The Role of Inner Speech in Executive Functioning Tasks: Schizophrenia With Auditory Verbal Hallucinations and Autistic Spectrum Conditions as Case Studies

Abstract

Several theories propose that one of the core functions of inner speech (IS) is to support subjects in the completion of cognitively effortful tasks, especially those involving executive functions (EF). In this paper we focus on two populations who notoriously encounter difficulties in performing EF tasks, namely, people diagnosed with schizophrenia who experience auditory verbal hallucinations (Sz-AVH) and people with autism spectrum conditions (ASC). We focus on these two populations because they represent two different ways in which IS can fail to help in EF tasks, which can be illustrative for other mental conditions. First, we review the main components of EF (see section "Executive Functions"). Then we explain the functions that IS is taken to perform in the domain of EF (see section "Inner Speech and Executive Functions") and review the evidence concerning problems about EF in the two populations of our study: Sz-AVH (see section "Executive Functions and Inner Speech in Sz-AVH") and ASC (see section "Executive Function and Inner Speech in ASC"). After this we further detail our account about what a properly functioning IS can do for both populations and how different IS profiles may impact EF performance: in the case of Sz-AVH, the uncontrolled and intrusive character of IS negatively affects EF performance, whereas in ASC, EF is not sufficiently supported by IS, given the tendency in this population to present a diminished use of IS (see section "IS in ASC and Sz-AVH: How It Relates to EF"). We finally briefly discuss Attention Deficit/Hyperactivity Disorder (ADHD) and Developmental Language Disorders (DLD) (see section "Further Considerations").

Abstract Words as Social Tools: Which Necessary Evidence?

“…Individuals with ASC (Autism Spectrum Condition) and people diagnosed with schizophrenia–particularly patients who experience auditory verbal hallucinations (sz-AVH)–share some social behaviors: they have communication difficulties and tend to avoid eye contact (Dvir et al, 2011 ). Furthermore, their use of inner speech is anomalous: while individuals with ASC generally avoid using inner speech, the inner speech of individuals with sz-AVG is intruded by negative thoughts and auditory hallucinations (Petrolini et al, 2020 ).…”

“…Children with ASC do not differ from controls in the categorization of basic and superordinate concepts. However, they need to visualize items and situations, have difficulties with mental states terms, and rarely make use of inner speech (Petrolini et al, 2020 ). Hence, their mastering of ACs–except for numerical concepts (e.g., Iuculano et al, 2014 ) which are considered as less abstract than other abstract concepts such as e.g., philosophical ones–could be limited, even if this might be less true for individuals with high-functioning autism (including Asperger individuals).…”

Inner speech

“…Barkley (1997) proposes that delays in the development of self‐directed speech may be partly to blame for problems with self‐regulation seen in attention deficit hyperactivity disorder. More generally, (and as discussed by Petrolini, Vicente, & Jorba, in press), cognitive‐behavioral therapies employing forms of structured “self‐talk” have been relatively successful in supporting controlled behavior (Meichenbaum & Goodman, 1971; Miranda, Presentación, Siegenthaler, & Jara, 2011). It is natural to infer from the efficacy of self‐directed outer speech that inner speech often plays the same supporting role.…”

“…It is natural to infer from the efficacy of self‐directed outer speech that inner speech often plays the same supporting role. The role of inner speech executive function and self‐regulation remain open and contentious areas of research, however, in part due to a lack of uniformity in how each of these notions—namely, “executive function,” “self‐regulation,” and “inner speech”—are understood by researchers (Petrolini et al, in press).…”

Too much or too little? Disorders of agency on a spectrum

“…AVH). Issues with self-monitoring are also likely to affect cognitive control and executive functioning at various levels, from implementing basic goals to carrying out higher order plans (Petrolini, Jorba and Vicente 2020). Applied to inner speech production, these difficulties may particularly affect what has been labeled "dialogic inner speech" (Fernyhough 2004), which refers to the conversations we have with ourselves.…”