Decision making with ADHD: a simple strategy to help reduce decision-related stress

Decision-making with ADHD can be difficult. In this article we discuss some of the research behind this, and what we can do to support ourselves when coming to a resolution.

It's time to go over your notes. You open your notebook and think, "should I use a green or yellow highlighter?" You know this decision doesn't matter at some level, but it doesn't stop you from ruminating on this dilemma for 5 minutes. Finally, you give up. Maybe you'll read your notes later.

Those of us with ADHD can approach decisions differently

Do you relate to the example above? Research shows there are several links between ADHD and difficulty with decision-making. For instance, people with ADHD have been found to subconsciously favour decisions with immediate rewards over decisions with delayed rewards [5]. This tendency is sometimes known as temporal reward discounting or delay aversion [1], but you might be familiar with it as one of the driving forces behind procrastination. In addition to this short-term reward preference, those of us with ADHD often disregard the risk versus reward ratio of decision outcomes [3], so we may not correctly identify whether a decision is worth the risk.

There are pros and cons to this ADHD approach to decision-making. On one hand, our difficulty assessing the severity of the outcomes of our decisions may make us better entrepreneurs, because a willingness to take risks is a valuable trait in someone starting their own venture. On the other hand, difficulty assessing the risk-to-reward ratio of a decision can also mean the consequences of minor decisions are blown out of proportion. This can lead to something called 'decision fatigue', a state of mental tiredness that follows tasks that require us to monitor our behaviour [3]. Bigger decisions require more self-control, and so we experience greater decision fatigue as a result [2]. Therefore, to reduce decision fatigue, it's important that we can accurately and efficiently identify which decisions are significant and which are less significant.

The scientific approach as a strategy for ADHD decision making

Consider these decisions you might have to make in your life:

• Which socks to wear

• Which apartment to sign a lease on

• Which career to pursue

In science, there is an understanding that even a well-informed decision risks being wrong. The acceptable margin of error (the amount that something is allowed to be wrong) differs depending on the field of research. Even in the most consequential fields, such as medical research, scientists accept a 1% margin of error (a 1% chance that the results of the study are false, and any conclusions drawn from the research are potentially untrue)..T

Each of the decisions described above has levels of importance and, therefore, different acceptable margins of error. . Choosing between pairs of socks might have as high as a 50% acceptable margin of error, meaning it is safe to leave this decision to random chance because the consequences of wearing the less stylish pair of socks for a day is negligible. In contrast, choosing which career to pursue might have a 5% acceptable margin of error because the career you choose will determine how you spend many years of your life. How we approach these decisions should reflect how much you are willing to leave up to chance. Decisions with a low acceptable margin of error demand more time to reduce the risk of error, and in the case of picking a career, this might justify months of careful consideration. So when making a decision, it's helpful to consider:

• What are the consequences of making the wrong choice?

• What margin of error would I assign to this decision?

• Based on that margin of error, how much time should I dedicate to thinking about this decision?

As I mentioned at the beginning of this article, we often spend a great deal of time considering the pros and cons of an ultimately inconsequential decision. Knowing this weakness can make you aware of it, so consider these practical steps when you want to reduce decision-making.

Three practical tips for better decision making

1. Moderate your perfectionism. With ADHD, we often tend to be perfectionists [3], finding it hard to put a task down until the solution is perfected. Perfectionism can be a great asset in certain fields and is particularly useful when there are few limits on your time and energy. So, try to reserve the perfectionist urge for important decisions with a correspondingly significant margin of error.

2. Make decisions before they are made for you. There is preliminary evidence to suggest decisions we are forced to make are more mentally exhausting than decisions we make for our own reasons [7]. So procrastinating a decision to the point where your options are forcibly reduced brings about greater decision fatigue. For tips on managing procrastination, try this article.

3. Don't sweat the small stuff; conserve your energy. The effort involved in reducing the risk of error in a decision taxes our finite mental resources. especially our working memory. Reserve your focus and effort for decisions where the wrong choice has significant consequences. By doing so, you can reduce feelings of overwhelm that occur when you have too little energy and motivation about the tasks expected of you.

Making choices, particularly big choices, is one of the most difficult parts of life. For those of us who feel burdened by decision-making, this process can help us manage decision fatigue while striving to make the best-informed choices. P.S.  Whenever you’re ready... here are 4 ways I can help you reach your goals with ADHD:

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References

1. de Castro Paiva, G. C., de Souza Costa, D., Malloy-Diniz, L. F., Marques de Miranda, D., & Jardim de Paula, J. (2019). Temporal Reward Discounting in Children with Attention Deficit/Hyperactivity Disorder (ADHD), and Children with Autism Spectrum Disorder (ASD): A Systematic Review. Developmental Neuropsychology, 44(6), 468–480. https://doi.org/10.1080/87565641.2019.1667996

2. Gabaix, X., Laibson, D., Moloche, G., & Weinberg, S. (2006). Costly Information Acquisition: Experimental Analysis of a Boundedly Rational Model. American Economic Review, 96(4), 1043–1068. https://doi.org/10.1257/aer.96.4.1043

3. Luman, M., Oosterlaan, J., Knol, D. L., & Sergeant, J. A. (2008). Decision-making in ADHD: sensitive to frequency but blind to the magnitude of penalty? Journal of Child Psychology and Psychiatry, 49(7), 712–722. https://doi.org/10.1111/j.1469-7610.2008.01910.x

4. Pignatiello, G. A., Martin, R. J., & Hickman, R. L. (2018). Decision fatigue: A conceptual analysis. Journal of Health Psychology, 25(1), 135910531876351. https://doi.org/10.1177/1359105318763510

5. Sørensen, L., Sonuga-Barke, E., Eichele, H., van Wageningen, H., Wollschlaeger, D., & Plessen, K. J. (2017). Suboptimal decision making by children with ADHD in the face of risk: Poor risk adjustment and delay aversion rather than general proneness to taking risks. Neuropsychology, 31(2), 119–128. https://doi.org/10.1037/neu0000297

6. Strohmeier, C. W., Rosenfield, B., DiTomasso, R. A., & Ramsay, J. R. (2016). Assessment of the relationship between self-reported cognitive distortions and adult ADHD, anxiety, depression, and hopelessness. Psychiatry Research, 238, 153–158. https://doi.org/10.1016/j.psychres.2016.02.034

7. Vohs, K., Baumeister, R., & Twenge, J. (2002). Decision Fatigue Exhausts Self-Regulatory Resources — But So Does Accommodating to Unchosen Alternatives. Unpublished Manuscript.