Francesca M. Bosco

Predictive Factors of In‐Hospital Mortality in Older Patients Admitted to a Medical Intensive Care Unit

OBJECTIVES: To identify prognostic factors that are independently predictive of in‐hospital mortality in older patients hospitalized in a medical intensive care unit (MICU).

Communicative Impairment in Traumatic Brain Injury: A Complete Pragmatic Assessment.

The aim of the present study was to examine the communicative abilities of traumatic brain injury patients (TBI). We wish to provide a complete assessment of their communicative ability/disability using a new experimental protocol, the Assessment Battery of Communication, (ABaCo) comprising five scales--linguistic, extralinguistic, paralinguistic, context and conversational--which investigate all the main pragmatic elements involved in a communicative exchange. The ABaCo was administered to 21 TBI subjects and to a control group. The results showed that performance by TBI patients was worse than that of controls on all scales; moreover they showed a trend of increasing difficulty in understanding and producing different pragmatic phenomena, i.e., standard communication acts, deceits and ironies, whether such phenomena are expressed through the linguistic or extralinguistic modality.

Developmental pragmatics in normal and abnormal children.

We propose a critical review of current theories of developmental pragmatics. The underlying assumption is that such a theory ought to account for both normal and abnormal development. From a clinical point of view, we are concerned with the effects of brain damage on the emergence of pragmatic competence. In particular, the paper deals with direct speech acts, indirect speech acts, irony, and deceit in children with head injury, closed head injury, hydrocephalus, focal brain damage, and autism. Since no single theory covers systematically the emergence of pragmatic capacity in normal children, it is not surprising that we have not found a systematic account of deficits in the communicative performance of brain injured children. In our view, the challenge for a pragmatic theory is the determination of the normal developmental pattern within which different pragmatic phenomena may find a precise role. Such a framework of normal behavior would then permit the systematic study of abnormal pragmatic development.

Rethinking the ontogeny of mindreading.

We propose a mentalistic and nativist view of human early mental and social life and of the ontogeny of mindreading. We define the mental state of sharedness as the primitive, one-sided capability to take ones own mental states as mutually known to an interactant. We argue that this capability is an innate feature of the human mind, which the child uses to make a subjective sense of the world and of her actions. We argue that the child takes all of her mental states as shared with her caregivers. This allows her to interact with her caregivers in a mentalistic way from the very beginning and provides the grounds on which the later maturation of mindreading will build. As the latter process occurs, the child begins to understand the mental world in terms of differences between the mental states of different agents; subjectively, this also corresponds to the birth of privateness.

Th.O.m.A.S.: An exploratory assessment of theory of mind in schizophrenic subjects

A large body of literature agrees that persons with schizophrenia suffer from a Theory of Mind (ToM) deficit. However, most empirical studies have focused on third-person, egocentric ToM, underestimating other facets of this complex cognitive skill. Aim of this research is to examine the ToM of schizophrenic persons considering its various aspects (first- vs. second-order, first- vs. third-person, egocentric vs. allocentric, beliefs vs. desires vs. positive emotions vs. negative emotions and how each of these mental state types may be dealt with), to determine whether some components are more impaired than others. We developed a Theory of Mind Assessment Scale (Th.o.m.a.s.) and administered it to 22 persons with a DSM-IV diagnosis of schizophrenia and a matching control group. Th.o.m.a.s. is a semi-structured interview which allows a multi-component measurement of ToM. Both groups were also administered a few existing ToM tasks and the schizophrenic subjects were administered the Positive and Negative Symptoms Scale and the WAIS-R. The schizophrenic persons performed worse than control at all the ToM measurements; however, these deficits appeared to be differently distributed among different components of ToM. Our conclusion is that ToM deficits are not unitary in schizophrenia, which also testifies to the importance of a complete and articulated investigation of ToM.

Understanding the communicative impairments in schizophrenia: A preliminary study

UNLABELLED The aim of the present study was to evaluate the pragmatic abilities of patients with schizophrenia in a variety of pragmatic phenomena expressed through different communicative means (language, gestures, and paralinguistic modality). For this purpose we used the Assessment Battery of Communication (ABaCo; Sacco et al., 2008). The ABaCo is a validated clinical tool for assessing pragmatic skills, which comprises five evaluation scales-linguistic, extralinguistic, paralinguistic, context, and conversational-investigating both comprehension and production of the main pragmatic phenomena involved in a communicative exchange, such as direct and indirect speech acts, irony, deceit, the violation of Grices maxims, topic management, and turn-taking. The battery was administered to a group of seventeen patients with schizophrenia, and matched healthy controls. We expected the clinical group to perform widely worse than the control group in the different pragmatic dimensions investigated. Results showed that patients with schizophrenia performed significantly worse than controls on all the five scales of the battery, both in comprehension and production tasks. Moreover, the results within each scale showed a differentiated performance in the clinical group among the pragmatic phenomena, with irony assessed as the most difficult task. The implications of these results for research and treatment in schizophrenia are discussed. LEARNING OUTCOMES After reading this article, the reader will be able to: (1) summarize thepreliminary assessment of pragmatic impairments in patients with schizophrenia; (2) describea variegated communicative profile regarding different pragmatic phenomena; and (3) discuss the planning and evaluating specific rehabilitation programs.

Sharedness and privateness in human early social life

This research is concerned with the innate predispositions underlying human intentional communication. Human communication is currently defined as a circular and overt attempt to modify a partners mental states. This requires each party involved to possess the ability to represent and understand the others mental states, a capability which is commonly referred to as mindreading, or theory of mind (ToM). The relevant experimental literature agrees that no such capability is to be found in the human species at least during the first year of life, and possibly later. This paper aims at advancing a solution to this theoretical problem. We propose to consider sharedness as the basis for intentional communication in the infant and to view it as a primitive, innate component of her cognitive architecture. Communication can then build upon the mental grounds that the infant takes as shared with her caregivers. We view this capability as a theory of mind in a weak sense.

A broad assessment of theory of mind in adolescence: The complexity of mindreading

The aim of this research was to provide an articulated assessment of several different ToM components, namely first- vs. third-person, egocentric vs. allocentric, and first- vs. second-order ToM, in preadolescence and adolescence. Our expectations for the sample of 80 juveniles that participated in the research were that: (1) ToM abilities would improve with age; (2) participants would perform better at first-person than at third-person tasks; (3) participants would perform better at first-order than at second-order tasks; (4) girls will perform systematically better than boys. We also explored possible differences in performance (5) in the allocentric vs. the egocentric perspectives as well as (6) in the comprehension of different types of mental states, namely desires, beliefs and positive and negative emotions. Overall our expectations were confirmed. Our data confirmed that all ToM aspects we investigated keep maturing during preadolescence and adolescence.

The fundamental context categories in understanding communicative intention

We propose a taxonomy of the different categories of context which contribute to reconstruct the communicative intention of a speaker. In particular, we investigate the following categories: Access, Space, Time, Discourse, Move, and Status. We propose that different contexts pertaining to the same category make the hearer assign different communicative meanings to the same expressive act. We validate our expectations through an experiment on three groups of children aged 3–7 years. The results confirm our predictions and reveal that different context categories and within them, different contexts, play different roles in the reconstruction of the communicative intentions in children belonging to the different age groups.

No more a child, not yet an adult: Studying social cognition in adolescence

There are several reasons why adolescence is interesting. It is in this phase that an individual finds herself fully facing the external world: basically equipped with the kind of social cognition that s/he has acquired at home, at school and through the media during childhood, s/he has now to meet a host of other, diverse views of what “reasonable,” “appropriate,” or “expected” courses of thought and emotions are, in the wild with friends and peers, romantic or sexual partners, teachers and employers, and the society at large. Furthermore, she is also expected, both at home and in the external world, to have a wholly new degree of control over such courses. While the idea that the development of social cognition still progresses after infancy (and possibly throughout the life span) is clearly gaining consensus in the field, the literature building on it is still scarce. One of the reasons for this probably is that most tests used to study it focus on its basic component, namely theory of mind, and have been mostly devised for us with children; therefore, they are not suitable to deal with the hugely increasing complexity of social and mental life during adolescence and adulthood. Starting from a review of the literature available, we will argue that the development of social cognition should be viewed as a largely yet-to-be-understood mix of biological and cultural factors. While it is widely agreed upon that the very initial manifestations of social life in the newborn are largely driven by an innate engine with which all humans are equally endowed, it is also evident that each culture, and each individual within it, develops specific adult versions of social cognition.