65

The
British
Psychological
Journal of Neuropsychology (2012), 6, 65–78
C 2011 The British Psychological Society
Society

www.wileyonlinelibrary.com

Prefrontal cortex dysfunction and ‘Jumping to

Conclusions’: Bias or deficit?

Laura Lunt1 ∗ , Jessica Bramham1 , Robin G. Morris1 ,

Peter R. Bullock2 , Richard P. Selway2 , Kiriakos Xenitidis3
and Anthony S. David4
1
Department of Psychology, Institute of Psychiatry, King’s College London, UK
2
Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, UK
3
Adult ADHD Clinic, The Maudsley Hospital, Denmark Hill, London, UK
4
Department of Cognitive Neuropsychiatry, Institute of Psychiatry, King’s College
London, UK

The ‘beads task’ is used to measure the cognitive basis of delusions, namely the ‘Jumping
to Conclusions’ (JTC) reasoning bias. However, it is not clear whether the task merely
taps executive dysfunction – known to be impaired in patients with schizophrenia – such
as planning and resistance to impulse. To study this, 19 individuals with neurosurgical
excisions to the prefrontal cortex, 21 unmedicated adults with Attention Deficit
Hyperactivity Disorder (ADHD), and 25 healthy controls completed two conditions
of the beads task, in addition to tests of memory and executive function as well as
control tests of probabilistic reasoning ability. The results indicated that the prefrontal
lobe group (in particular, those with left-sided lesions) demonstrated a JTC bias relative
to the ADHD and control groups. Further exploratory analyses indicated that JTC on
the beads task was associated with poorer performance in certain executive domains.
The results are discussed in terms of the executive demands of the beads task and
possible implications for the model of psychotic delusions based on the JTC bias.

It is widely accepted that a probabilistic reasoning bias, ‘Jumping to Conclusions’ (JTC),

underpins the formation and maintenance of delusions in individuals with schizophrenia.
The JTC bias in individuals with delusions has been demonstrated in numerous studies
utilizing variants of an extensively used paradigm, the beads task (see Fine, Gardener,
Craigie, & Gold, 2007; Garety & Freeman, 1999 for reviews). This is a probabilistic
reasoning task requiring individuals to judge from which of two jars coloured beads
are being drawn based on information about the colour proportions within each jar.
Individuals with delusions have been shown to make rapid and overconfident decisions
based on less evidence than controls, that is, they ‘jump to conclusions’ (see Fine et al.,

∗ Correspondence should be addressed to Dr Laura Lunt, The Developmental Neuropsychiatry & Neuropsychology Service,
Michael Rutter Centre for Children, Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK (e-mail: laura.lunt@slam.nhs.uk).

DOI:10.1111/j.1748-6653.2011.02005.x
66 Laura Lunt et al.

2007; Garety & Freeman, 1999 for reviews). It is theorized that this JTC reasoning style is
implicated in the formation and maintenance of delusions by causing a rapid acceptance
of beliefs with limited evidence to support them (Freeman, 2007).
However, it possible that the neuropsychological deficits associated with schizophre-
nia may be responsible for the observed JTC bias, as some authors have suggested that the
JTC bias is a function of having schizophrenia rather than a function of delusions (Menon
et al., 2002). Indeed, one of the original studies of JTC and delusions found that JTC was
less marked in a delusional disorder subgroup relative to the main group of people with
schizophrenia (Garety, Hemsley, & Wessely, 1991). It has also been found that there
was no correlation between level of delusions and JTC in a group of individuals with
schizophrenia (Mortimer et al., 1996). A recent meta-analysis (Fine et al., 2007) suggested
that the JTC effect found in deluded schizophrenia groups may not be exclusively related
to delusions, and that at least some of the bias may arise from other schizophrenic
symptoms or impairments. This leaves open the possibility that cognitive deficits rather
than biases (see Bentall, 1995; David, 1995) underlie the JTC effect in schizophrenia.
It also raises questions regarding which cognitive deficits might predispose an indi-
vidual to jump to conclusions on the beads task, which is the focus of the current
study.
Previously the cognitive demands of the beads task have been investigated in those
with schizophrenia, and it was found that the JTC effect was significantly influenced by
the memory demands of the task (Menon et al., 2006). However, the cognitive demands
of the task have never been investigated outside investigations of schizophrenia, which
makes it difficult to disentangle the relationships between JTC and delusions, and JTC
and cognitive impairment. The current study aimed to infer the executive demands of
the beads task by determining whether JTC occurs in those with executive impairments
but without delusions, since executive dysfunction is widely documented as a core
cognitive deficit within schizophrenia (see Weickert et al., 2000), and speculations have
been made about various executive elements of the task, such as impulse control (van
Dael et al., 2006), and working memory (Dudley, John, Young, & Over, 1997; Menon,
Pomarol-Clotet, McKenna, & McCarthy, 2006).
Therefore, two non-deluded clinical groups with executive impairments were investi-
gated in the current study to determine the effects of wider executive dysfunction versus
impulsivity on JTC. Firstly, adults with discrete neurosurgical lesions of the prefrontal
cortex who show evidence of similar executive impairments to schizophrenia groups
(e.g., Haut et al., 1996; Pantelis, Barnes, & Nelson, 1997, Pantelis et al., 1999; Rushe
et al., 1999) were selected. Assessment of this prefrontal group would therefore allow
examination of the relationship between JTC and generalized executive dysfunction.
Secondly, unmedicated adults with Attention Deficit Hyperactivity Disorder (ADHD)
were involved because difficulties with impulse control are a prominent feature of
ADHD (Barkley, 1997) and are also found in those with schizophrenia (e.g., Ross,
Harris, O’Lincy, & Radant, 2000). Utilizing this sample would help determine whether
impulsivity was related to the JTC bias.
To our knowledge, this was the first study to examine the executive correlates
of the beads task outside of the delusions context, and therefore it was decided to
include two clinical groups with differing executive impairments. Based on previously
outlined evidence that those with schizophrenia irrespective of delusional status
jump to conclusions, it was predicted that both groups in the current study would
show the JTC bias relative to controls, and that this would be related to executive
functioning.
 Prefrontal cortex dysfunction and Jumping to Conclusions 67

Table 1. Characteristics of participants within the prefrontal group

Age Lesion location

Code Sex (years) Aetiology Laterality Orbital Medial Dorsolateral

FL1 M 25 Cavernoma R +
FL2 M 39 Epilepsy R + +
FL3 M 36 Oligodendroglioma R + +
FL4 M 64 Meningioma R + +
FL5 F 27 Epilepsy L + +
FL6 M 46 Epilepsy L +
FL7 M 38 Epilepsy L + + +
FL8 F 40 Malignant L + +
ependymona
FL9 M 70 Meningioma L +
FL10 F 33 Oligodendroglioma R +
FL11 F 47 Meningioma R +
FL12 F 35 Epilepsy L + + +
FL13 F 55 Epilepsy L + + +
FL14 M 75 Meningioma R +
FL15 M 30 Oligodendroglioma L +
FL16 F 58 Anterior R +
communicating
artery aneurysm
and
sub-arachnoid
haemorrhage
FL17 F 25 Epilepsy R + +
FL18 F 57 Meningioma R + + +
FL19 F 45 Epidermoid cyst L + +

Method
Participants
Prefrontal cortex lesions group
Nineteen participants (9 males and 10 females; aged 25–75 years) were recruited
from King’s College Hospital, Neuroscience Centre for having undergone neurosurgical
excisions exclusively within the prefrontal cortex at least 6 months prior to participating
in the current study (approximate mean duration = 5 years, range 0.75–13 years).
The participants had neurosurgery relating to epilepsy, low-grade tumours or frontal
lobe epilepsy. They were currently not taking medication. Details of participants’
neurosurgical lesion locations were obtained from medical records and also by MRI
scans taken following surgery. Table 1 presents background information on participants
within this group.

Adult Attention Deficit Hyperactivity Disorder (ADHD) group

Twenty-one adults diagnosed with ADHD were included who were not taking medication
for this condition at the time of the assessment (9 males and 12 females, aged
18–38 years). The ADHD diagnoses were made by a Consultant Psychiatrist based
on participants’ developmental history, neuropsychological assessment results, and
68 Laura Lunt et al.

presence of hyperactive/impulsive and/or inattentive symptoms according to DSM-IV

(Diagnostic and Statistical Manual of Mental Disorder 4th Edition; American Psychiatric
Association, 2000) criteria. Participants were recruited via their attendance at a specialist
adult ADHD service for standard neuropsychological assessment as part of their full
diagnostic evaluation.

Healthy control group

The control group consisted of 25 participants (11 males and 14 females, aged 18–
75 years), with no psychiatric or neurological history, recruited from a departmental
database of volunteer participants living locally.

Demographic characteristics
There was no significant difference between the groups on gender (␹ 2 = 0.09, p = 0.96).
An ANOVA (Analysis of Variance) revealed a significant main of effect of age between
the groups (F = 7.83, p < 0.01). Post hoc LSD (Fisher’s Least Significant Difference) tests
revealed that the ADHD group was significantly younger than the control (p < 0.01) and
prefrontal (p < 0.01) groups. The control and prefrontal group were not significantly
different in age (p = 0.12) (see Table 2).

Exclusion and inclusion criteria, payment, and ethics

All participants had an absence of past or present diagnosis of a psychotic disorder;
current or past history of alcohol or substance dependence. They all had English as a
first language and a full-scale IQ above 70. All participants gave their informed consent
by signing an information and consent form prior to participating in the study. All
participants received £10 for their participation. Ethical approval was obtained from the
local Research Ethics Committee.

Procedures
Background neuropsychological measures
Background neuropsychological procedures were used to measure intelligence, working
memory and executive functioning. For intelligence, the participants were assessed
using the Wechsler Abbreviated Scale of Intelligence (WASI). For working memory, the
Digit Span and Spatial Span subtests from the Wechsler Memory Scale – 3rd Edition
(WMS-III) were used. To measure executive function they were tested using the Hayling
Sentence Completion Test, a measure of response inhibition, the Brixton Test, a measure
of planning and set shifting, and the Stroop Color-Word Interference Test, measuring
inhibitory control.

General probabilistic reasoning measures

In order to control for generalized deficits in probabilistic reasoning, three measures
of general probabilistic reasoning ability were selected from a larger battery described
by Musch and Ehrenberg (2002) These were, the Tossing Coins Task (Blackmore &
Troscianko, 1985), which involves judging whether a coin is biased based on information
given about the number of tosses and the proportion of ‘heads’ obtained; the Dice
Sequences Task (Brugger, Landis, & Regard, 1990), which requires a judgement about
the likelihood of two sequences of six consecutive dice rolls occurring first; and the
Dice Throws Task (Brugger, Regard, & Landis, 1991), in which participants must judge
 Prefrontal cortex dysfunction and Jumping to Conclusions 69

Table 2. Mean/median (SD/range) scores on neuropsychological, executive, probabilistic reasoning,

and psychopathology questionnaire measures for each group, with ANOVA/Kruskal–Wallis results

Prefrontal ADHD Control

(n = 19) (n = 21) (n = 25) F p

Age 44.47 27.48 37.92 7.83 ⬍0.01

(15.06) (8.08) (16.29)
FSIQ 104.89 111.71 106.24 1.58 0.21
(11.80) (15.17) (12.04)
VIQ 100.37 106.52 105.64 1.38 0.26
(11.15) (14.98) (11.54)
PIQ 108.74 114.10 105.36 2.24 0.12
(14.30) (14.15) (13.61)
Vocabulary T-score 50.95 55.38 54.76 1.28 0.28
(8.59) (10.58) (9.11)
Similarities T-score 49.74 52.24 52.24 0.68 0.51
(7.82) (8.85) (7.07)
Block design 54.89 58.24 54.12 1.17 0.32
T-score (9.93) (8.77) (9.67)
Matrix reasoning 55.32 58.14 52.32 2.6 0.08
T-score (9.03) (7.88) (8.90)
Digit Span forwards 9.47 10.80 10.68 2.13 0.13
(1.95) (2.26) (2.4)
Digit Span backwards 6.53 7.50 6.44 1.17 0.32
(1.78) (2.70) (2.76)
Spatial Span forwards 8.37 8.95 7.72 1.48 0.24
(1.77) (3.12) (2.11)
Spatial Span backwards 7.47 8.00 7.64 0.31 0.73
(1.98) (2.41) (2.02)
PDI yes/no score 4.17 7.95 4.16 8.06 0.01
(2.53) (4.89) (2.73)
HADS total anxiety 7.72 11.14 6.40 7.75 0.01
(3.75) (4.52) (4.07)
HADS total depression 4.22 6.48 3.68 3.87 0.21
(3.59) (2.86) (3.96)
Barkley inattentive 2.39 7.29 2.08 23.15 ⬍0.01
symptoms (3.07) (2.17) (3.07)
Barkley impulsivity/ 1.78 6.10 1.60 29.97 ⬍0.01
hyperactivity symptoms (1.56) (2.28) (2.38)

Prefrontal ADHD Control Kruskal–Wallis ␹ 2 p

Hayling overall scaled score 6.00 6.00 6.00 3.34 0.19

(7.00) (7.00) (8.00)
Brixton scaled score 6.00 7.00 7.00 0.74 0.69
(9.00) (8.00) (5.00)
Stroop number of responses 100.00 98.50 109.00 2.85 0.24
(72.00) (79.00) (67.00)
Dice Sequences task – total correct 1.00 2.00 1.00 1.31 0.52
(6.00) (6.00) (6.00)
Tossing Coins task 0.00 0.00 0.00 0.70 0.71
(3.00) (6.00) (5.00)
Dice Throws task 1.00 1.00 1.00 0.36 0.84
(1.00) (1.00) (1.00)

Note. VIQ, Verbal IQ; PIQ, Performance IQ

70 Laura Lunt et al.

which event is more likely: ‘(1) throwing one dice 10 times in succession and getting 10
consecutive “6”s; or (2) throwing 10 dice at once and getting all “6”s at once’.

Questionnaire measures
Although the groups did not have schizophrenia, it was important to control for
delusional ideation in order to explore the hypothesized executive mediators of a JTC
bias in the experimental groups. The Peters Delusions Inventory (PDI-21; Peters, Day,
Joseph, & Garety, 2004) was used for this purpose, as it measures delusional ideation
or schizotypal traits in the general population. Since there is mixed evidence (Garety
et al., 2005) about the potential role of anxiety/depression in mediating a JTC bias, the
Hospital Anxiety and Depression Scale (HADS, Zigmond & Snaith, 1983) was selected
to explore any relationship between affective state and JTC bias. Finally, the Barkley
Current Symptom Scale (CSS; Barkley & Murphy, 1998) is a self-report instrument to
assess the frequency of the 18 DSM-IV symptoms of ADHD. This scale was used as a
screening measure of ADHD symptoms within the control group, as well as a subjective
measure of impulsivity as a potential correlate of a JTC reasoning bias.

Jumping to Conclusion task

The beads task is the main measure of JTC reasoning bias used in studies of schizophrenia.
In this task, participants are shown two jars and it is explained that they each contain
specific proportions of two bead colours. For instance, Jar A contains 85 red beads and 15
blue beads, whereas Jar B contains 85 blue and 15 red beads. They have to decide which
of the two jars the examiner has chosen based on given information. Specifically, the jars
are removed from view and the participants are informed that one of the jars has been
chosen at random, and beads will be drawn at random from the selected jar only and
replaced afterwards so that the proportions stay the same. The participant is told they
may see as many beads as they like before making a decision of which they are certain.
Two conditions of the task were used: the 85:15 ratio, and a 60:40 ratio for consistency
with the existing research and in order to explore potential differential performance that
might be associated with differing executive demands. Originally Dudley, Johns, Young,
and Over (1997) designed the more difficult 60:40 version in order to begin exploring
the cognitive components of the task by increasing complexity. They speculated that
JTC style may be a way of reducing cognitive demands, which might happen in response
to working memory deficits. Both conditions of the beads task were presented in graphic
form via a laptop PowerPoint presentation, based on a design by Robert Dudley at the
Newcastle Cognitive Therapy Centre, where for each decision the bead was shown
centrally with a graphic presentation of beads previously seen below (in a line from
left to right). The pseudo-random sequence of beads drawn was the same used in the
original beads task (Huq, Garety, & Hemsley, 1988).
Two measurements were used: (1) ‘Extreme Responding’, which is defined as making
the decision after just one or two draws. This dichotomous variable is used frequently in
studies of delusions, so it was included in the current study to enable a direct comparison
with previous research; and (2) ‘Draws to Decision’, the number of beads drawn until
a decision is made. This variable was found to be the best measure of the JTC bias in
schizophrenia groups according to a recent meta-analysis (Fine et al., 2007).
The entire testing session ranged from approximately 75–150 min depending on the
number of breaks, speed, and ability level of the participant.
 Prefrontal cortex dysfunction and Jumping to Conclusions 71

Results
Statistical analysis
The data were analysed using the Statistical Package for Social Sciences (SPSS) for Win-
dows, version 13.0. Between group differences on the background neuropsychological,
reasoning, and psychopathology measures were tested (using MANOVA (Multivariate
Analysis of Variance)) analyses for parametric data and Kruskal–Wallis for non-parametric
data) prior to running analyses on the beads test data. Results from the beads test were
divided into two dependent variables described below, with analysis of the dichotomous
extreme responding variable using Fisher’s exact test, and MANOVA analyses used for the
draws to decision data. Covariate MANOVA analyses were run to determine the effects of
the background neuropsychological variables on the draws to decision outcomes across
groups. Correlational analyses (Spearman’s rank) were used to determine the relationship
between executive functioning measures and draws to decision on the beads test across
the whole sample. Finally, laterality analyses (Kruskal–Wallis) were run to determine the
effect of prefrontal lesion site on beads task performance.

Background neuropsychological measures

There was no significant difference between the groups’ scores on FSIQ (Full Scale IQ)
(F = 1.58, p = 0.21), Digit Span forwards (F = 2.13, p = 0.13), Digit Span backwards
(F = 1.17, p = 0.32), Spatial Span forwards (F = 1.48, p = 0.24), Spatial Span backwards
(F = 0.31, p = 0.73), Hayling overall score (Kruskal–Wallis ␹ 2 = 3.34, p = 0.19), Brixton
test (Kruskal–Wallis ␹ 2 = 0.74, p = 0.69), and the Stroop test (Kruskal–Wallis ␹ 2 = 2.85,
p = 0.24).

General probabilistic reasoning measures

On the probabilistic reasoning tests, there were no significant differences between the
groups on any of the measures (Dice Sequences, Kruskal–Wallis ␹ 2 = 1.31, p = 0.52;
Tossing Coins, Kruskal–Wallis ␹ 2 = 0.70, p = 0.71; Dice Throws, Kruskal–Wallis ␹ 2 =
0.36, p = 0.84).

Questionnaire measures
The ADHD group scored significantly higher (more pathological) on the PDI, HADS
anxiety scale, and Barkley scales relative to prefrontal and controls following Bonferroni
correction (p < 0.01). There was no significant difference between the prefrontal and
control groups on any of these measures (p < 0.99).

Jumping to Conclusion task

Accuracy
Accuracy was defined as whether individuals made the correct choice of jar that the beads
were being drawn from. The overall accuracy rate of the sample was 84.6% collapsed
across both conditions of the beads task. Seven participants from the prefrontal group,
one from the ADHD group, and two from the control group made errors in their choice
of jar.
72 Laura Lunt et al.

Table 3. Mean (SD) draws to decision on both conditions of the beads task, with MANOVA results

Prefrontal ADHD Control

(n = 17) (n = 20) (n = 19) F p†

Beads task condition 3.47 5.05 5.58 4.10 0.04

85:15 (2.29) (2.42) (2.12)
Beads task condition 5.82 8.40 9.47 8.36 ⬍0.01
60:40 (3.73) (2.70) (1.39)

†
Bonferroni corrected.

Extreme responding
This was treated as a dichotomous variable with participants characterized as either
responding after just one or two bead presentations (extreme) or more than this number
(not extreme). The data were collapsed across the two bead ratio conditions. Over 26%
of the prefrontal group demonstrated extreme responses compared to 9% and 4% in the
ADHD and control groups, respectively. Fisher’s exact tests revealed that the prefrontal
group ‘jump to conclusions’ significantly more than the control group only (Bonferroni
corrected p = 0.01).

Draws to decision
Before analysing the ‘draws to decision’ data on the beads task, extreme outliers were
excluded. Outliers were identified via inspection of box plots and were excluded if they
were positioned three or more box lengths (i.e., the inter-quartile range) above or below
the 25th and 75th percentiles. Across both beads task conditions, this resulted in the
exclusion of two participants in the prefrontal group, one in the ADHD group and six in
the control group. Exclusion of outliers was considered appropriate as this was the first
investigation of the JTC bias in these clinical groups, and so it was important to obtain
means that were more representative of the group majority that could be explored in
future replication studies, in line with the arguments of Judd & McClelland (1989). The
resulting data are presented in Table 3.
Both conditions of the beads task were entered into a MANOVA, which revealed
significant group effects across both conditions.
Post hoc LSD tests revealed that the prefrontal group made fewer draws to decisions
than the control group on both the 85:15 beads condition (p < 0.05, Bonferroni
corrected) and on the 60:40 condition (p < 0.01, Bonferroni corrected). The prefrontal
group made significantly fewer draws to decision than the ADHD group on the 85:15
beads condition using a Bonferroni uncorrected analysis (p = 0.04), but this difference
did not remain following the Bonferroni correction (p = 0.25). However, on the 60:40
beads condition the prefrontal group made significantly less draws to decision compared
to the ADHD group following Bonferroni correction (p = 0.04). The ADHD group was
not significantly different from the control group on either the 85:15 or 60:40 beads
conditions (p = 0.47 and p = 0.23, respectively).

Covariate analyses
Because the groups were not matched on age, the JTC analyses for ‘draws to decision’
were repeated using age as a covariate. This did not alter the significance of the results on
 Prefrontal cortex dysfunction and Jumping to Conclusions 73

Table 4. Median (range) ‘draws to decision’ on the beads task for the left and right prefrontal groups
and control group

Left prefrontal Right prefrontal Control Kruskal–Wallis

(n = 9) (n = 8) (n = 19) ␹2 p†

Beads task condition 3.0 4.0 5.0 10.02 0.02

85:15 (5.0) (8.0) (7.0)
Beads task condition 4.0 7.0 9.0 8.97 0.03
60:40 (10.0) (10.0) (6.0)

†
Bonferroni corrected.

either the 85:15 condition (F = 4.21, p = 0.02) or the 60:40 condition of the beads task
(F = 7.05, p < 0.01). Covariate analyses were also run to examine the possible moderating
effects of the background neuropsychological and psychopathology measures on the
observed group differences on beads task performance. Adding these covariates also did
not alter the significance of the results on either condition of the beads task.

Association between executive functioning and Jumping to Conclusions

Although the prefrontal and ADHD groups did not show impairments on the working
memory or executive tasks, the data were analysed using Spearman’s Rank correlations
to explore whether executive functioning across the groups was associated with JTC.
There were significant, moderate correlations between draws to decision on the 60:40
condition of the beads task and Spatial Span backwards (rho = 0.36, p = 0.03) and
Brixton test (rho = 0.35, p = 0.01) scores, following Bonferroni correction.

Laterality analysis
Using the dichotomous JTC dependent variable, Fisher’s exact test revealed that the
left prefrontal group jumped to conclusions significantly more than the control group
(Bonferroni corrected, p < 0.01). Almost 39% of the left prefrontal lesion group
demonstrated the JTC bias, compared to 15% and 4% in the right prefrontal and control
groups, respectively.
On the ‘draws to decision’ data, the laterality analyses revealed a main effect of group
on both conditions of the beads task only following Bonferroni correction (see Table 4).
Post hoc Mann–Whitney Tests on the 85:15 condition revealed that the left prefrontal
group made significantly fewer draws to decision than the control group (U = 21.50,
Bonferroni corrected p < 0.01). There was no significant difference between the right
prefrontal group and the control group (U = 52.50, p = 0.21). The difference between
the left and right prefrontal groups did not reach significance (U = 22.0, p = 0.17). Post
hoc Mann–Whitney Tests on the 60:40 condition revealed the same pattern of results.
The left prefrontal group made significantly fewer draws to decision than the control
group (U = 31.50, Bonferroni corrected p = 0.02). The right prefrontal group was not
significantly different to either the left prefrontal (U = 30.0, p = 0.56) or the control
group (U = 38.50, Bonferroni corrected p = 0.13).
There were no significant differences on any of the other cognitive tests (neu-
ropsychological, probabilistic reasoning, or questionnaire measures) between the left
prefrontal group, right prefrontal group, and control groups.
74 Laura Lunt et al.

Discussion
In summary, the results reveal that the prefrontal group, in particular those with left
prefrontal lesions, demonstrate a JTC bias relative to controls, and that the ADHD group
perform in line with the control group on the beads task. The JTC effect in the prefrontal
group is not explained by any group executive impairments relative to other groups.
However, across the sample a relationship emerged between JTC and poor performance
on the Spatial Span backwards test and the Brixton test. The JTC effect in the prefrontal
group was not related to a general probabilistic reasoning deficit (which is consistent
with Dudley, Johns et al., 1997), or affective state (in line with Garety et al., 2005).
Contrary to the original hypothesis, the ADHD group did not show a JTC bias.
This may suggest that JTC is unrelated to impulsivity because response inhibition is
assumed to be a central deficit in ADHD (Barkley, 1997). Indeed this ADHD group scored
significantly higher, and into the impaired range, compared to controls and prefrontal
participants on the impulsivity subscale of the Barkley self-report measure of ADHD
symptoms. Further evidence that JTC is unrelated to impulsivity is the current finding of
no correlation between JTC and any executive measures of response inhibition. Instead,
these exploratory correlational analyses revealed an association between JTC on the
60:40 version of the beads task and executive measures of working memory (Spatial
Span backwards) and Brixton set shifting across the entire sample. Taken together, these
findings raise consideration of the executive processes involved in completing the beads
task. This specific association may be due to aspects of the task unrelated to the core
JTC construct. For example, all three tasks require spatial and temporal sequencing, and
it is likely that the 60:40 beads task condition places a higher demand on these abilities
than the 85:15 condition. This may also be congruent with Dudley, John et al.’s (1997)
argument that JTC might reflect an attempt to reduce working memory load, as well as
Young and Bentall’s (1995) notion that difficulties in processing sequential information
might underlie the JTC bias. Nevertheless, the absence of a deficit on the Spatial Span and
Brixton set shifting in the prefrontal group suggests that these aspects do not provide
an explanation for the JTC deficit.
There are potential explanations for the apparent left prefrontal involvement in the
beads task from a neuropsychological perspective. There is evidence that cognitive
switching is a function of the left prefrontal cortex (Goldstein, O’Brzut, John, Ledakis, &
Armstrong, 2004; Seidman et al., 1994; Stuss et al., 2002); as well as inductive reasoning
ability (Reverberi, Lavaroni, Gigli, Skrap, & Shallice, 2005). Left prefrontal involvement
has been found in functional neuroimaging studies of the Wisconsin Card Sorting Test
(Liu, Tam, Xie, & Zhao, 2002), which is closely related to the Brixton, which in turn was
found to be correlated with the harder condition of the beads task in the current study.
Additionally, there is evidence that left prefrontal cortical damage is associated with
‘novelty detection’ on problem solving tasks, for example, dealing with goal–subgoal
conflicts on the Tower of Hanoi task (Morris, Miotto, Feigenbaum, & Polkey, 1997).
Although the study did not reveal significant executive dysfunction within either of
the experimental groups, one should be cautious in ruling out a relationship between
executive impairment and the JTC bias. It is possible that individual deficits on executive
measures are masked when the prefrontal lobe participants are collapsed as a group,
due to fractionation of different executive functions within different prefrontal regions
(Goldstein, Bernard, Fenwick, Burgess, & McNeil, 1993; Shallice & Burgess, 1998).
Secondly, it is likely that the relatively small sample size within the current ADHD group
limited the power to detect group executive impairments; neuropsychological deficits
 Prefrontal cortex dysfunction and Jumping to Conclusions 75

in adult ADHD tend to have small effect sizes (Hervey et al., 2004). Nevertheless the data
suggest that impulsivity at the behavioural level, as seen in ADHD, is not an invariable risk
factor for JTC since no association was found between JTC and self-reported symptoms
of impulsivity on the Barkley scale.
Although the current study did not set out to study the relationship between
delusional thinking and JTC, delusional ideation (as measured by the PDI) was not related
to the JTC effect displayed by the prefrontal group. This is inconsistent with Colbert &
Peters (2002), but is consistent with Warman, Lysaker, Martin, Davis, and Haudenschield
(2007) who found no relationship between JTC and delusional ideation in the general
population. Thus, the current findings may appear to show some correspondence
with the view of JTC being an epiphenomenal effect of broader cognitive deficits in
schizophrenia. These studies (Garety et al., 1991; Menon, Pomarol-Clotet, McCarthy, &
McKenna, 2002; Moritz & Woodward, 2005; Mortimer et al., 1996) have found a JTC
effect in patients with schizophrenia but without delusions. This suggests that JTC is
not a cognitive bias, but rather a cognitive deficit (see Bentall, 1995; David, 1995), and
that this deficit alone cannot explain the occurrence of delusions. It is likely that a more
complex relationship exists between delusions, affective factors, and different cognitive
functions (Phillips & David, 2000), but there is the possibility that the JTC effect, as
measured by the beads task, is causally unrelated to delusions, even indirectly. While the
current study found no relationship between JTC and affective measures, it is possible
that different results may have been found if a more emotionally salient version of the
beads task was used as there is evidence that utilizing emotionally salient versions of
the beads task generates an increased JTC effect in psychiatric samples (Dudley, John
et al., 1997; Fraser, Morrison, & Wells, 2006; Warman et al., 2007; Young & Bentall,
1997).
In order to further explore the potential involvement of prefrontal/executive dysfunc-
tion in the JTC effect in delusions, the current investigation should be replicated with the
inclusion of individuals with schizophrenia. Our deficit model of JTC would be supported
if both prefrontal and schizophrenia groups showed a similar degree of JTC. It would
also be useful to match the groups on executive impairments or include individuals with
schizophrenia with known prefrontal abnormalities based on neuroimaging evidence.
This would provide a more direct comparison of prefrontal involvement in JTC across
both groups.
The finding of a marked JTC effect in the left prefrontal lesion group points to
future functional neuroimaging research with the beads task in healthy volunteers, in
order to determine whether the left prefrontal region contains a neural substrate for the
computation of probabilistic judgements. If so, it would be predicted that schizophrenia
patients would show less activation in this region compared to controls while performing
the beads task.
In summary, the study suggests that the JTC deficit is not specific to delusional
states or schizophrenia and is seen in prefrontal lobe damage. The lack of increased
delusional ideation in the participants with prefrontal damage in the presence of
the JTC deficit lends weight to this conclusion. However, the lack of executive
dysfunction in the prefrontal group suggests that JTC cannot straightforwardly be
seen as secondary to executive dysfunction. It is possible that JTC is measuring an
aspect of impulsivity not measured by the tests of response inhibition used in the
current study. Further delineation of the cognitive components that contribute to JTC
responses would help develop an understanding of the neurocognitive basis of this
phenomenon.
76 Laura Lunt et al.

Acknowledgements
The authors thank all the participants, and Esther Rose and Rhianna Watts for their help with
recruitment and data collection.

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Received 19 July 2010; revised version received 4 March 2011