When listening is much more than hearing the words

• Affective prosodic comprehension (APC) is the ability to detect emotion/attitude in someone's voice.
• Individuals with poor APC have difficulties managing personal and work-related relationships.
• Detoxified alcoholics and those with a history of fetal alcohol exposure have significant deficits in APC.
• The earlier the alcohol exposure, especially when it happens prenatally, the worse the deficits.

"Affective prosodic comprehension is a cognitive skill that enables us to perceive emotions and attitudes in a speaker's voice," said Marilee Monnot, clinical assistant professor in the department of neurology at the University of Oklahoma Health Sciences Center and first author of the study. "With this skill, we can detect whether someone is being sarcastic or ironic. That adds meaning to communication because sometimes our word message does not match our emotional message. Affective prosodic production, on the other hand, is the cognitive and vocal skill that allows us to infuse our own speech with emotion and attitudes so that others can understand our intent more clearly. Altogether, affective prosodic functioning is a part of emotional intelligence."

"There are many brain regions that control emotion," noted Marlene Oscar-Berman, professor of neurology and psychiatry at Boston University School of Medicine, and research scientist at the Boston Veteran Affairs Healthcare System. "Dr. Mannot and her colleagues are interested in understanding the role of the right half of the brain. The right hemisphere controls some aspects of emotion. It also controls those aspects of language that are very different from understanding the printed or spoken word, or the utterances of words, or the writing of words. It is involved in functions such as music perception, melody production, map reading and other non-language abilities. One important right hemisphere function is 'prosody,' and it is an essential component of language. If it weren't for prosody, the spoken voice would sound like a computer speaking, just bland, flat words without intonation, without punctuation, monotonic output. You could understand the words, but the sentences just wouldn't sound right."

Functions associated with the right hemisphere of the brain - such as visual spatial abilities and certain emotional skills - are often impaired in alcoholics. Researchers wanted to know if that impairment extended to APC. As the project developed, researchers encountered several subjects who reported fetal alcohol exposure below that which results in the medical diagnoses of Fetal Alcohol Effects or Fetal Alcohol Syndrome (FAS). This group, referred to as fetal alcohol exposed, is often omitted from studies of adult alcoholics because they are not outwardly affected by maternal drinking, lacking the full syndrome of severe physiological, anatomical, and functional damage common in FAS. However, they were included in the study by Monnot and her colleagues, receiving the Aprosodia Battery along with a group of detoxified alcoholics.

The Aprosodia Battery is a test designed to assess affective prosodic functioning (which includes comprehension and production) in adults by presenting a range of listening/responding exercises. Patients with focal lesions of the left hemisphere may have aphasia (an inability to communicate through speech and writing). However, even if someone with aphasia cannot understand a complete articulated sentence, they can still perceive the emotion in the voice if areas that control affective prosody in the right hemisphere are undamaged. The Aprosodia Battery can differentiate between language deficits caused by left and right hemisphere lesions.

"Our study had two key findings," said Monnot. "One, deficits in APC were found in detoxified alcoholics with at least 21 days of sobriety, and in those with a putative history of fetal alcohol exposure below that which results in the medical diagnosis of FAS. Two, these deficits are closely associated with, or can be predicted by, how early the exposure started in each individual's developmental history. The earlier someone started getting drunk or developed the disease of alcoholism, the worse their APC tested using the Aprosodia Battery. For example, if someone were exposed to alcohol as a fetus, their APC ability is severely impacted. They may understand only half as much emotion in the voice of a speaker as a 'normal' adult." It is important to note that the fetal-alcohol-exposed group, while very deficient in APC, performed as well as the others on traditional IQ tests, showing no difference in abstract reasoning and vocabulary.

Monnot spoke of another study of rodents in which a fetus or a pup was exposed to high levels of alcohol for several hours or more. Results indicated a death of brain cells (apoptosis) by as much as 30 percent. "The authors of that study hypothesized that this cell die-off was the mechanism underlying the deformities and deficits in FAS," she said. "If this process works in humans, it may explain both FAS and the APC deficits we found in our study. In other words, binge drinking by a pregnant mother or by a younger person with a developing brain (up to late adolescence or young adulthood in humans) may result in deficits that impair affective communication ability."

Oscar-Berman concurred that the abnormalities are very likely related to brain damage. She was less certain which came first, alcohol abuse or dependence or the social and work problems associated with deficits in APC. "With adult alcoholics, it's important to remember the 'chicken-or-egg' debate," she said. "You don't know which came first. You don't know if they have social or emotional problems because of their alcoholism, or if they had these problems ahead of time, which then contributed to their drinking."

What is known or well documented is that alcoholics have social- and work-related problems. Monnot and her colleagues plan to investigate further the association between early exposure to alcohol, deficits in APC, and social skills and abilities. "We found that the severity of APC deficits discovered in this study is much greater than many other cognitive problems described in the literature for detoxified alcoholics. In other words, this deficit in the ability to perceive emotion in a voice is more pronounced than most other defects caused by excessive alcohol exposure."

Co-authors of the Alcoholism: Clinical & Experimental Research paper included: Sara Nixon of the Department of Psychiatry & Behavioral Sciences, and the Center for Alcohol & Drug Related Studies, at the University of Oklahoma Health Sciences Center; William Lovallo of the Department of Psychiatry & Behavioral Sciences, and the Behavioral Sciences Laboratories, at the Veterans Affairs Medical Center in Oklahoma City; and Elliot Ross of the Department of Neurology in the College of Medicine and Affective Communication Research Laboratory at the Veterans Affairs Medical Center in Oklahoma City. The study was funded by the Department of Veterans Affairs, and the Tharp Foundation.