Abstract-Two experiments are reported in which hyperactive and control children repeatedly chose between small immediate and large delayed rewards. In experiment 1, the best choice option was manipulated by varying levels of delay after reward delivery. In experiment 2 it was manipulated by changing the economic constraint (10 minutes or 20 trials). Both groups were equally efficient at earning points under most conditions, but hyperactive children exhibited a maladaptive preference for the small reward under the trials constraint. The results suggest that hyperactive children were more concerned to reduce overall delay levels than either to maximize reward amount or immediacy.

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Significant levels of psychopathology were identified in this cohort. However, there were no significant differences in the levels of depression, anxiety, PTSD symptoms and autobiographical memory between stroke and non-stroke hospitalized patients. Of particular interest was the finding that PTSD-like symptoms did not appear to be influenced by the nature of the person's illness. In combined data (stroke and non-stroke) autobiographical memories (intrusive images of their illness, intrusive memories of other events and overgeneral memory recall variables) were significant predictors of depression in this cohort. This suggests that psychological intervention of memory processes may be a worthwhile target in psychological intervention for depression in these cohorts. Gender, cognitive impairment, antidepressant medication, and estimated IQ were significant predictors of overgeneral memory recall and further investigation into the validity of these findings are warranted. Suggestions for further research and limitations of the study are also discussed.

SUMMARYBackground and purpose. Psychological reactions after stroke have been recognized for some time. The present study examined whether psychological symptoms consistent with post-traumatic stress disorder (PTSD) could occur after stroke as a consequence of the sudden and unpredictable occurrence of a life-threatening internal stressor.Methods. Sixty-one patients who had experienced a ®rst-ever stroke or transient ischaemic attack were assessed using standard self-report clinical measures for anxiety, depression and PTSD. Those patients who ful®lled criteria on at least one PTSD self-report measure were subsequently assessed using a structured clinical interview for PTSD.Results. Six (9.8%) patients ful®lled criteria for PTSD. No signi®cant dierences were found between the poststroke PTSD group and the non-PTSD group in terms of premorbid health and lifestyle, or experiences of adverse life events. Signi®cant dierences were noted with respect to self-reported post-stroke mental health and premorbid neuroticism. The post-stroke PTSD group also scored consistently higher on measures of anxiety, depression and psychiatric caseness.Conclusions. The results of this study demonstrate a number of close similarities between post-stroke PTSD and classical PTSD. We therefore conclude that PTSD or a PTSD-like syndrome can occur after stroke. # 1998 John Wiley & Sons, Ltd.

Cognitive behaviour therapy (CBT) treatments have been developed and validated with respect to specific diagnoses. In routine clinical practice diagnostic accuracy is poor, making for poorly targeted treatment. The problems posed by lack of diagnostic rigour, including non-detection of co-morbidity, are rarely the subject of supervision sessions and treatment failures may be inappropriately attributed to other factors such as lack of therapeutic skill or an unmotivated client. It is argued that a false dichotomy exists between diagnosis and case formulation fuelled by professional territorial disputes. We suggest that diagnosis acts as a lens, focusing attention on the range of cognitions salient to a case formulation and also highlights psychosocial and environmental factors that may affect treatment outcome. It is recommended that practitioners enhance their effectiveness by using structured interviews routinely as a part of their ongoing assessment of clients.