The effects of direct and indirect speech on discourse comprehension in Dutch listeners with and without aphasia

Background: Research on language comprehension in aphasia has primarily focused on comprehension of isolated words and sentences. Even though previous studies have provided insights into comprehension abilities of individuals with aphasia at the word and grammatical level, our understanding of the nature and extent of their language comprehension (dis)abilities is not yet complete. In contrast to the highly restricted semantic and syntactic interpretation of sentences, discourse comprehension requires additional pragmatic and non-linguistic skills.Aims: The purpose of this study was to assess language comprehension in individuals with and without aphasia at the discourse level. In particular, it addressed the question of whether the use of direct speech, compared to indirect speech, affects comprehension of narrative discourse in Dutch aphasic and non-brain-damaged (NBD) listeners.Methods & Procedures: The Direct Speech Comprehension (DISCO) test was developed to examine the effects of manipulating direct vs. indirect speech on discourse comprehension. Twenty-three individuals with aphasia and 20 NBD participants were presented with spoken narratives that contained either direct or indirect speech reports. The narratives were presented audio-visually on an iPad, and comprehension was assessed with yes/no questions.Outcomes & Results: The performance of the participants with aphasia was significantly poorer than that of the NBD participants. Moreover, a main effect for condition type was found, indicating that narratives with direct speech reports were better understood than narratives with indirect speech reports by listeners with and without aphasia. There was no interaction between group and condition type indicating that this main effect held for both the aphasic and the NBD listeners. However, for the participants with aphasia, there was an interaction between condition and Token Test error score indicating that the positive effect of direct speech constructions diminishes for individuals with poorer comprehension.Conclusions: Direct speech constructions facilitate language comprehension in listeners with and without aphasia. One explanation for this finding is the occurrence of additional "layers" of communication, such as intonation and facial expression, often accompanying direct speech constructions. An alternative account is the degree of grammatical complexity: In Dutch, the syntactic construction of indirect speech requires embedding, whereas in direct speech the introductory sentence and the quote are both main clauses. The finding that the beneficial effect of direct speech on language comprehension diminishes for individuals with severe aphasia may indicate that the DISCO is too difficult for them to reveal an effect of a subtle manipulation such as that of condition type.