Cognitive pathways to communicative-pragmatic dysfunction in schizophrenia: The role of autistic symptoms

Background Communicative-pragmatic dysfunction is recognized as a core feature of schizophrenia, as well as a hallmark of Autism Spectrum Disorders (ASD), strongly intertwined with neurocognitive and sociocognitive domains. Autistic symptoms, i.e., autistic-like traits below ASD diagnostic threshold, occur in over 50% of patients with schizophrenia, affecting social cognition and functioning. Strikingly, their specific link with pragmatics remains unexplored. This study tests the relationship between autistic symptoms and pragmatics in schizophrenia, modelling their interplay with executive functions (EF) and Theory of Mind (ToM), in the context of the sprout model of pragmatics. Methods A sample of 125 individuals with schizophrenia was assessed for autistic symptoms, pragmatics, ToM, and EF. Path analysis examined direct and indirect effects of autistic symptoms on global pragmatics and on pragmatic production and comprehension, with EF and ToM as mediating variables. Results Autistic symptoms were negatively associated with EF, ToM, and pragmatics. Path analysis revealed that autistic symptoms have a direct effect on global pragmatics, as well as an indirect one, via EF and ToM consecutively. Furthermore, autistic symptoms indirectly affected both pragmatic production, via EF, and comprehension, through EF and ToM sequentially. Conclusions Results show a strong link between autistic symptoms and pragmatics in schizophrenia, highlighting a cognitive pathway from EF to ToM in supporting pragmatics, in line with the sprout model, with a key role of the former in production and of the latter in comprehension. Clinically, this study highlights that assessing autistic symptoms in routine care may help identify patients at higher risk for pragmatic deficits and guide targeted rehabilitation strategies.