Psychiatry Research 187 (2011) 610

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Psychiatry Research
j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / p s yc h r e s

Impaired reading comprehension in schizophrenia: Evidence for underlying

phonological processing decits
Wendy Arnott a,, Lauren Sali a, David Copland a,b
a
b

Division of Speech Pathology, The University of Queensland, St Lucia, QLD 4072, Australia
Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4072, Australia

a r t i c l e

i n f o

Article history:
Received 12 November 2009
Received in revised form 23 August 2010
Accepted 13 November 2010
Keywords:
Reading self-concept
Phonological awareness
Visual naming speed
Written language

a b s t r a c t
The present study examined reading ability in high functioning people with schizophrenia. To this end, 16
people with schizophrenia who were living in the community and 12 matched controls completed tests of
passage reading (comprehension, accuracy, and rate), word recognition, and phonological processing
(phonological awareness, phonological memory and rapid naming) and ratings of reading self-concept and
practices. Performance of the participants with schizophrenia was impaired relative to control participants on
reading comprehension and rapid naming and relative to the population norms on phonological awareness,
and rapid naming. In addition, self-rating data revealed that participants with schizophrenia had poorer
perceptions of their reading ability and engaged in reading activities less frequently than their control
counterparts. Consistent with earlier research, signicant correlations were found between phonological
awareness and reading comprehension. These ndings expand on previous research in the area to suggest
that community-based individuals with schizophrenia experience problems with reading comprehension
that may have a phonological basis.
2010 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
People with schizophrenia experience wide-ranging cognitive
decits including communication and oral language problems.
Evidence of schizophrenia-related reading difculties has also
emerged (e.g. Hayes and O'Grady, 2003; Revheim et al., 2006a),
however, the underlying processing decits associated with poor
reading in this population are yet to be clearly established. While this
is not to suggest that reading decits are likely to be a fundamental
aspect of the disease, given that reading is an essential skill for
everyday living and functioning, and a core prerequisite for many
psychoeducational programs in mental health, there is an urgent need
to understand reading difculties in schizophrenia and to develop
appropriate intervention programs. Accordingly, the present study
sought to further elucidate the nature of reading difculties in
schizophrenia.
Investigations into reading in schizophrenia are limited. Hayes and
O'Grady (2003) employed the Reading Comprehension Battery for
Aphasia (RBCA) (LaPointe and Horner, 1979) with a group of 30
people with schizophrenia, the majority of whom were males who
were living in a rehabilitation unit in a psychiatric hospital. The results
indicated that participants with schizophrenia took signicantly
longer to complete the test than controls and performed worse on

Corresponding author. Tel.: + 61 7 3365 9725; fax: + 61 7 3365 1877.

E-mail address: w.arnott@uq.edu.au (W. Arnott).
0165-1781/$ see front matter 2010 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.psychres.2010.11.025

nine of the 10 subtests, exhibiting impaired word, sentence, and

paragraph comprehension. Of particular concern was that the people
with schizophrenia performed most poorly on the functional reading
comprehension subtest. Given that the task did not require background knowledge and that comprehension was measured in
response to multiple choice questions, the authors contended that
real-life functional reading comprehension may in fact be even
poorer in this population.
Further research reported a link between decits in working
memory function and reading comprehension in schizophrenia
(Bagner et al., 2003). Bagner et al. examined reading rate and
comprehension for sentence stimuli manipulated for length and
syntactic complexity. In addition, the authors explored the relationship between comprehension, working memory, and disease symptoms such as hallucinations and thought disorder. Consistent with the
ndings of Hayes and O'Grady (2003), participants with schizophrenia exhibited impairments in overall comprehension and rate, with
comprehension decreasing as a function of sentence length but not
complexity. Further, while results did not support the hypothesised
relationship between disease symptoms and comprehension, a
signicant correlation was found between working memory ability
and comprehension.
With respect to the etiology of schizophrenia-related reading
impairments, Condray (2005) has hypothesised a neurodevelopmental cause that links reading decits in schizophrenia to developmental
dyslexia though this link is yet to be clearly established. Several lines
of evidence suggest that reading impairment in schizophrenia

W. Arnott et al. / Psychiatry Research 187 (2011) 610

emerges in adolescence (Fuller et al., 2002; Reichenberg et al., 2002;

Weiser et al., 2004). Associations have been reported between very
poor reading comprehension in adolescent males with normal general
cognitive function and increased risk of both developing schizophrenia later in life (Weiser et al., 2004) and later hospitalisation for
schizophrenia (Weiser et al., 2007). Further, retrospective studies
have demonstrated that participants who were later diagnosed with
schizophrenia exhibited poorer reading accuracy and reading comprehension prior to the onset of their illness (Fuller et al., 2002;
Reichenberg et al. 2002). It is less clear, however, whether reading
problems in schizophrenia, as in developmental dyslexia, can be
attributed to an underlying phonological processing impairment.
Three related yet distinct aspects of phonological processing have
been proposed to contribute to reading (Wagner et al., 1999). These
are phonological awareness, phonological memory and rapid naming.
Phonological awareness refers to an individual's explicit awareness of
the sound structures of words and includes the ability to rhyme,
substitute, and manipulate sound segments (Catts, 1991). Phonological memory refers to the process by which phonological information
is stored temporarily in working memory and is often assessed using
nonword repetition tasks (Wagner et al., 1999). Finally, rapid naming
is viewed as a measure of the individual's ability to automatically
retrieve phonological information from long term memory and is
particularly important for the development of reading uency
(Wagner et al., 1999). Numerous studies have shown a relationship
between impaired phonological processing and poor reading ability in
both children (Wagner and Torgesen, 1987; Adams, 1990; Bowers and
Wolf, 1993; Siegel, 1993; Wagner et al., 1994; Wolf and Bowers, 1999)
and adults ( Pratt and Brady, 1988; Pennington et al., 1990; Gottardo
et al., 1997; Bone et al., 2002; Loureiro et al., 2004; Sawyer, 2006).
To date, only one study has explored the relationship between
reading performance and phonological processing in schizophrenia
(Revheim et al., 2006a). Consistent with earlier research (Bagner et al.,
2003; Hayes and O'Grady, 2003), Revheim et al. reported signicant
decits in reading comprehension and reading rate in participants
with schizophrenia as compared to both their control counterparts
and to adult population norms. In addition, the schizophrenia group
performed worse than population norms in phonological awareness,
phonological memory, and rapid naming but were impaired relative
to the control group on tests of PA only (segmenting and blending
nonwords). Further, phonological awareness performance was positively correlated with passage reading comprehension as measured
by multiple choice questions. As in earlier research (Hayes and
O'Grady, 2003), participants with schizophrenia were predominately
males who were not living independently in the community with over
a third of participants having such low levels of global functioning that
they required maximum supervision. Accordingly, further research
into phonological processing and reading with higher functioning
individuals is needed to further prole reading problems in
schizophrenia.
To this end, the objective of the present study was to examine the
reading performance (reading comprehension, reading accuracy and
reading rate) and phonological processing skills (phonological
awareness, phonological memory, and rapid naming) of people with
schizophrenia who were living independently in the community. The
current research also aimed to investigate the relationship between
these measures. Based on previous research in the area (Bagner et al.,
2003; Hayes and O'Grady, 2003; Revheim et al., 2006a), it was
hypothesised that people with schizophrenia would exhibit abnormal
reading performance and related phonological processing decits.
Further, it was predicted that phonological processing abilities would
be correlated with reading performance. To date, no study has
examined how often people with schizophrenia engage in reading
activities and how they perceive their reading performance. Accordingly, the current study also sought to explore reading practices and
self-concept in schizophrenia. It was hypothesised that people with

schizophrenia would read less frequently than controls and, based on

the paediatric research in reading self-concept (Chapman et al., 2000),
have decreased self-perceptions relative to control participants. A
positive relationship was also predicted between reading self-concept
and reading performance.
2. Methods
2.1. Participants
Sixteen people (10 males and six females) who had a diagnosis of DSM-III-R
schizophrenia and were living in the community and 12 healthy controls (six males and
six females) matched to the participants with schizophrenia for gender, age and
education level participated in the present study. All participants gave informed
consent. Participants were excluded if: English was not their rst language; they had a
current substance abuse or history of substance dependence or withdrawal in the last
three weeks; they had a history of neurological impairment in addition to
schizophrenia or of neurological surgery; or they reported a history of behavioural,
learning, or reading difculties. There were no signicant differences between the
two groups with respect to age (Z = 0.093, p = 0.926) or education (Z = 0.560,
p = 0.575).
The Positive and Negative Syndrome Scale (PANSS) (Kay et al., 1989) and the Scale
for the Assessment of Thought, Language and Communication (TLC) (Andreasen, 1986)
were used to assess the symptoms of schizophrenia. As per McGrath et al. (2001), six
symptom summary scores were obtained. These were: a positive symptom score (P); a
negative symptom score (N); a general psychopathology score (G); a reality distortion
score (RDS); a psychomotor poverty score (PPS); and a thought disorder summary
score (TDSS). See Table 1 for further details of each participant group.
2.2. Assessments
The Neale Analysis of Reading Ability Third Edition (NARA) (Neale et al., 1999)
involves reading aloud and measures reading comprehension (in response to open
ended questions; maximum score = 44), accuracy (number of errors including
mispronunciations, substitutions, refusals, additions, omissions, and reversals), and
rate (words per minute). Raw scores were used as normative data is only provided for
children up to 13 years of age.
Three subtests of the Woodcock Reading Mastery Test Revised (WRMT-R)
(Woodcock, 1998) were employed. Word Identication (words) and Word Attack
(nonwords) form the Basic Skills composite score, a measure of word recognition while
Passage Comprehension was included to further assess reading comprehension for
passages using silent reading and a sentence cloze response format. Subtest raw scores
were converted to standard scores with a mean of 100 and a SD of 15.
The Reading Comprehension Battery for Aphasia Second Edition (RCBA-2)
(LaPointe and Horner, 1998) measures the comprehension of single words, sentences,
paragraphs, functional information, synonyms and morpho-syntactic information
using a multiple choice response format and silent reading. Each of the test's 10 core
subtests was scored for accuracy and the time taken to complete each subtest was
added to provide a total reading time.
The three components of phonological processing, phonological awareness (PA),
phonological memory (PM), and rapid naming (RN), were assessed using the six core
subtests of the Comprehensive Test of Phonological Processing (CTOPP) (Wagner et al.,
1999). These were: Elision and Blending Words (CTOPP-PA), Memory for Digits and
Nonword Repetition (CTOPP-PM), Rapid Digit Naming and Rapid Letter Naming (CTOPPRN). A further measure of PA was obtained using the supplementary subtests Blending
Nonwords and Segmenting Nonwords (CTOPP-APA). For the RN subtests, the raw score
obtained is the total number of seconds taken to complete the naming of all stimuli. For

Table 1
Characteristics of the participant groups.
Group

N
Male:Female
Age (yr)
Education (yr)
Disease duration (yr)
Age at onset (yr)
Daily chlorpromazine equivalent (mg)
PANSS-P
PANSS-N
PANSS-G
PANSS-RDS
PANSS-PPS
TDSS
Note. Data are expressed as mean (SD).

Schizophrenia

Control

16
10:6
41.19 (13.43)
11.88 (1.78)
14.88 (12.50)
25.15 (5.93)
417.86 (375.22)
17.77 (8.11)
17.38 (7.05)
33.23 (9.19)
9.23 (4.19)
10.08 (5.30)
1.62 (2.40)

12
6:6
42.17 (15.56)
11.75 (2.18)

W. Arnott et al. / Psychiatry Research 187 (2011) 610

all other subtests, raw scores represent correct items. Normative data is provided for a
maximum age of 24 years and so were not applicable to all of the current participants. To
allow for comparisons, however, in a manner after Revheim et al. (2006a), raw scores
were converted to standard composite scores with a mean of 100 and standard
deviation of 15.
The reading practices of participants were examined using an adapted version of
the Communicative Activities Checklist (COMCAT) (Cruice, unpublished results). This
checklist was employed to measure the range and frequency of participants' reading
activities. The checklist included 18 reading activities such as reading letters and cards,
newspapers and reading bus and train timetables. For each activity, the participants
self-rated the frequency of their involvement using a six point scale with a score of 1
being the least frequent (not at all) and a score of 6 being the most frequent (daily). The
total score was the mean of all 18 responses.
A reading self-concept questionnaire of 34 items based on the Reading SelfConcept Scale (RSCS) (Chapman and Tunmer, 1999) examined participants' perceived
reading competence (e.g., Do you think you read well?), attitude (e.g., Do you like
reading newspapers?) and difculty (e.g., Is reading forms and bills hard for you?).
Participants rated their responses on a ve point scale from no-never (1) to yesalways (5). Negatively worded items were reverse-scored and mean competence,
difculty, attitude, and total scores were calculated.
2.3. Procedure
Testing took between two and four hours and was conducted in a quiet
environment over one or two sessions with opportunities for rest periods. Scoring
was completed on-line. Responses were also tape recorded to allow later conrmation
of scoring. The order of task presentation was randomised.

3. Results
Test performance (reading and phonological processing) and selfrating data were analysed separately using one-way ANOVAs. For all
dependent variables, Levene's Test of Homogeneity of Variance
revealed normal distribution. To account for the multiple comparisons
undertaken for reading and phonological processing, a Bonferroni
adjusted alpha level (Howell, 1992) of 0.003 was employed by
dividing the 0.05 alpha level by 20 or the number of comparisons.
Where standard scores were available (WRMT-R and CTOPP), the data
for both groups were also compared to population norms by way of
separate one sample t-tests with test values of 100. Separate Pearson
correlations were then performed for each group on measures that
were found to be signicant.
As illustrated in Table 2, the performance of participants with
schizophrenia was signicantly worse than their control counterparts for NARA reading comprehension and CTOPP Rapid Naming. All
other comparisons of reading performance and phonological processing failed to reach signicance. With respect to the WRMT-R and
CTOPP data, test scores for the schizophrenia group were reduced
relative to the population norms for CTOPP Rapid Naming, t(15) =
6.213, p b 0.001, and phonological awareness, CTOPP PA: t(15) =
2.479, p b 0.05 and CTOPP APA: t(15) = 2.902, p b 0.05. WRMT-R
Basic Skills performance, t(15) = 2.305, p b 0.05, on the other hand,
was better for the schizophrenia group. To further examine real word
versus nonword reading, the WRMT-R Basic Skills subtests of Word
Identication and Word Attack were also compared to the population norms. Nonword reading was signicantly better for the
schizophrenia group, t(15) = 3.595, p b 0.01. No difference was
found for word reading, t(15) = 0.655, p = 0.52. The control group
did not differ from the population norms with respect to any of the
CTOPP composite scores or the WRMT-R Word Identication subtest
but performed signicantly better than the norms on the WRMT-R
Basic Skills, t(11) = 3.092, p = 0.010, Word Attack, t(11) = 3.757,
p = 0.003, and passage comprehension, t(11) = 3.378, p = 0.006.
As shown in Table 3, participants with schizophrenia recorded
signicantly lower total reading self-concept, difculty, and attitude
scores than controls and indicated that they read less often than
controls. A univariate analysis of variance revealed that the group
difference with respect to NARA reading comprehension reported
above remained signicant when the frequency of reading activity
was covaried, F(1, 25) = 9.484, p = 0.005.

Table 2
Means (standard deviations) for reading and phonological processing.
Test

Group
Schizophrenia
(n = 16)

NARA: Accuracya
NARA:
Comprehensiona
NARA: Ratea
WRMT-R:
Basic skillsb
WRMT-R: Passageb
RCBA-2: Ia
RCBA-2: IIa
RCBA-2: IIIa
RCBA-2: IVa
RCBA-2: Va
RCBA-2: VIa
RCBA-2: VIIa
RCBA-2: VIIIa
RCBA-2: IXa
RCBA-2: Xa
RCBA-2:
Total time (s)a
CTOPP-PAb
CTOPP-PMb
CTOPP-RNb
CTOPP-APAb

0.31
0.001*

Control
(n = 12)

92.50
26.25

(11.83)
(8.96)

96.50
36.92

(7.22)
(3.85)

1.068
14.851

98.06
109.81

(34.50)
(17.03)

129.71
111.58

(25.54)
(12.98)

7.135
0.090

0.01
0.77

(14.17)
(1.01)
(1.00)
(1.51)
(1.01)
(1.91)
(1.26)
(2.21)
(1.26)
(1.10)
(1.71)
(1024.18)

110.92
9.92
10.00
10.00
9.25
9.83
9.92
9.25
9.75
9.58
9.50
988.33

(11.20)
(0.29)
(0.00)
(0.00)
(0.75)
(0.39)
(0.29)
(0.97)
(0.62)
(0.67)
(0.67)
(318.25)

6.326
0.573
0.743
1.311
2.601
3.312
1.647
0.674
0.618
0.54
2.80
5.478

0.02
0.46
0.40
0.26
0.12
0.08
0.21
0.42
0.44
0.82
0.11
0.03

(14.22)
(12.75)
(16.22)
(13.44)

92.92
104.25
101.83
93.33

(20.76)
(10.58)
(23.63)
(19.59)

0.069
0.595
12.903
0.245

98.44
9.69
9.75
9.50
8.69
8.81
9.44
8.69
9.44
9.50
8.63
1707.81
91.19
100.75
74.81
90.25

0.80
0.44
0.001*
0.63

Note. araw scores; b standard scores.

*p b 0.003 (Bonferroni correction for 20 comparisons).

p b 0.05 versus adult population norms.

p b 0.01 versus adult population norms.

For participants with schizophrenia, the PANSS-N and PANSS-G

were negatively correlated with CTOPP RN, r(16)= 0.563, p b 0.05 and
r(16) = 0.542, p b 0.05, respectively. That is, the more severe their
symptoms, the slower the participants with schizophrenia were to
name letters and digits. In addition, the PANSS-P was negatively
correlated with CTOPP PA, r(16) = 0.505, p b 0.05. With respect to the
relationship between phonological processing and reading, both CTOPP
PA and APA were correlated with NARA comprehension, r(16) = 0.513,
p b 0.05 and r(16) = 0.661, p b 0.01.
No relationships were identied between total reading self-ratings
(total self-concept and reading activity) and reading or phonological
processing measures for participants with schizophrenia. For control
participants, however, a signicant positive correlation was found for
WRMT-R Basic Skills and total reading self-concept, r(16) = 0.934,
p b 0.001, and reading activity , r(16) = 0.787, p b 0.01.
4. Discussion
As hypothesised, participants with schizophrenia demonstrated
impaired reading comprehension, performing signicantly worse on
the NARA reading comprehension than controls. Indeed, closer

Table 3
Reading self-ratings.
Reading Self-Rating
Scale

Group
Schizophrenia
(n = 16)

Control
(n = 12)

Ready activity
Reading self-concept
Total
Difculty subscale
Competence subscale
Attitude subscale

3.14
3.73

(0.77)
(0.42)

3.89
4.29

3.96
3.72
3.35

(0.59)
(0.39)
(0.65)

4.53
4.15
4.00

Note. Data are reported as means (standard deviations).

*p b 0.05; **p b 0.01.

(0.68)
(0.62)

7.095
8.439

0.01*
0.007**

(0.61)
(0.74)
(0.71)

6.216
3.922
6.299

0.02*
0.06
0.02*

W. Arnott et al. / Psychiatry Research 187 (2011) 610

inspection of individual response proles revealed that 75% of the

schizophrenia group scored less than the lowest scoring control
participant, with fewer than 32 out of a possible 44 points. The scores
for this subgroup (range: 1031) correspond to reading ages of
between 7 years 1 month and 13 years. Hence, the present ndings
build upon existing evidence of schizophrenia-related reading
comprehension decits (Bagner et al., 2003; Hayes and O'Grady,
2003; Revheim et al., 2006a) and, by demonstrating impairments in
both males and females living independently in the community,
suggest that reading comprehension problems occur irrespective of
gender and functional capacity. In the present study, participants with
schizophrenia exhibited normal comprehension on the RCBA. In
contrast, Hayes and O'Grady (2003) reported widespread impairments on the RCBA for their participants, the majority of whom were
not living independently in the community. Taken together, these
ndings are consistent with Revheim et al.'s (2006a) observation of a
positive relationship between level of community supervision and
reading comprehension.
Several lines of evidence converge to suggest a phonological
processing impairment as underlying observed reading problems.
Firstly, participants with schizophrenia recorded rapid naming
impairments relative to both their control counterparts and the
population norms and problems with naming speed have been shown
to contribute to passage comprehension impairments in children
(Kirby et al., 2003). Secondly, phonological awareness scores for the
schizophrenia group, which were impaired relative to the general
population, were positively correlated with NARA reading comprehension. The further nding that rapid naming and phonological
awareness skills were related to symptomatology suggests that
phonological processing impairments may be linked to disease
processes. Further research is needed, however, to determine whether
they are a precursor or a manifestation of schizophrenia.
Whether the reading difculties exhibited by the participants with
schizophrenia represent a specic dyslexia or a more garden
variety reading problem associated with generalised language
impairments (Stanovich, 1988) is unclear. While the nding of
normal phonological decoding or nonword reading skills appears
contrary to both acquired and developmental models of phonological
dyslexia (Hoover and Gough, 1990; Castles and Coltheart, 1993), it is
consistent with the prole of adults with developmental dyslexia who
have been shown to demonstrate persistent phonological decits in
the presence of normal performance on standardised reading
measures (Wilson and Lesaux, 2001). Regardless, it is important to
acknowledge that other factors such as oral language and working
memory impairments may also have contributed to the observed
reading difculties. The simple view of reading (Hoover and Gough,
1990; Catts et al., 2006) holds that reading comprehension difculties
may result from oral language comprehension decits, word
recognition problems, or both. As previously discussed, the present
participants with schizophrenia exhibited good word recognition
ability. There is an abundance of evidence, however, supporting
semantic and syntactic decits in this population (e.g., Ruchsow et al.,
2003; Chenery et al., 2004; Stephane et al., 2007). Further, Bagner et
al. (2003) have demonstrated links between sentence comprehension
and working memory function in this population. Within working
memory systems, the phonological loop is considered critical to
language processing while the central executive has been ascribed a
more generalised role in attentional control (Baddeley, 2003). Recent
evidence, however, suggests that the function of the central executive
may also involve a more specialised contribution to the maintenance
of lexical semantic information (van Daal et al., 2008). While the
present participants with schizophrenia obtained normal phonological memory scores, other working memory components were not
considered. Accordingly, future research should examine the contributions of linguistic decits per se and should more comprehensively assess working memory contributions to reading difculties.

As hypothesised, participants with schizophrenia engaged in

reading activities less often than their control counterparts. For
example, 80% of people with schizophrenia versus 42% of controls
reported reading a book less often than monthly and 31 % of people
with schizophrenia versus 8% of controls reported reading the
newspaper less frequently than monthly. These ndings are similar
to those in adult dyslexia (Bruck, 1985) and, consistent with
Stanovich's (1986) Matthew Effect, imply that reduced engagement
in literacy experiences may also underpin observed reading decits.
With respect to reading self-concepts, people with schizophrenia
indicated that they found reading signicantly more difcult and less
enjoyable than controls, however, the ratings regarding their
perceived reading competence, while appearing worse than controls,
were not signicantly so. In addition, while control participants
recorded a positive relationship between total self-concept and
WRMT-R Basic Skills, a similar relationship was not identied for
the participants with schizophrenia. Given reports that people with
schizophrenia have decreased insight (Dickerson et al., 1997), the
present results suggest a lack of insight required to accurately selfrate reading competence and shed doubt on the notion that
participants with schizophrenia are able to reliably self-report literacy
problems (Behan et al., 1991).
The present ndings have implications for health management.
Many rehabilitation programs for people with schizophrenia rely on
the comprehension of written information (Hayes et al., 1995;
Macdonald et al., 1998; Velligan et al., 2006). Written health and
psychoeducational material and consent forms, however, are often
created above the reading comprehension ability of their target
population ( Miles and Davis, 1995; Baker, 1997; Grace and
Christensen, 1998; Wirshing et al., 1998; Christensen and Grace,
1999; Carpenter et al., 2000; Mathew and McGrath, 2002; Christopher
et al., 2007). Additionally, numerous studies have shown that people
with low literacy have difculty comprehending drug warning labels
(Davis et al., 2006; Revheim et al., 2006b; Wolf et al., 2006).
Accordingly, the present ndings suggest that, even for communitydwelling people with schizophrenia, written material needs to be less
complex. Further, reading intervention should include tasks to
strengthen the speed and accuracy of phonological recoding.
The limitations of the present study include its small sample sizes
and range of assessment. While the schizophrenia group performed
worse than controls on a number of test measures, including WRMT-R
Passage comprehension, NARA Rate, and RCBA Total Time, group
differences failed to reach signicance on these subtests. This may be
due to the small participant numbers and reduced statistical power.
Hence, research with larger sample sizes is needed to replicate the
present ndings. The appropriateness of the WRMT-R norms for the
Australian population must also be questioned, given that the control
participants performed signicantly better than the population on
two (passage comprehension and word attack) of the three subtests
employed and the schizophrenia group performed better than norms
on one subtest (word attack). Further, it is important to note that the
present ndings are representative of community-dwelling people
with schizophrenia and not the population as a whole. In addition,
oral language, alphabetic knowledge, ocular function and neurocognitive measures such as working memory, IQ, processing speed, and
verbal learning were not investigated. Accordingly, future research
would benet from examining the contribution of possible decits in
these areas to schizophrenia-related reading decits. Other areas of
literacy such as writing and spelling also warrant investigation.
In summary, the current results provide clear evidence that
community-dwelling people with schizophrenia experience problems
comprehending written information. They also read less often and
nd reading more difcult and less enjoyable than healthy controls.
Results were inconsistent, however, with the presence of dyslexia.
While aberrant phonological processing and decreased literacy
activity may contribute to observed reading problems, the part played

10

W. Arnott et al. / Psychiatry Research 187 (2011) 610

by oral language decits is yet to be investigated. The present study

has important implications for reading intervention, rehabilitation,
psychoeducational material, and drug management in schizophrenia.
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