Decision-Making: When Your Brain Is Fighting You

in ADHD Issues & Info
Decision-Making: When Your Brain Is Fighting You
Anatomy of a decision from the ADHD Perspective: This illustrates a common path as observed by this researcher as to how a decision comes to fruition. From the time a person is presented with their choices, they will commonly learn about the differences and similarities of each choice. They will then consider the benefits and problems with each option, weighing out the one that may bring more pleasure, and reduce pain. Then comes the feeling of doubt, which must be tackled in order to move forward, followed by resisting procrastination. The decision may be hijacked by a sense of fear of making the wrong decision, dealing with the decision, and the person may go back and forth multiple times before a decision is finally made. After the decision, doubt may resume, yet the finality of the choice made has to eventually be accepted.

Decisions, and the ability to make them, play an important role with regard to our sense of independence. The very act of being able to make decisions confirms our ability to live independently.2 We are, quite literally, confronted with decision-making situations constantly. But what happens if too many of the decisions we make on a regular basis don’t come easily? When each choice is a struggle? When we are paralyzed with the simple act of making a decision?

Decision-making, at least certain kinds of decisions, can become a tremendous burden for an individual, stifling their ability to be productive in school, later in life with choosing and subsequently sustaining a career, or even enduring negative life events.2 The problem of decision-making for those with ADHD has been scientifically shown to be a lack of activation in the hippocampus and anterior cingulate in the brain. The hippocampus is seen as important in functions associated with decision-making, specifically encoding unfamiliar stimuli or situations, processing spatial information, and being able to ‘call up’ past experiences in order to influence the current decision.4

Many times making a decision needs to be done in a limited or specific time frame. This would be difficult for someone with ADHD because being able to actually understand the options could stop one in their tracks from the start. Since the working memory of those with ADHD is often faulty, the act of remembering all the subtleties and variables of each option may not be doable for the ADHD person. Sequencing, and making sense of all the options could also prove difficult for the person with ADHD as the brain and neurological differences can make it difficult to put all the options being decided upon in a logical order.i Human beings generally make many of their decisions by focusing on the various options one at a time and then eliminate each option one-by-one until a choice is narrowed down --- basically what is ‘left’ after applying the criteria to the options being decided between.

Many individuals find themselves stuck not knowing what they should choose, and wind up either making no decision at all and missing an opportunity, or making a rushed decision resulting in a potentially bad choice, financial loss, or health loss. Individuals who have ADHD have difficulty giving close attention to detail, tend to make careless mistakes, have difficulty following instructions, fail to complete tasks, have difficulty organizing tasks, avoid activities that demand sustained mental effort, and who are easily distracted, thus will quite logically struggle with the act of making a decision.1

Impulsivity control can exacerbate the decision-making process because important decisions take time – something that many people don’t typically allow when confronted with a decision. Perfectionism is often a method that those with ADHD use in order to compensate for their impulsivity–which is essentially thinking about it and analyzing a decision ‘to death’ until they eventually give up and make no decision at all.3 Dopamine and noradrenaline play a part in decision-making. This, of course, is important information as those neurotransmitters play a key role in the executive functioning skills of the pre-frontal cortex and are typically diminished in the ADHD brain.1 One way to support the need for immediate gratification and curtail the impulsivity challenge of the ADHD brain could be to build in small rewards for benchmark steps in the decision-making process. By receiving milestone rewards this feeds the ADHD brain’s desire for pleasure and immediate gratification at the same time.6 Meditation, another process, helps to give the ADHD person a chance to ‘slow down’ and regain better focus, creating mindfulness. The idea of ‘sleeping on it’ many times helps individuals to come up with a decision with less effort and doubt as well.

Solutions:

In order to accomplish the decision-making task, it is important that there be fewer pieces of information with which to consider.ii Unfortunately, this is precisely the difficulty that those with ‘decision-challenges’ struggle with: filtering out data. Many people have difficulty determining what information is crucial to the decision, and many times feel compelled to look at ALL their options, which are too many in reality. A person may spend unnecessary hours of time to make a decision by reviewing too many details and options of each possibility - which is simply not warranted for the decision at hand. This process, and the stress associated with it, often results in procrastination and not making a decision at all. Or conversely, the person may wind up making an impulsive decision simply in order to avoid the drudgery and overwhelm of the process! (Getting it over with!).

  1. Set boundaries, such as setting a time limit. The individual would block out a determined amount of time in order to address and make a decision. They would be limited to the time they set in order to not have their research of the many choices become a ‘run-away train’ resulting in more confusion than before. A second boundary may be a budget limit: exemplified by determining the top amount of money that will be spent on the items being considered, and removing those that exceed the budget from the choices. A third could be a physical boundary. For example, if someone is trying to decide which items in their closet or drawers to keep versus discard, they can determine that only the items which fit into the drawer may be kept…end of decision! When the drawer or closet is full, then that is all the items that can be retained. Another boundary could be a number limit – for example, say a person is getting bids for a home improvement project, this can go on forever without some limitations in place, so they can limit the number of bids to three and decide between those only.
  2. Bottom-line – pick the most To reduce the options by identifying the most important criterion, whether that be the lowest cost, the higher safety rating, the aesthetic, etc., and basing the decision on that one main criteria, can help a decision to be made. So essentially, reduce the criteria to one component which you deem as the most important component, can aid in making a suitable and quick decision.
  3. Go with your gut! Research shows that going with your gut can be just as successful as weighing all the factors before you – and going with your gut takes far less time typically too.6

The inability to make conclusive and timely decisions can negatively impact the lives of individuals, and those with ADHD fall into this category more often than not. This would logically impact their home life, their work life, their relationships, and their overall success and joy. The key component seems to be that when it comes to making decisions, having some ‘rules’ or ‘direction’ helps, not just for those with ADHD - but for all individuals. In the Harvard Business Review article of October 2016, entitled, “Noise” it was stated that there is a problem with reliability of human decision-making because the judgments of humans can be strongly influenced by irrelevant factors such as one’s mood, what we may have last eaten, and even the weather. So, there is no ‘perfect’ solution!

In working with adults living with ADHD I see the problems first-hand…many are so stuck just deciding what to make for dinner nightly, or how to even begin on a project or task of any kind, that hours in their day may be sucked away grappling with these seemingly simple decisions. Decisions need to be made constantly – rarely does an hour go by without several decisions needing to be addressed in one area or another. Helping individuals, particularly those with ADHD to make decisions easier, waste less time doing so, and be more confident with their choice would result in more productivity, less stress and anxiety, better work and personal relationships, and quite possibly higher levels of success and joy in life. This could have far reaching benefits to the person’s entire life style due to better decisions being made with regard to finances, purchasing decisions, employment/career choices, and behavioral choices.

After all is said and done, making a decision should leave a person feeling complete and satisfied and able to move forward to the next task at hand…and be able to tackle, yet again…another decision.

REFERENCES:

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2. Hegde, S., & Ellaiosyula, R. (2016). Capacity issues and decision-making in dementia. Annals of Indian Academy of Neurology, 19S34-S39. doi:10.4103/0972-2327.192890
3. Kolberg, J., & Nadeau, K. (2012). ADD-Friendly Ways to Organize Your Life: Strategies that Work from a Professional Organizer and a Renowned ADD Clinician. Routledge.
4. Monique, Ernst, M. a., Alane S. Kimes, P. a., Edythe D. London, P. a., John A. Matochik, P. a., Dana Eldreth, B. a., Satva Tata, M. a., & … Karen Bolla, P. a. (2003). Neural Substrates of Decision Making in Adults With Attention Deficit Hyperactivity Disorder. American Journal Of Psychiatry: Official Journal Of The American Psychiatric Association, (6), 1061. doi:10.1176/appi.ajp.160.6.1061
5. Mowinckel, A. M., Pedersen, M. L., Eilertsen, E., & Biele, G. (2015). A meta-analysis of decision-making and attention in adults with ADHD. Journal Of Attention Disorders. 19(5). 355-367. doi:10.1177/1087054714558872
6. Sternberg, Robert J., and Karin Sternberg. Cognitive Psychology. 6th ed. Belmont: Wadsworth Cengage Learning, 2012. Print.







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You take my abstract problems and come back with concrete solutions
Andy M.