Background: In a previous study, we demonstrated that narratives containing direct speech constructions were easier to comprehend than narratives with indirect speech constructions for Dutch listeners with and without aphasia. There were two possible explanations for this finding: either that direct speech has increased liveliness compared to indirect speech or that direct speech is less grammatically complex. Aims: This study aimed to provide further insight into the mechanisms underlying the differences between direct and indirect speech constructions on discourse comprehension in Dutch. More specifically, it aimed to examine the role that the grammatical characteristics of direct and indirect speech play in discourse comprehension success by comparing English- and Dutch-speaking individuals with and without aphasia. Methods & Procedures: An English version of the Dutch iPad-based Direct Speech Comprehension (DISCO) test was developed. Twenty individuals with aphasia and 19 neurologically healthy control participants were presented with spoken narratives that contained either direct or indirect speech constructions. Their performance was compared to that of the participants of the Dutch DISCO study. To assess the effect of language on performance, we conducted a single analysis in which we contrasted the English data with the Dutch data. Outcomes & Results: Control participants performed better than participants with aphasia; English-speaking participants performed worse than Dutch participants, and narratives containing direct speech were easier to comprehend than narratives with indirect speech constructions. However, a subsequent analysis including only individuals with aphasia showed that the Dutch group differed from the English-speaking group: direct speech was only beneficial for the Dutch participants with aphasia. Conclusions: This study expanded on the findings of a previous study, in which a facilitating effect of direct over indirect speech constructions for audiovisual discourse comprehension was found. The differential effects of direct speech on comprehension in Dutch and English showed that rather than one or other explanation being "correct", both liveliness and grammatical characteristics play a role in discourse comprehension success. Grammatically less complex constructions (direct speech) are not necessarily always easier to comprehend than grammatically more complex constructions (indirect speech) for individuals with aphasia. In our study grammatically simple constructions introduced grammatical ambiguity and therefore possible interpretation difficulties for the English-speaking participants with aphasia.

Most studies investigating the impact of literacy on oral language processing have shown that literacy provides phonological awareness skills in the processing of oral language. The implications of these results on aphasia tests could be significant and pose questions on the adequacy of such tools for testing non-literate individuals. Aiming at examining the impact of literacy on oral language processing and its implication on aphasia tests, this study tested 12 non-literate and 12 literate individuals with a modified Amharic version of the Bilingual Aphasia Test (Paradis and Amberber, 1991, Bilingual Aphasia Test. Amharic version. Hillsdale, NJ: Lawrence Erlbaum.). The problems of phonological awareness skills in oral language processing in non-literates are substantiated. In addition, compared with literate participants, non-literate individuals demonstrated difficulties in the word/sentence-picture matching tasks. This study has also revealed that the Amharic version of the Bilingual Aphasia Test may be viable for testing Amharic-speaking non-literate individuals with aphasia when modifications are incorporated.