and executive functioning in pragmatics in the schizophrenia spectrum: A systematic review and meta-analysis.

Pragmatic impairment is diffused in schizophrenia spectrum disorders, but the literature still debates its neurocognitive underpinnings. This systematic review and meta-analysis aimed to investigate the neurocognitive correlates of pragmatic disorders in schizophrenia and determine the weight of social cognition and executive functioning on such disorders. Of the 2,668 records retrieved from the literature, 16 papers were included in the systematic review, mostly focused on non-literal meanings and discourse production in schizophrenia. Ten studies were included in the meta-analysis: pragmatics was moderately associated with both social cognition and executive functions (especially inhibition), but the link with social cognition was stronger. The mediation analysis showed that social cognition mediated the relationship between executive functions and pragmatics. Based on this, we proposed a hierarchical neurocognitive model where pragmatics stems from social cognition, while executive functions are the fertile ground supporting the other two domains, and we discuss its theoretical and clinical implications.

Corrigendum: Case report: Pragmatic impairment in multiple sclerosis after worsening of clinical symptoms.

[This corrects the article DOI: 10.3389/fpsyg.2022.1028814.].

The relationship between metaphor skills and Theory of Mind in middle childhood: Task and developmental effects.

Theoretical pragmatics in the post-Gricean tradition argued that metaphor requires understanding of how another person sees the world. Yet, it is unclear what role mindreading plays in developing metaphor skills. Here we examined the relationship between metaphor and Theory of Mind (ToM) in middle childhood by using two different tasks. In addition to the Physical and Mental Metaphors task (PMM), based on the verbal explanation of physical and mental metaphors, we revived the Referential Metaphors task for children (Noveck, Bianco, & Castry, 2001), where metaphorical and literal referents are presented in a narrative context. The sample included 169 8-, 9-, and 10-year-old children, assessed also for ToM (via the Strange Stories) and other linguistic and cognitive skills as control variables. In the PMM, ToM supported the understanding of mental (but not physical) metaphors in 9-year-olds only, whereas in the Referential Metaphors task ToM supported accuracy of understanding metaphors (but not literal items) in younger children as well. At age 10, ToM effects were negligible in both tasks. These findings suggest that ToM has a task-specific role in metaphor, linked to the characteristics of the items in the task at stake, being for instance greater for metaphors with mental (compared to physical) content and for non-literal (compared to literal) referents. The findings also suggest that the relationship between ToM and metaphor skills is developmental sensitive, as children start to capitalize on ToM earlier in development when the metaphor context is richer, and these effects fade with age. Theoretically, these data argue in favor of the relevance-theoretic account of metaphor, spelling out different ways in which ToM might support metaphor resolution across tasks, for instance by providing better access to the psychological lexicon (i.e., terms referring to mental states) and better context processing, serving as a springboard to achieve sophisticated pragmatic skills in middle childhood.

Case report: Pragmatic impairment in multiple sclerosis after worsening of clinical symptoms.

Pragmatics, defined as the ability to integrate language and context to communicate effectively, may be impaired in Multiple Sclerosis (MS). We present the case of a patient with active secondary progressive MS who, after a first neuropsychological assessment that evidenced only a slight pragmatic impairment, suffered a sudden worsening of her clinical conditions, treated with corticosteroids. After this clinical worsening, her pragmatic abilities declined markedly, both in comprehension and production. This worsening was accompanied by a decline only in one attention task, in the context of an overall stable cognitive functioning. We conclude that pragmatics may be a domain particularly susceptible to cognitive worsening, highlighting the importance of its assessment in clinical practice.

It is time to address language disorders in schizophrenia: A RCT on the efficacy of a novel training targeting the pragmatics of communication (PragmaCom).

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Deconstructing heterogeneity in schizophrenia through language: a semi-automated linguistic analysis and data-driven clustering approach.

Previous works highlighted the relevance of automated language analysis for predicting diagnosis in schizophrenia, but a deeper language-based data-driven investigation of the clinical heterogeneity through the illness course has been generally neglected. Here we used a semiautomated multidimensional linguistic analysis innovatively combined with a machine-driven clustering technique to characterize the speech of 67 individuals with schizophrenia. Clusters were then compared for psychopathological, cognitive, and functional characteristics. We identified two subgroups with distinctive linguistic profiles: one with higher fluency, lower lexical variety but greater use of psychological lexicon; the other with reduced fluency, greater lexical variety but reduced psychological lexicon. The former cluster was associated with lower symptoms and better quality of life, pointing to the existence of specific language profiles, which also show clinically meaningful differences. These findings highlight the importance of considering language disturbances in schizophrenia as multifaceted and approaching them in automated and data-driven ways.

It is not always a matter of time: Addressing the costs of metaphor and metonymy through a speed-accuracy trade-off study.

One of the most debated topics in figurative language studies is whether the access to non-literal meanings is direct or indirect. Although models that argue for longer processing times for figurative compared to literal meanings have been largely criticized, figurative language is often associated with increased cognitive work. We investigated whether such greater cognitive work is indicative of more time-consuming processes or rather lower availability of figurative meanings, and whether there are differences between figurative types. We used a multi-response Speed-Accuracy Trade-off paradigm, where a meaningfulness judgment task was combined with a response deadline procedure to estimate speed and accuracy independently for metaphorical (Those dancers are butterflies) and metonymic sentences (That student reads Camilleri), compared with literal equivalents. While both metaphors and metonymies showed lower asymptote, that is, they were judged less accurately than literal counterparts, only metonymies were associated with a processing delay. Moreover, the difference in asymptote with respect to the literal condition was greater for metaphor than for metonymy. These findings indicate that the process that derives metaphor and metonymy is more complex than the process that derives literal meanings, even more so for metaphor. The processing delay, however, is present only in the case of metonymies. Taken together, our study offers key findings that reconcile a lively debate on the time course of figurative language comprehension, showing that the cost of non-literal meaning is not always a matter of time, and depends also on the figurative type. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Communicative-pragmatic abilities mediate the relationship between cognition and daily functioning in schizophrenia.

OBJECTIVE: Pragmatics refers to the capacity to understand the speaker's meaning and thus to appropriately engage in a conversation. This study aims at establishing the role of communicative-pragmatic abilities in functioning, defined as a set of daily activities, in schizophrenia. This would contribute to enrich current models of the neurocognitive predictors of functioning, which have so far neglected pragmatics. METHOD: One hundred people with schizophrenia underwent a comprehensive assessment including functioning, cognition, theory of mind (ToM), and pragmatics. We tested the effects of cognition as a predictor of functioning, first mediated by ToM, then sequentially mediated by ToM and pragmatics. Next, we explored the predictive effect of cognition, sequentially mediated by ToM and pragmatics, on different functional domains (i.e., interpersonal relations, instrumental role, and personal autonomy). RESULTS: The first model confirmed that ToM acts as a mediator between cognition and functioning. Importantly, the second model highlighted also the main mediating role of pragmatics. The mediation models on different functional domains showed that, when considered together, both pragmatics and ToM significantly influenced all aspects of functioning. When considered separately, pragmatics was significantly related to interpersonal functioning, while ToM to personal autonomy. CONCLUSIONS: Innovatively, our findings highlight that pragmatics has a main role, both direct and indirect, in affecting functioning. Of particular interest is that the impact of pragmatics encompasses different functional domains, and especially interpersonal functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

How to improve social communication in aging: Pragmatic and cognitive interventions.

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.

A leopard cannot change its spots: A novel pragmatic account of concretism in schizophrenia.

Concretism is a well-known feature of schizophrenia, tracing back to the early descriptions of the disease and commonly associated with the literal interpretation of figurative expressions such as proverbs, metaphors, and idioms. However, figurative expressions are not all alike in terms of linguistic and pragmatic processes. Determining if some figurative types are more impaired than others and if the type of task affects the performance constitutes an open issue with implications for the description of the clinical profile and for treatment. We run a fine-grained assessment of figurative language comprehension by comparing 47 patients with schizophrenia and 39 controls in three figurative types (idioms, metaphors, proverbs) presented in two response formats (multiple-choice, verbal-explanation), considering also the role of cognitive and clinical variables and the impact on quality of life. Mixed-effects models analysis revealed that: i) patients performed worse than controls across figurative types and response formats, indicating a diffuse impairment; ii) there is an interplay of figurative type and response format, which makes verbal-explanation of proverbs especially challenging; iii) in patients, problems in figurative language are largely connected with formal thought disorder and global IQ. Moreover, multiple-choice of metaphors was associated with patients' quality of life. This study offers a novel account of concretism, framed in pragmatics and figurative language processing. Adopting this perspective allowed us to describe the nuances of concretism, which areas in the figurative domain are especially challenging for patients and which ones capture differences in functioning, in order to guide intervention programs and integration in society.