Dondé, C., Palmer-Cooper, E., Gauld, C., Polosan, M., & Alderson-Day, B. (2025). Early auditory impairments as a candidate marker of attenuated sensory symptoms of psychosis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 136, 111214.
Background
Experiences of psychosis often involve changes in how people experience sounds. One well-known issue is difficulty in early auditory processing (EAP), which is the brainâs ability to detect and distinguish sounds quickly and accurately. It reflects the initial stages the human ability to process sound, which are essential for higher-level auditory skills, and involve both subcortical and cortical pathways.
A common way to measure EAP is through a tone-matching task. This involves asking people to listen to pairs of tones and decide if they are the same or different. People with schizophrenia and psychotic illness often struggle with this task, and these difficulties are linked to broader problems in thinking and general functioning.
Aims
However, it is unclear when these auditory issues begin. This study investigated EAP in people at clinical high risk (CHR) for psychosis. CHR refers to people who show early warning signs of psychosis, but havenât developed psychosis, or their experiences donât meet the criteria to be counted âsymptomsâ. We wanted to understand if people who may be at CHR for psychosis show problems with tone-matching, to see if tone-matching could be used as an early marker to identify those at risk.
Methods
We recruited 892 young adults (aged 18â35); 352 (39.2 %) from France and 547 (60.8 %) from the UK, using online platforms. Participants completed two questionnaires: the Prodromal Questionnaire (PQ16), which screens for early psychotic symptoms like unusual thoughts or perceptions, and the Perceptual and Cognitive Aberrations (PCA), which looks for more subtle changes in thinking and perception. They also completed a tone-matching task online, where they listened to pairs of tones and judged whether they were the same or different.
Participants were grouped based on their questionnaire scores, those who met the threshold for CHR, and those who did not, and were compared for tone-matching performance. Participants met CHR criteria by saying Yes to 6 or more PQ16 â„ items (n = 505, 56.6 %) or saying Yes to 3 or more basic symptoms on the PCA (n = 614, 68.3 %). In this sample 647 (72.0 %) met criteria on at least one scale, and 358 (40.1 %) met criteria for both of them.
Results
Surprisingly, there were no significant differences in tone-matching performance between CHR and non-CHR participants. Even those with the highest levels of symptoms performed similarly to those without symptoms. This suggests that tone-matching may not be a reliable way to identify people at risk for psychosis.
However, looking at specific symptoms in the CHR group highlighted that certain Auditory and Tactile sensory symptoms symptoms were linked to poorer tone-matching performance. Symptoms included hearing unusual sounds or being overly sensitive to distant noises, and distorted sense of body ownership. This means that while tone-matching does not predict overall risk status, it might be related to specific unusual sensory experiences that some people have before developing psychosis.
Implications
These findings suggest that tone-matching is not a general marker for psychosis risk, but it could help identify people who are prone to sensory disturbances, especially in auditory and tactile senses. This could be useful for tailoring early interventions. For example, therapies that improve auditory processing might help reduce distressing sensory symptoms and possibly prevent progression to psychosis.
The study also highlights the complexity of identifying psychosis risk. Many people who score high on screening questionnaires may not actually be at risk, especially if they are not seeking help or are not distressed by their experiences. Future research should combine tone-matching with other brain-based measures and follow people over time to see who develops psychosis.