Which protocol for prostate biopsies in patients with a positive MRI? Interest of systematic biopsies by sectors.

BACKGROUND: Current prostate biopsy (PBx) protocol for prostate cancer (PCa) diagnosis is to perform systematic biopsies (SBx) combined with targeted biopsies (TBx) in case of positive MRI (i.e. PI-RADS ≥ 3). To assess the utility of performing SBx in combination with TBx, we determined the added value of SBx brought to the diagnosis of PCa according to their sextant location and MRI target characteristics. METHODS: In our local prospectively collected database, we conducted a single-center retrospective study including all patients with a suspicion of PCa, who underwent transrectal ultrasound-guided (TRUS) prostate biopsies (PBx) with a prior MRI and a single lesion classified as PI-RADS ≥ 3. We have characterized the SBx according to their location on MRI: same sextant (S-SBx), adjacent sextant (A-SBx), ipsilateral side (I-SBx) and contralateral side (C-SBx). The added value of SBx and TBx was defined as any upgrading to significant PCa (csPCa) (ISUP ≥2). RESULTS: 371 patients were included in the study. The added value of SBx was 10% overall. Regarding the lesion location and the SBx sextant, the added value of SBx was: 5.1% for S-SBx, 5.4% for A-SBx, 4.9% for I-SBx and 1.9% for C-SBx. The overall added value of SBx was 6.8% for PI-RADS 3 lesions, 14% for PI-RADS 4 lesions and 6.7% for PI-RADS 5 lesions (p = 0.063). The added value of SBx for contralateral side was 1.9% (2/103), 3.1% (5/163) and 0% (0/105) for PI-RADS 3, PI-RADS 4 and PI-RADS 5 lesions, respectively (p = 0,4). The added value of SBx was lower when the number of TBx was higher (OR 0.57; CI 95% 0.37-0.85; p = 0.007). CONCLUSIONS: Our results suggest that the utility of performing SBx in the contralateral lobe toward the MRI lesion was very low, supporting that they might be avoided.

Childhood trauma increases vulnerability to attempt suicide in adulthood through avoidant attachment.

BACKGROUND: Childhood trauma and affective disorders are known risk factors for adult suicidal behavior. Studies have shown a mediating effect of insecure attachment on the effect of childhood trauma and suicidal behavior but so far it is not clear whether this effect is related to an attachment dimension (anxiety, avoidance). AIM: The present study sought to examine the mediating effect of attachment anxiety and avoidance on suicidal behavior. METHODS: We analyzed data on childhood trauma, attachment style, depression severity, presence of prior suicide attempts and current suicide ideation from 96 patients diagnosed with an affective disorder. Two mediation analyses were conducted to assess the effect of childhood trauma on 1) prior suicide attempts and 2) current suicidal ideation through its effect on attachment. RESULTS: We found that childhood trauma had a complete mediated effect on the presence of prior suicide attempts through its effect on avoidant attachment (a1b1 = 0.0120, 95%-CI [0.0031, 0.0276]). However, only emotional abuse had a direct influence on suicidal ideation (c' = 0.0273, p < 0.01) without any indirect effect of anxious or avoidant attachment. LIMITATIONS: Variables were not assessed in a prospective way and sample size was small. CONCLUSIONS: Our findings suggest that individuals with avoidant attachment and childhood trauma are likely to present a high suicide risk. Since avoidant attachment is associated with altered perceptions and eventual rejection of social support, we recommend to screen for attachment early and to engage patients in therapeutical approaches focusing on the client-therapist alliance.

[Use of virtual reality in eating disorders]. / Utilisation de la réalité virtuelle dans les troubles des conduites alimentaires.

Virtual reality is a new technology that can be used to model an environment with which an individual can interact using all five senses. It is notably used in psychiatry for anxiety disorders and addictions, and its use in eating disorders has been growing in recent years. Indeed, virtual reality offers interesting advantages, such as its ability to personalize any environment, which is also more secure and controllable. Recent studies show promising results in the understanding, evaluation, and therapeutic management of eating disorders. The use of avatars in anorexia nervosa allows for a correct assessment of the perceptual (body image distortion) and cognitive-affective (body dissatisfaction) components of the body image disorder in a similar way to conventional methods, but also for a better understanding of them. Moreover, avatars allow the development of innovative therapeutic protocols and are thus used in the context of exposure therapy. The new body swapping protocol, based on a multisensory illusion, offers particularly promising results in the reduction of body image disorder. For bulimia nervosa and binge eating disorder, virtual reality has made it possible to better characterize the triggering mechanisms of binge eating episodes through studies that have observed different responses to food-related environments and stimuli. At the therapeutic level, virtual reality cue exposure therapy has the most empirical support. Its aim is to reduce or eliminate the anxiety and craving felt by a patient in response to exposure to food or other food-related cues by preventing the patient from consuming food, and results show clear reductions in anxiety, craving and binge eating episodes. While all these results seem to indicate a bright future for virtual reality in eating disorders, further studies are needed to validate the positive impact of its use, but also its limitations. Notably, cyber sickness could alter the smooth running of virtual reality therapy sessions by causing nausea and disorientation. Moreover, it is important to verify that a therapeutic protocol does not lose its effectiveness when it is transposed into virtual reality. However, virtual reality seems to be a therapeutic tool that is better accepted by patients, and even better by adolescents, which is very interesting for eating disorders since adolescents are the most affected. Virtual reality could therefore help motivate patients to pursue treatment and reduce the dropout rate while offering good therapeutic results. Thus, studies conducted in recent years have shown that virtual reality is a promising tool in the understanding, assessment and treatment of eating disorders, and future research should confirm this, particularly in the adolescent population.

[Outcomes of GreenLight XPS-180W laser photovaporization for BPH larger than 80mL]. / Résultats de la photovaporisation prostatique par laser GreenLight XPS-180W dans l'hyperplasie bénigne de prostate (HBP) de gros volume (≥80mL).

AIM: To evaluate the results of GreenLight XPS photovaporization (PVP/XPS) with intraoperative transrectal ultrasonographic monitoring for the treatment of large Benign Prostatic Hyperplasia (BPH) (>80mL). PATIENTS AND METHODS: Operative and perioperative data of 82 patients were collected prospectively. Complications and functional outcomes (IPSS, quality of life (QoL) score, maximal flow rate and post-void residual (PVR)) were evaluated at 1, 3, 12 months post-operatively prostate volume and PSA were assessed at 3 and 12 months post-operatively. RESULTS: Median patient age was 68.5years (50-85). Twenty percent had an indwelling catheter and 5%/22% were on anticoagulant/antiplatelet therapy. Median prostate volume and PSA were 103mL (80-220) and 6.4ng/mL (0.66-44.0). Median operative time and energy delivered were 107min (46-219) and 581kJ (212-1193). Energy delivered/prostate volume was 5.4kJ/mL (1.6-10.5). Transurethral catheter was removed at day 1 or 2 in 96% of cases. Patients were discharged as outpatient, p.o. day 1 or day 2 in 4%, 55% and 21% of cases, respectively. Transfusion and Clavien≥3 complication rates were 1.2% and 3.7%. Significant improvement of IPSS (4 vs 19.5), QoL (1 vs 5), maximum flow rate (19.1 vs 8.2mL/s) and PVR (26 vs 100mL) was observed (P<0.001) at 12-months evaluation. PSA and prostate volume were decreased by 61 and 62%. Late complications were urethral strictures (6%), stress incontinence (1.2%). Eighty-five percent of patients had no antegrade ejaculation. CONCLUSION: The treatment of large BPH with PVP/XPS is safe and effective, with a long operative time. The functional outcomes are good and stable at mid-term evaluation. LEVEL OF EVIDENCE: 4.

[Recognition of facial expressions of emotions by 3-year-olds depending on sleep and risk of depression]. / Reconnaissance émotionnelle chez les enfants de 3ans en fonction du sommeil et du risque de dépression.

INTRODUCTION: The emotional process is characterized by a negative bias in depression, thus it was legitimate to establish if they same is true in very young at-risk children. Furthermore, sleep, also proposed as a marker of the depression risk, is closely linked in adults and adolescents with emotions. That is why we wanted first to better describe the characteristics of emotional recognition by 3-year-olds and their links with sleep. Secondly we observed, if found at this young age, an emotional recognition pattern indicating a vulnerability to depression. MATERIAL AND METHOD: We studied, in 133 children aged 36 months from the AuBE cohort, the number of correct answers to the task of recognition of facial emotions (joy, anger and sadness). Cognitive functions were also assessed by the WPPSI III at 3 years old, and the different sleep parameters (time of light off and light on, sleep times, difficulty to go to sleep and number of parents' awakes per night) were described by questionnaires filled out by mothers at 6, 12, 18, 24 and 36 months after birth. Of these 133 children, 21 children whose mothers had at least one history of depression (13 boys) were the high-risk group and 19 children (8 boys) born to women with no history of depression were the low-risk group (or control group). RESULTS: Overall, 133 children by the age of 36 months recognize significantly better happiness than other emotions (P=0.000) with a better global recognition higher in girls (M=8.8) than boys (M=7.8) (P=0.013) and a positive correlation between global recognition ability and verbal IQ (P=0.000). Children who have less daytime sleep at 18 months and those who sleep less at 24 months show a better recognition of sadness (P=0.043 and P=0.042); those with difficulties at bedtime at 18 months recognize less happiness (P=0.043), and those who awaken earlier at 24 months have a better global recognition of emotions (P=0.015). Finally, the boys of the high-risk group recognize sadness better than boys in the control group (P=0.015). CONCLUSION: This study confirms that the recognition of emotion is related to development with a female advantage and a link with the language skills at 36 months of life. More importantly, we found a relationship between sleep characteristics and emotional recognition ability and a negative bias in emotional recognition in young males at risk for depression.

On the Influence of Confounding Factors in Multisite Brain Morphometry Studies of Developmental Pathologies: Application to Autism Spectrum Disorder.

Pooling data acquired on different MR scanners is a commonly used practice to increase the statistical power of studies based on MRI-derived measurements. Such studies are very appealing since they should make it possible to detect more subtle effects related to pathologies. However, the influence of confounds introduced by scanner-related variations remains unclear. When studying brain morphometry descriptors, it is crucial to investigate whether scanner-induced errors can exceed the effect of the disease itself. More specifically, in the context of developmental pathologies such as autism spectrum disorders (ASD), it is essential to evaluate the influence of the scanner on age-related effects. In this paper, we studied a dataset composed of 159 anatomical MR images pooled from three different scanners, including 75 ASD patients and 84 healthy controls. We quantitatively assessed the effects of the age, pathology, and scanner factors on cortical thickness measurements. Our results indicate that scan pooling from different sites would be less fruitful in some cortical regions than in others. Although the effect of age is consistent across scanners, the interaction between the age and scanner factors is important and significant in some specific cortical areas.

Deep sulcal landmarks: algorithmic and conceptual improvements in the definition and extraction of sulcal pits.

Recent interest has been growing concerning points of maximum depth within folds, the sulcal pits, that can be used as reliable cortical landmarks. These remarkable points on the cortical surface are defined algorithmically as the outcome of an automatic extraction procedure. The influence of several crucial parameters of the reference technique (Im et al., 2010) has not been evaluated extensively, and no optimization procedure has been proposed so far. Designing an appropriate optimization framework for these parameters is mandatory to guarantee the reproducibility of results across studies and to ensure the feasibility of sulcal pit extraction and analysis on large cohorts. In this work, we propose a framework specifically dedicated to the optimization of the parameters of the method. This optimization framework relies on new measures for better quantifying the reproducibility of the number of sulcal pits per region across individuals, in line with the assumptions of one-to-one correspondence of sulcal roots across individuals which is an explicit aspect of the sulcal roots model (Régis et al., 2005). Our procedure benefits from a combination of improvements, including the use of a convenient sulcal depth estimation and is methodologically sound. Our experiments on two different groups of individuals, with a total of 137 subjects, show an increased reliability across subjects in deeper sulcal pits, as compared to the previous approach, and cover the entire cortical surface, including shallower and more variable folds that were not considered before. The effectiveness of our method ensures the feasibility of a systematic study of sulcal pits on large cohorts. On top of these methodological advances, we quantify the relationship between the reproducibility of the number of sulcal pits per region across individuals and their respective depth and demonstrate the relatively high reproducibility of several pits corresponding to shallower folds. Finally, we report new results regarding the local pit asymmetry, providing evidence that the algorithmic and conceptual approach defended here may contribute to better understanding of the key role of sulcal pits in neuroanatomy.

Benchmark data for sulcal pits extraction algorithms.

This article contains data related to the research article Auzias et al. (2015) [1]. This data can be used as a benchmark for quantitative evaluation of sulcal pits extraction algorithm. In particular, it allows a quantitative comparison with our method, and the assessment of the consistency of the sulcal pits extraction across two well-matched populations.

Atypical sulcal anatomy in young children with autism spectrum disorder.

Autism spectrum disorder is associated with an altered early brain development. However, the specific cortical structure abnormalities underlying this disorder remain largely unknown. Nonetheless, atypical cortical folding provides lingering evidence of early disruptions in neurodevelopmental processes and identifying changes in the geometry of cortical sulci is of primary interest for characterizing these structural abnormalities in autism and their evolution over the first stages of brain development. Here, we applied state-of-the-art sulcus-based morphometry methods to a large highly-selective cohort of 73 young male children of age spanning from 18 to 108 months. Moreover, such large cohort was selected through extensive behavioral assessments and stringent inclusion criteria for the group of 59 children with autism. After manual labeling of 59 different sulci in each hemisphere, we computed multiple shape descriptors for each single sulcus element, hereby separating the folding measurement into distinct factors such as the length and depth of the sulcus. We demonstrated that the central, intraparietal and frontal medial sulci showed a significant and consistent pattern of abnormalities across our different geometrical indices. We also found that autistic and control children exhibited strikingly different relationships between age and structural changes in brain morphology. Lastly, the different measures of sulcus shapes were correlated with the CARS and ADOS scores that are specific to the autistic pathology and indices of symptom severity. Inherently, these structural abnormalities are confined to regions that are functionally relevant with respect to cognitive disorders in ASD. In contrast to those previously reported in adults, it is very unlikely that these abnormalities originate from general compensatory mechanisms unrelated to the primary pathology. Rather, they most probably reflect an early disruption on developmental trajectory that could be part of the primary pathology.

[Comparison of the morbidity between limited and extended pelvic lymphadenectomy during laparoscopic radical prostatectomy]. / Comparaison de la morbidité entre curage étendu et curage limité au cours de la prostatectomie radicale laparoscopique.

OBJECTIVE: To compare the morbidity of limited pelvic lymphadenectomy to extended lymphadenectomy in patients undergoing LRP (Laparoscopic Radical Prostatectomy) for clinically localized prostate cancer. PATIENTS AND METHODS: We performed a prospective monocentric study focused on 303 consecutive patients having a pelvic lymphadenectomy during LRP from June 2000 to April 2010. One hundred and seventy six patients had a limited pelvic lymphadenectomy (June 2000-June 2006, group 1). One hundred and twenty seven patients had an extended pelvis lymphadenectomy (June 2006-April 2010, group 2) including two sub-groups according to the lateral limit of the procedure i.e. with (group 2a, 60 patients) or without dissection of the lateral side of the iliac artery (group 2b, 67 patients). RESULTS: Preoperative data (age, BMI, cTNM, Gleason score and PSA) were comparable between the groups. The number of lymph nodes and the incidence of metastatic lymph nodes were lower in group 1 (6,7 lymph nodes and 5,7%) compared to group 2 (a+b) (15.6 lymph nodes and 18.9%) (P=0.001 and P=0.0004). However, there was no difference between groups 2a and 2b (15.4 and 16.7% vs 15,8 and 20.8% P=0.65 respectively). There were more complications in the extended lymphadenectomy group compared to the limited procedure (35.4% vs 14.2%, P=0.0001), in particular more lymphatic complications (27.5% vs 10.2% P=0.0001) and lymphoedema (LO) (15.7% vs 0.6% P=0.00001). However the lymphorhea (LR) and lymphocele (LC) rate was not different (P=0.11 and P=0.17). All complications were mainly of low Clavien's classification grade (1+2) whatever the group of lymphadenectomy. The hospital stay was not increased in group 2a or 2b in regard to group 1. The rate of LR and LC was higher in group 2a than in group 1 (P=0.02 and P=0.05) but not between group 2b and 1 (P=0.81 and P=0.47). CONCLUSION: Our study showed a higher rate of complications after extended pelvic lymphadenectomy but of low grade in most cases. Moreover the lateral dissection sparing the lateral side of the iliac artery reduced the risk of lymphatic complications without decreasing the number of lymph nodes removed and the rate of metastasis.

The sleep macroarchitecture of children at risk for depression recruited in sleep centers.

OBJECTIVE: The primary aim of this study was to compare the sleep macroarchitecture of children and adolescents whose mothers have a history of depression with children and adolescents whose mothers do not. METHOD: Polysomnography (PSG) and Holter electroencephalogram (EEG) were used to compare the sleep architecture of 35 children whose mothers had at least one previous depressive episode (19 boys, aged 4-18 years, "high-risk" group) and 25 controls (13 males, aged 4-18 years, "low-risk" group) whose mothers had never had a depressive episode. The total sleep time, wakefulness after sleep onset (WASO), sleep latency, sleep efficiency, number of awakenings per hour of sleep, percentages of time spent in each sleep stage, rapid eye movement (REM) latency and the depressive symptoms of participants were measured. RESULTS: In children (4-12 years old), the high-risk group exhibited significantly more depressive symptoms than controls (P=0.02). However, PSG parameters were not significantly different between high-risk children and controls. In adolescents (13-18 years old), the high-risk subjects presented with significantly more depressive symptoms (P=0.003), a significant increase in WASO (P=0.019) and a significant decrease in sleep efficiency compared to controls (P=0.009). CONCLUSION: This study shows that children and adolescents born from mothers with a history of at least one depressive episode had significantly more depressive symptoms than controls. However, only high-risk adolescents presented with concurrent alterations of sleep macroarchitecture.

[Urinary continence following laparoscopic radical prostatectomy: qualitative analysis]. / Étude qualitative de la continence urinaire après prostatectomie radicale laparoscopique.

PURPOSE: The main purpose of this study was to report urinary continence after laparoscopic radical prostatectomy (LRP) for localised prostate cancer and the return to baseline rate for urinary continence. The minor purpose was to determine the risk factors, which influence return to baseline urinary continence after radical prostatectomy. METHODS: Prospective evaluation of urinary continence with self-administered questionnaire in 300 consecutive LRP for localized prostate cancer. RESULTS: After LRP, at 3, 6 and 12 months, respectively 12.5%, 23% and 33.7% of patients recover baseline urinary continence. Fifty-four percent, 72.3% and 78.4% of patients did not wear pads 3, 6 and 12 months after LRP. In patients without pad, 43 % recovered baseline continence one year after radical prostatectomy. In univariate analysis, age older than 60 years (P=0.003, P=0.003, P=0.02, 3, 6 and 12 months after LRP) and no sparing of neurovascular bundles (P=0.01, P=0.08 at 3 and 6 months after LRP) were risks factors of urinary incontinence. In multivariate analysis, only age older than 60 years (P=0.018, P=0.01 and P=0.01 at 3, 6 and 12 months after LRP) was a risk factor of urinary incontinence. CONCLUSION: One year after LRP, 66.3% of patients had urinary incontinence according to our evaluation using stringent criteria, i.e. return to baseline continence status. However, only 21.6% of patients wore pads and less than 2% wore more than two pads per day.

[Usefulness of real time transrectal ultrasonography to monitor the Greenlight XPS(®) (180W) laser prostatectomy]. / Intérêt du contrôle échographique endorectal en temps réel dans le traitement de l'hypertrophie bénigne de la prostate par vaporisation Laser Greenlight(®) XPS (180W).

We report a technical improvement of the Greenlight(®) XPS prostatectomy by using real time transrectal ultrasonography (TRUS) during the procedure. The TRUS probe lays on a flexible support fastened to the operative table. A wide screen with double display allows the surgeon to control the progress of the procedure with simultaneous ultrasonographic and endoscopic views. The depth of vaporization clearly appears as an hyperechogenic line together with an enlargement of the vaporization area. Real time TRUS monitoring during photovaporization of BPH decreases the learning curve, the risk of prostatic capsule perforation and bleeding, and allows to check the completeness of the procedure.

How to increase academic performance in children with oppositional defiant disorder? An implicit theory effect.

The aim of the present study was to determine whether the implicit theory effect extends to children with oppositional defiant disorder (ODD), with academic difficulties. Twenty-five male children, aged 8-11 years with ODD were randomly assigned to one of two experimental conditions (Incremental Theory highlighting the possibility of self-improvement vs. control). An increase of cognitive performance (IQ) was found for children with ODD in the incremental condition, but not in the control condition. This cognitive improvement could be viewed as a protective factor for children and adolescents with ODD on academic setting.

[Bipolar disorder: Continuity from child to adult?]. / Troubles bipolaires : continuité enfant-adulte ?

Early onset (pediatric) bipolar disorders are still an issue of much controversy due to several clinical particularities of the thymic episodes at this age. To date, there is indeed no consensus regarding the prevalence of bipolar disorders before puberty. Diagnosis criteria in children and young adolescents remain thus elusive. The purpose of this review is to provide an overview of this issue. The idea of continuity, from childhood to adulthood, in bipolar disorders also raises important questions regarding predictive factors of bipolar disorders in adults. Studies on the childhood of bipolar adults, as well as studies on the children of bipolar parents will be reviewed, in an attempt to identify the psychopathological substrates of bipolar disorders.

Electrodermal reactivity to emotion processing in adults with autistic spectrum disorders.

Although alterations of emotion processing are recognized as a core component of autism, the level at which alterations occur is still debated. Discrepant results suggest that overt assessment of emotion processing is not appropriate. In this study, skin conductance response (SCR) was used to examine covert emotional processes. Both behavioural responses and SCRs of 16 adults with an autistic spectrum disorder (ASD) were compared to those of 16 typical matched adults. Participants had to judge emotional facial expressions, the age of faces or the direction of a moving object. Although behavioural performance was similar in the two populations, individuals with an ASD exhibited lower SCRs than controls in the emotional judgement task. This suggests that such individuals may rely on different strategies due to altered autonomic processing. Furthermore, failure to produce normal physiological reactions to emotional faces may be related to social impairments in individuals with an ASD.

Preterm birth affects dorsal-stream functioning even after age 6.

With increasing numbers of preterm infants surviving, the impact of preterm birth on later cognitive development presents a major interest. This study investigates the impact of preterm birth on later dorsal- and ventral-stream functioning. An atypical pattern of performance was found for preterm children relative to full-term controls, but in the dorsal-drawing task only. These findings suggest that the number of gestational weeks does affect dorsal-stream functioning, even after more than 6 years of favorable environmental conditions in healthy preterm children.

Negative emotion does not enhance recall skills in adults with autistic spectrum disorders.

Recent empirical findings suggest a significant influence of emotion on memory processes. Surprisingly, although emotion-processing difficulties appear to be a hallmark feature in autism spectrum disorders (ASD), their impact on higher-level cognitive functions, such as memory, has not been directly studied in this population. The aim of this study was to address this issue by assessing whether the emotional valence of visual scenes affects recall skills in high-functioning individuals with ASD. To this purpose, their recall performance of neutral and emotional pictures was compared with that of typically developing adults (control group). Results revealed that while typically developing individuals showed enhanced recall skills for negative relative to positive and neutral pictures, individuals with ASD recalled the neutral pictures as well as the emotional ones. Findings of this study thus point to reduced influence of emotion on memory processes in ASD than in typically developing individuals, possibly owing to amygdala dysfunctions.

Global and local processing in Williams syndrome: drawing versus perceiving.

It has been hypothesized that a local processing bias underlies overall visuospatial impairments in Williams syndrome (WS). However, recent studies have challenged this hypothesis by providing evidence against a local processing bias at the perceptual level. The aim of the present study was to further examine drawing and perceptual skills in children with WS using closely matched-hierarchical stimuli. In the drawing task children with WS exhibited a local processing bias. However, no significant preferential bias was found in the perceptual task. This indicates that children with WS do not systematically present a preferential bias for local information. Taken together the findings of the present study suggest that perceptual processing deficits per se are unlikely to explain local processing biases in visuoconstructive tasks often described in people with WS.

[Theory of mind in Asperger syndrome]. / Syndrome d'Asperger et théorie de l'esprit.

INTRODUCTION: Theory of mind deficit can be used to explain social and communication impairments that define the autism spectrum disorder. Theory of mind is the ability to attribute mental states to self and others in order to understand and predict behavior. It involves the distinction between the real world and mental representations of the world. Several studies established that high functioning autistic individuals and individuals with Asperger syndrome (ASP) tend to be as proficient as controls in understanding first order false belief tasks. In contrast, they still lag behind their typical peers in understanding second order false belief tasks or more advanced tasks of theory of mind (e.g., Baron-Cohen, 1993). Most of these studies focus on the adult population and it seems particularly interesting to investigate whether children with ASP would present the same pattern of strengths and deficits as adults. In our research, children with ASP were tested in an advanced task of theory of mind based on a visual presentation of comic strips and in a more traditional assessment of false belief understanding: the Smarties test. METHOD: Two experimental groups participated in this study: a group of 16 high functioning children and adolescents with autism or with Asperger syndrome (ASP) and a group of 16 typically developing children matched on gender and age (CONT). The task was designed to assess the ability of children with ASP to infer the mental state of others. Stimuli were 26 different comic strips depicting a short story. Each comic strip was composed of three pictures and was shown on the upper half of the screen. Then three pictures numbered 1 to 3 showing possible outcomes of the scenario were superimposed on the bottom half of the screen. Only one of these three pictures represented a plausible conclusion to the scenario. This experiment contained two conditions: A Character intention (CI) condition and a Physical causality (PC) condition. The comic strips in the CI condition involved one character whose intentions had to be inferred by the subject in order to choose the correct picture. Comic strips in PC condition only required to understand physical causalities. Subjects were asked to watch the comic strip attentively and then they were required to make a choice between the three story endings by pressing the corresponding keyboard button. Both answers and response times were recorded. Additionally, all participants were enrolled in the classical false belief (Smarties) task. RESULTS: Comic strips: An ANOVA [2 groups (CONT/ASP) x 2 conditions (CI/PC)] was performed on the number of correct responses. Neither the Group nor the Condition factor was significant (p>0.05). In contrast, the interaction Group x Condition reached significance level [F(1-30)=4.3, p<0.05)]. Further analysis revealed that performance of the ASP group was significantly higher in the CP (M=10.8, SD=2.5) than in the CI (M=9.8, SD=2) condition [t (1-14)=2.9, p<0.001)], whereas there was no condition difference in the control group (p>0.05). False belief: all ASP participants succeeded in the task. DISCUSSION: Our data clearly demonstrated that children and adolescents with Asperger syndrome or high functioning autism exhibited an impairment in understanding the intention of others. In the comic strip task, children with ASP have more difficulties in the character's intention condition than in the physical causality condition. This impairment is not imputable to a deficit in taking into account the context (Weack Central Coherence theory) since they performed as well as controls in the physical causality condition which also required the processing of the whole scene. In contrast, all children with ASP succeeded at the false belief task. These contradictory findings suggest that, although testing theory of mind, the two tasks do not tap similar mechanisms. It is possible that the use of verbal material in the false belief task improved performance of the ASP children who are known to present particular strengths in this domain. Another possible explanation that needs further testing would be that the level of complexity differs between the two tasks.