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Impaired visual target detection is a common finding in schizophrenia that is linked to poor functional outcomes. However, the neural mechanisms that contribute to this deficit remain unclear. Recent research in healthy samples has identified relationships between the phase of pre-stimulus electroencephalographic (EEG) activity in the alpha band (8-12 Hz) or theta band (4-7 Hz) and the likelihood of visual target detection with and without attentional cueing, but these effects have not yet been explored in schizophrenia. We performed a study to investigate such effects in schizophrenia (n = 19) and healthy participants (n = 14), using a visual target detection task with attentional cues. We found significant relationships between pre-stimulus EEG phase properties and visual target detection in both groups, but also clear differences in the effects as a function of frequency, group, and attentional cueing. Alpha-band phase effects were relatively uniform across groups and conditions. By contrast, theta-band phase effects showed differences by group and attentional condition which could be consistent with attentional hyperfocusing in the schizophrenia group. Thus, our results elucidate a novel neural mechanism that may help to explain known impairments affecting both visual target detection and attention in schizophrenia.

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BACKGROUND: Schizophrenia (SCZ) and bipolar disorder (BD) are associated with information processing abnormalities, including visual perceptual and cognitive impairments, that impact daily functioning. Recent work with healthy samples suggests that peak alpha frequency (PAF) is an electrophysiological index of visual information processing speed that is correlated with cognitive ability. There is evidence that PAF is slowed in SCZ, but it remains unclear whether PAF is reduced in BD or whether slower PAF is associated with impaired visual perception and cognition in these clinical disorders. METHODS: We recorded resting-state brain activity (both eyes open and closed) with electroencephalography in 90 participants with SCZ, 62 participants with BD, and 69 healthy control participants. Most participants also performed a visual perception task (backward masking) and cognitive testing (MATRICS Concensus Cognitive Battery). RESULTS: We replicated previous findings of reduced PAF in patients with SCZ compared with healthy control participants. In contrast, PAF in patients with BD did not differ significantly from that in healthy control participants. Furthermore, PAF was significantly correlated with performance on the perceptual and cognitive measures in SCZ but not BD. PAF was also correlated with visual perception in the healthy control group and showed a trend-level correlation with cognition. CONCLUSIONS: Together, these results suggest that PAF deficits characterize SCZ, but not BD, and that individual differences in PAF are related to abnormalities in visual information processing and cognition in SCZ.

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BACKGROUND: People with schizophrenia on average are more socially isolated, lonelier, have more social cognitive impairment, and are less socially motivated than healthy individuals. People with bipolar disorder also have social isolation, though typically less than that seen in schizophrenia. We aimed to disentangle whether the social cognitive and social motivation impairments observed in schizophrenia are a specific feature of the clinical condition v. social isolation generally. METHODS: We compared four groups (clinically stable patients with schizophrenia or bipolar disorder, individuals drawn from the community with self-described social isolation, and a socially connected community control group) on loneliness, social cognition, and approach and avoidance social motivation. RESULTS: Individuals with schizophrenia (n = 72) showed intermediate levels of social isolation, loneliness, and social approach motivation between the isolated (n = 96) and connected control (n = 55) groups. However, they showed significant deficits in social cognition compared to both community groups. Individuals with bipolar disorder (n = 48) were intermediate between isolated and control groups for loneliness and social approach. They did not show deficits on social cognition tasks. Both clinical groups had higher social avoidance than both community groups. CONCLUSIONS: The results suggest that social cognitive deficits in schizophrenia, and high social avoidance motivation in both schizophrenia and bipolar disorder, are distinct features of the clinical conditions and not byproducts of social isolation. In contrast, differences between clinical and control groups on levels of loneliness and social approach motivation were congruent with the groups' degree of social isolation.

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The COVID-19 pandemic disproportionately impacted marginalized populations including Black Americans, people with serious mental illness, and individuals experiencing homelessness. Although the double disadvantage hypothesis would suggest that individuals with multiple minoritized statuses would experience worse psychosocial impacts from the pandemic, this may not be the case for vulnerable Black Veterans. The present study investigated the sustained mental health and functional responses to the pandemic in Black and White Veterans with psychosis or recent homelessness and in a control group of Veterans enrolled in the Department of Veterans Affairs healthcare services. Clinical interviews and questionnaires were administered remotely by telephone at five time points from May 2020 through July 2021, including a retrospective time point for March 2020 (i.e., before the pandemic started). Overall, there was a striking absence of systematic differences by race in the trajectories of psychiatric symptoms and functioning among Veterans during the study period. These findings are consistent with a report on initial responses to the pandemic that revealed only a few select differences by race among Veteran groups. The lack of racial disparities is inconsistent with the double disadvantage hypothesis. Although further investigation is needed, one possible interpretation is that the wrap-around services offered by the Veterans Health Administration may have mitigated expected differences by race among Veterans with psychosis or homelessness. Future research should continue to examine whether VA services mitigate disparities in mental health and psychosocial outcomes.

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People with schizophrenia (SCZ) and bipolar disorder (BD) have impairments in processing social information, including faces. The neural correlates of face processing are widely studied with the N170 ERP component. However, it is unclear whether N170 deficits reflect neural abnormalities associated with these clinical conditions or differences in social environments. The goal of this study was to determine whether N170 deficits would still be present in SCZ and BD when compared with socially isolated community members. Participants included 66 people with SCZ, 37 with BD, and 125 community members (76 "Community-Isolated"; 49 "Community-Connected"). Electroencephalography was recorded during a face processing task in which participants identified the gender of a face, the emotion of a face (angry, happy, neutral), or the number of stories in a building. We examined group differences in the N170 face effect (greater amplitudes for faces vs buildings) and the N170 emotion effect (greater amplitudes for emotional vs neutral expressions). Groups significantly differed in levels of social isolation (Community-Isolated > SCZ > BD = Community-Connected). SCZ participants had significantly reduced N170 amplitudes to faces compared with both community groups, which did not differ from each other. The BD group was intermediate and did not differ from any group. There were no significant group differences in the processing of specific emotional facial expressions. The N170 is abnormal in SCZ even when compared to socially isolated community members. Hence, the N170 seems to reflect a social processing impairment in SCZ that is separate from level of social isolation.

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PURPOSE: Mental health trajectories during the COVID-19 pandemic have been examined in Veterans with tenuous social connections, i.e., those with recent homelessness (RHV) or a psychotic disorder (PSY), and in control Veterans (CTL). We test potential moderating effects on these trajectories by psychological factors that may help individuals weather the socio-emotional challenges associated with the pandemic (i.e., 'psychological strengths'). METHODS: We assessed 81 PSY, 76 RHV, and 74 CTL over 5 periods between 05/2020 and 07/2021. Mental health outcomes (i.e., symptoms of depression, anxiety, contamination concerns, loneliness) were assessed at each period, and psychological strengths (i.e., a composite score based on tolerance of uncertainty, performance beliefs, coping style, resilience, perceived stress) were assessed at the initial assessment. Generalized models tested fixed and time-varying effects of a composite psychological strengths score on clinical trajectories across samples and within each group. RESULTS: Psychological strengths had a significant effect on trajectories for each outcome (ps < 0.05), serving to ameliorate changes in mental health symptoms. The timing of this effect varied across outcomes, with early effects for depression and anxiety, later effects for loneliness, and sustained effects for contamination concerns. A significant time-varying effect of psychological strengths on depressive symptoms was evident in RHV and CTL, anxious symptoms in RHV, contamination concerns in PSY and CTL, and loneliness in CTL (ps < 0.05). CONCLUSION: Across vulnerable and non-vulnerable Veterans, presence of psychological strengths buffered against exacerbations in clinical symptoms. The timing of the effect varied across outcomes and by group.

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People with schizophrenia experience difficulties with social interactions. One contributor to these social deficits is dysfunction in processing facial features and facial emotional expressions. However, it is not known whether face processing deficits are evident in those with other psychotic disorders or in those genetically at-risk for psychosis (i.e., first-degree relatives of those with psychosis). We assessed event-related potentials (ERPs) during a facial and emotion processing task in 100 people with a diagnosis of schizophrenia or another psychotic condition (PSY), 32 of their siblings (SIB) and 45 healthy comparison participants (CTL). In separate blocks, participants identified the sex (male or female) or emotion (happy, angry, neutral) of faces. In a comparison condition, participants indicated whether buildings had one or two floors. ERPs were examined in two stages. First, we compared ERPs across the emotion, sex and building identification conditions. Second, we compared ERPs among the three different facial emotions. PSY exhibited significantly lower amplitudes over parietal-occipital regions between 111 and 151 ms when viewing faces but not buildings than CTL, consistent with a face-selective N170 ERP component deficit. The SIB group was intermediate for faces, but not significantly different than PSY or CTL. During emotion identification, all three groups showed increased N170 amplitudes to angry and happy versus neutral expressions, with no group differences. In follow up analyses, we examined differences between PSY with or without affective psychosis, and differences between those with schizophrenia versus other psychotic disorders; there were no significant differences in these analyses. Face processing deficits assessed with ERPs were observed in a group of diverse psychotic disorders, though deficits were not seen to be modulated by facial emotion expression. Additionally, N170 deficits are not evident in siblings of those with PSY.

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BACKGROUND: Individuals with psychosis spectrum disorders (PSD) have difficulty developing social relationships. This difficulty may reflect reduced response to social feedback involving functional alterations in brain regions that support the social motivation system: ventral striatum, orbital frontal cortex, insula, dorsal anterior cingulate cortex, and amygdala. Whether these alterations span PSD is unknown. METHODS: 71 individuals with PSD, 27 unaffected siblings, and 37 control participants completed a team-based fMRI task. After each trial, participants received performance feedback paired with the expressive face of a teammate or opponent. A 2 × 2 (win versus loss outcome x teammate versus opponent) repeated measures ANOVA by group was performed on activation in the five key regions of interest during receipt of feedback. RESULTS: Across groups, three social motivation regions, ventral striatum, orbital frontal cortex, and amygdala, showed sensitivity to feedback (significant main effect of outcome), with greater activation during win versus loss trials, regardless of whether the feedback was from a teammate or opponent. In PSD, ventral striatum and orbital frontal cortex activation to win feedback was negatively correlated with social anhedonia scores. CONCLUSIONS: Patterns of neural activation during social feedback were similar in PSD, their unaffected siblings, and healthy controls. Across the psychosis spectrum, activity in key social motivation regions during social feedback was associated with individual differences in social anhedonia.

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OBJECTIVE: Negative symptoms are a primary cause of disability in schizophrenia for which there are no established pharmacotherapies. This study evaluated a novel psychosocial intervention that combined two evidence-based practices-motivational interviewing and cognitive-behavioral therapy (MI-CBT)-for the treatment of motivational negative symptoms. METHODS: Seventy-nine participants with schizophrenia and moderate to severe negative symptoms were included in a randomized controlled trial comparing the 12-session MI-CBT treatment with a mindfulness control condition. Participants were assessed at three time points through the study period, which included 12 weeks of active treatment and 12 weeks of follow-up. The primary outcome measures were motivational negative symptoms and community functioning; the secondary outcomes included a posited biomarker of negative symptoms: pupillometric response to cognitive effort. RESULTS: Compared with the control group, participants in the MI-CBT group showed significantly greater improvements in motivational negative symptoms over the acute treatment period. Their gains relative to baseline were maintained at follow-up, although the differential benefit relative to control subjects was attenuated. There were nonsignificant effects toward improvements in community functioning and differential change in the pupillometric markers of cognitive effort. CONCLUSIONS: The results show that combining motivational interviewing with CBT yields improvements in negative symptoms, a feature of schizophrenia generally thought of as resistant to intervention. Motivational negative symptoms not only responded to the novel treatment, but the gains were maintained over the follow-up period. Implications for future studies and for improving the generalization of the negative symptom gains to daily functioning domains are discussed.

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Functional connectome organization is altered in schizophrenia (SZ) and bipolar disorder (BD). However, it remains unclear whether network reorganization during a task relative to rest is also altered in these disorders. This study examined connectome organization in patients with SZ (N = 43) and BD (N = 42) versus healthy controls (HC; N = 39) using fMRI data during a visual object-perception task and at rest. Graph analyses were conducted for the whole-brain network using indices selected a priori: three reflecting network segregation (clustering coefficient, local efficiency, modularity), two reflecting integration (characteristic path length, global efficiency). Group differences were limited to network segregation and were more evident in SZ (clustering coefficient, modularity) than in BD (clustering coefficient) compared to HC. State differences were found across groups for segregation (local efficiency) and integration (characteristic path length). There was no group-by-state interaction for any graph index. In summary, aberrant network organization compared to HC was confirmed, and was more evident in SZ than in BD. Yet, reorganization was largely intact in both disorders. These findings help to constrain models of dysconnection in SZ and BD, suggesting that the extent of functional dysconnectivity in these disorders tends to persist across changes in mental state.

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Several studies of reward processing in schizophrenia have shown reduced sensitivity to positive, but not negative, outcomes although inconsistencies have been reported. In addition, few studies have investigated whether patients show a relative deficit to social versus nonsocial rewards, whether deficits occur across the spectrum of psychosis, or whether deficits relate to negative symptoms and functioning. This study examined probabilistic implicit learning via two visually distinctive slot machines for social and nonsocial rewards in 101 outpatients with diverse psychotic disorders and 48 community controls. The task consisted of two trial types: positive (optimal to choose a positive vs. neutral machine) and negative (optimal to choose a neutral vs. negative machine), with two reward conditions: social (faces) and nonsocial (money) reward conditions. A significant group X trial type interaction indicated that controls performed better on positive than negative trials, whereas patients showed the opposite pattern of better performance on negative than positive trials. In addition, both groups performed better for social than nonsocial stimuli, despite lower overall task performance in patients. Within patients, worse performance on negative trials showed significant, small-to-moderate correlations with motivation and pleasure-related negative symptoms and social functioning. The current findings suggest reward processing disturbances, particularly decreased sensitivity to positive outcomes, extend beyond schizophrenia to a broader spectrum of psychotic disorders and relate to important clinical outcomes.

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Schizophrenia is associated with deficits in both object perception and visual attention. However, few studies in schizophrenia have investigated object-based attention, which is dissociable from other forms of visuospatial attention. Recent research in healthy populations has shown that the 'spotlight' of sustained visual attention flickers in a rhythmic, oscillatory fashion at specific frequencies in the 4-12 Hz range. In healthy samples, this oscillatory signature has been used to investigate spatiotemporal dynamics of object-based attention, showing that the attentional spotlight spreads to uncued locations within cued objects, and also periodically alternates focus between cued and uncued objects. In this study, we adapted a performance-based visual object cueing task to investigate object-based attention in individuals with a schizophrenia diagnosis and healthy controls. In controls, spatiotemporal patterns of object-based attention closely resembled those reported in previous studies of healthy individuals. In the schizophrenia group, the oscillatory signature of attention also appeared in the location of the cue and on uncued objects, similar to the effects in controls. Indeed, the oscillatory signature of attention at the spatial location of the cue was stronger in the schizophrenia group than in controls. However, attention did not spread across the cued object in schizophrenia; rather, attention appeared to remain hyperfocused at the spatial location of the cue. These findings provide the first evidence that visual attention has oscillatory characteristics in schizophrenia, as in the general population. The results also show that the fundamental process of attentional spreading which underlies object-based attention is abnormal in schizophrenia.

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BACKGROUND: The COVID-19 pandemic has had unprecedented effects on mental health and community functioning. Negative effects related to disruption of individuals' social connections may have been more severe for those who had tenuous social connections prior to the pandemic. Veterans who have recently experienced homelessness (RHV) or have a psychotic disorder (PSY) are considered particularly vulnerable because many had poor social connections prior to the pandemic. METHODS: We conducted a 15-month longitudinal study between May 2020 -July 2021 assessing clinical (e.g., depression, anxiety) and community (e.g., social functioning, work functioning) outcomes. Eighty-one PSY, 76 RHV, and 74 Veteran controls (CTL) were interviewed over 5 assessment periods. We assessed changes in mental health and community functioning trajectories relative to pre-pandemic retrospective ratings and examined group differences in these trajectories. RESULTS: All groups had significantly increased symptoms of depression, anxiety, and concerns with contamination at the onset of the pandemic. However, RHV and PSY showed faster returns to their baseline levels compared to CTL, who took nearly 15 months to return to baseline. With regards to functioning, both RHV and PSY, but not CTL, had significant improvements in family and social networks over time. Work functioning worsened over time only in PSY, and independent living increased over time in both RHV and PSY but not CTL. CONCLUSIONS: These results reveal that vulnerable Veterans with access to VA mental health and case management services exhibited lower negative impacts of the COVID-19 pandemic on mental health and community functioning than expected.

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Event-related potential (ERP) studies of motivated attention in schizophrenia typically show intact sensitivity to affective vs. non-affective images depicting diverse types of content. However, it is not known whether this ERP pattern: 1) extends to images that solely depict social content, (2) applies across a broad sample with diverse psychotic disorders, and (3) relates to self-reported trait social anhedonia. We examined late positive potential (LPP) amplitudes to images involving people that were normatively pleasant (affiliative), unpleasant (threatening), or neutral in 97 stable outpatients with various psychotic disorders and 38 healthy controls. Both groups showed enhanced LPP to pleasant and unpleasant vs. neutral images to a similar degree, despite lower overall LPP in patients. Within the patients, there were no significant LPP differences among subgroups (schizophrenia vs. other psychotic disorders; affective vs. non-affective psychosis) for the valence effect (pleasant/unpleasant vs. neutral). Higher social anhedonia showed a small, significant relation to lower LPP to pleasant images across all groups. These findings suggest intact motivated attention to social images extends across psychotic disorder subgroups. Dimensional transdiagnostic analyses revealed a modest association between self-reported trait social anhedonia and an LPP index of neural sensitivity to pleasant affiliative images.

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The COVID-19 pandemic continues to disproportionately impact people of color and individuals experiencing psychosis and homelessness. However, it is unclear whether there are differences by race in psychosocial responses to the pandemic in vulnerable populations. The double jeopardy hypothesis posits that multiply marginalized individuals would experience worse psychosocial outcomes. The present study investigated the clinical and functional initial responses to the pandemic in both Black (n = 103) and White veterans (n = 98) with psychosis (PSY), recent homelessness (RHV), and in a control group (CTL) enrolled in Department of Veterans Affairs (VA) healthcare services. Clinical interviews were administered via phone at two time points: baseline (mid-May through mid-August 2020) and follow-up (mid-August through September 2020). The baseline interview also included retrospective measures of pre-COVID status from January 2020. There were no significant differences between Black and White veterans in depression, anxiety, or loneliness. However, Black veterans did endorse more fears of contamination, F(1, 196.29) = 9.48, p = .002. Across all groups, Black veterans had better family integration compared to White veterans, F(1, 199.98) = 7.62, p = .006. There were no significant differences by race in social integration, work/role productivity, or independent living. In sum, there were few significant differences between Black and White veterans in initial psychosocial response to the pandemic. The lack of racial disparities might reflect the presence of VA's wrap-around services. The findings also highlight the robust nature of social support in Black veterans, even in the context of a global pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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The COVID-19 pandemic and social distancing have directly impacted the socioeconomic well-being of most Americans. Veterans with psychosis (PSY) and Veterans who were recently housed (RHV) through a supportive housing programme may be especially vulnerable to experiencing negative socioeconomic effects of the pandemic. In this study, we investigated socioeconomic experiences and challenges during the pandemic in these two putatively vulnerable Veteran groups and in Veterans with no history of PSY or homeless (i.e., control Veterans, CTL). A total of 231 Veterans (81 PSY, 76 RHV, 64 CTL) participated in the baseline assessment, and 203 in the follow-up assessment (74 PSY, 63 RHV, 66 CTL). At both assessment points we obtained socioeconomic information, including personal finances, financial concerns, housing concerns, experience of material hardships, and employment status. All groups of Veterans reported socioeconomic challenges during the pandemic, but the pattern of effects differed across groups. Although RHV was in a similar position to the PSY group with respect to personal finances, they reported lower levels of financial well-being and were more prone to experiencing material hardships compared to the other two groups. CTL was most vulnerable to experiencing negative financial shocks. Contrary to expectations, PSY did not experience disproportionate material hardships compared to CTL. Veterans face significant socioeconomic challenges during the COVID-19 pandemic. However, RHV disproportionately experienced certain concerns and hardships, and these are a target for intervention by clinicians and service providers. PSY generally fared better than anticipated, possibly reflecting longstanding engagement with VA services that could serve to buffer the socioeconomic impact of the pandemic.

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Representation of people who identify as members of sexual and gender minority (SGM) groups is lacking in psychiatric research. Few researchers openly identify as members of an SGM group, and those who do continue to face career obstacles. Separately, in the context of psychiatric research studies, little attention has been paid to how participants' SGM identities might intersect with other factors to influence each individual's experience of mental illness. In this brief commentary, we summarize these and related issues, then offer suggestions for how institutions, professional societies, labs, and individuals might help to improve SGM representation in psychiatric research.

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The COVID-19 pandemic has upended the lives of everyone in the United States, negatively impacting social interactions, work, and living situations, and potentially exacerbating mental health issues in vulnerable individuals. Within the Department of Veterans Affairs (VA) healthcare system, two vulnerable groups include those with a psychotic disorder (PSY) and those who have recently experienced homelessness (recently housed Veterans, RHV). We conducted phone interviews with PSY (n = 81), RHV (n = 76) and control Veterans (CTL, n = 74) between mid-May - mid-August 2020 ("initial") and between mid-August - mid-October 2020 ("follow-up"). At the initial period, we also collected retrospective ratings relative to January 2020 ("pre-COVID-19"). We assessed clinical factors (e.g., depression, anxiety, loneliness) and community integration (e.g., social and role functioning). All groups reported worse clinical outcomes after the onset of the COVID-19 pandemic. However, PSY and RHV exhibited improvements in depression and anxiety from initial to follow up, whereas CTL continued to exhibit elevated levels. There was little change in community integration measures. Our results indicate that all groups reported increased mental health problems after the onset of the pandemic, but vulnerable Veterans were not disproportionately affected and had better mental health resilience (i.e., for depression and anxiety) as the pandemic progressed compared to CTL. This effect could be due to the availability and utilization of VA services for PSY and RHV (e.g., housing and financial support, medical and mental health services), which may have helped to mitigate the impact of the pandemic.

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Visual processing abnormalities in schizophrenia (SZ) are poorly understood, yet predict functional outcomes in the disorder. Bipolar disorder (BD) may involve similar visual processing deficits. Converging evidence suggests that visual processing may be relatively normal at early stages of visual processing such as early visual cortex (EVC), but that processing abnormalities may become more pronounced by mid-level visual areas such as lateral occipital cortex (LO). However, little is known about the connectivity of the visual system in SZ and BD. If the flow of information to, from, or within the visual system is disrupted by reduced connectivity, this could help to explain perceptual deficits. In the present study, we performed a targeted analysis of the structural and functional connectivity of the visual system using graph-theoretic metrics in a sample of 48 SZ, 46 BD, and 47 control participants. Specifically, we calculated parallel measures of local efficiency for EVC and LO from both diffusion weighted imaging data (structural) and resting-state (functional) imaging data. We found no structural connectivity differences between the groups. However, there was a significant group difference in functional connectivity and a significant group-by-region interaction driven by reduced LO connectivity in SZ relative to HC, whereas BD was approximately intermediate to the other 2 groups. We replicated this pattern of results using a different brain atlas. These findings support and extend theoretical models of perceptual dysfunction in SZ, providing a framework for further investigation of visual deficits linked to functional outcomes in SZ and related disorders.

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BACKGROUND: Early-stage visual processing deficits are evident in chronic schizophrenia. Consistent with a cascade model of information processing, whereby early perceptual processes have downstream effects on higher-order cognition, impaired visual processing is associated with deficits in social cognition in this clinical population. However, the nature of this relationship in the early phase of illness is unknown. Here, we present data from a study of early visual processing and social cognitive performance in recent-onset schizophrenia (ROSz). METHOD: Thirty-two people with ROSz and 20 healthy controls (HC) completed a visual backward masking task using stimuli of real world objects (Object Masking) to assess early-stage (i.e., 0-125 ms post-stimulus onset) visual processing. Subjects also completed two tasks of social cognition, one assessing relatively low-level processes of emotion identification (Emotion Biological Motion, EmoBio), and another assessing more complex, higher-order theory of mind abilities (The Awareness of Social Inference Test, TASIT). Group differences were tested with repeated measures ANOVAs and t-tests. Bivariate correlations and linear regressions tested the strength of associations between early-stage visual processing and social cognitive performance in ROSz. RESULTS: For Object Masking, the mask interfered with object identification over a longer interval for ROSz than for HC [F (3.19, 159.35) = 8.51, p < 0.001]. ROSz were less accurate on the EmoBio task [t (50) = -3.36, p = 0.001] and on the TASIT compared to HC [F (1, 50) = 38.37, p < 0.001]. For the TASIT ROSz were disproportionately impaired on items assessing sarcasm detection [F (1, 50) = 4.30, p = 0.04]. In ROSz, better Object Masking performance was associated with better social cognitive performance [r EmoBio = 0.45, p < 0.01; r TASIT = 0.41, p < 0.02]. Regression analyses did not provide significant support for low-level social cognition mediating the relationship between visual processing and high-level social cognition. CONCLUSION: Early-stage visual processing, low-level social cognition, and high-level social cognition were all significantly impaired in ROSz. Early-stage visual processing was associated with performance on the social cognitive tasks in ROSz, consistent with a cascade model of information processing. However, significant cascading effects within social cognition were not supported. These data suggest that interventions directed at early visual processing may yield downstream effects on social cognitive processes.