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Impaired Comprehension of Nonliteral Language in Tourette Syndrome

Eddy, Clare M. PhD* †; Mitchell, Ian J. DPhil*; Beck, Sarah R. PhD*; Cavanna, Andrea E. MD; Rickards, Hugh E. MD

Cognitive and Behavioral Neurology: September 2010 - Volume 23 - Issue 3 - p 178-184
doi: 10.1097/WNN.0b013e3181e61cb7
Original Studies

Objective To investigate theory of mind and the understanding of nonliteral language in patients with Tourette syndrome (TS).

Background In TS, striatal dysfunction could affect the functioning of the frontal cortex. Changes in frontal functioning could lead to impairments in theory of mind: the understanding of mental states, such as beliefs, emotions, and intentions. Poor understanding of a speaker's mental state may also impair interpretation of their nonliteral remarks.

Method In this study, patients with TS and healthy controls completed tasks to assess their understanding of sarcasm, metaphor, indirect requests, and theory of mind. These tasks were the Pragmatic Story Comprehension Task, the Hinting task, and a faux pas task. Inhibitory ability was also assessed through the use of the Hayling task and a black and white Stroop test.

Results Patients with TS exhibited significant impairment on the faux pas task and Pragmatic Story Comprehension Task despite limited evidence of inhibitory impairment.

Conclusion TS may be associated with changes in theory of mind.

*Department of Psychology, University of Birmingham

Department of Neuropsychiatry, The Barberry National Centre for Mental Health, Birmingham, UK

Reprints: Clare Margaret Eddy, PhD, Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, The Barberry National Centre for Mental Health, 25 Vincent Drive, Birmingham, B152FG, UK (e-mail:

Received for publication October 27, 2009; accepted May 2, 2010

© 2010 Lippincott Williams & Wilkins, Inc.