By Elizabeth Ahmann, ScD, RN, ACC, of the ACO Research Committee

The process of decision-making commonly encompasses a range of experiences, from positive opportunities, to challenges, and even, at times, regret. A variety of factors can contribute to challenges in decision-making for individuals with ADHD, including impulsivity, distraction from the task, a feeling of overwhelm when considering a number of options, and difficulty organizing and prioritizing. The authors of a recent study in Journal of Attention Disorders (reviewed below) also suggest the possibility that both cognitive restlessness and the need for increased levels of mental stimulation related to ADHD could contribute to decision-making difficulties and a more frequent experience of regret (Shepman, Weyandt, Schlect & Swenotsky, p. 9).

This same study describes two approaches to decision-making, and the effort to avoid regret. One approach, called maximization, entails exploring all possible options or choices before selecting what one thinks will be “the best” among them. A different approach, called satisficing, involves looking at options only until finding one that is acceptable or “good enough.” Some prior research suggests that maximizers may be more likely than satisficers to experience regret associated with decision making.

The study described above—and reviewed below—examined the relationship of ADHD symptoms, and internal restlessness, to the tendency to maximize or satisfice as well as to regret.

Schepman, S. I., Weyandt, L., Schlect, S.D. and Swentosky, A. (2012). The relationship between ADHD symptomology and decision making. Journal of Attention Disorders,16(1), 3–12.

Brief Overview

In this study, researchers chose to examine the relationship of ADHD symptoms and internal restlessness to the tendency to maximize or satisfice as well as to regret. The relationship of gender to each of these factors was also explored.

The study’s four hypotheses were:

  1. Participants who reported more behaviors associated with ADHD and internal restlessness would report more maximizing tendencies,
  2. Participants reporting greater ADHD symptoms and internal restlessness symptoms would be more likely to report feelings of regret,
  3. Men would report more symptoms of ADHD and internal restlessness than women, and
  4. Men would be more likely to report maximization tendencies than women (p. 3).

Study Sample

A convenience sample (i.e. subjects not selected randomly and not selected for any specific characteristics) of 275 undergraduate students were recruited from psychology classes at one university and received extra credit in their class for completing study questionnaires. The majority of the student sample was between 18 and 22 years of age (78%), white (80%), unmarried (81%), female (59%), and not employed (55%) (p. 5). 94% reported that they had never been diagnosed with ADHD and 6% reported that they had a diagnosis (pp. 5-6).

Measures

Participants completed three study scales:
1) Adult Rating Scale (ARS), a 25-item measure derived from the ADHD criteria in the DSM-IV-TR 2)
2) Internal Restlessness Scale (IRS), a 24-item instrument evaluating symptoms of internal restlessness
3) MAX/Regret Scale, a combination of 13-items evaluating the inclination to maximize and 5-items assessing the propensity to feel regret. (For more information on the questionnaires, their sources and their reliability and validity, please see the study itself.)

Outcomes

This study demonstrated a relationship between maximizing tendencies in decision making and both ADHD symptoms (as measured by the ARS) and internal restlessness (as measured by the IRS).  A relationship was also found between a tendency to feel regret and both ADHD symptoms and internal restlessness. In terms of gender, men reported more behaviors typical of ADHD than did women, though scores related to internal restlessness did not differ significantly between the two groups. Men also reported both more maximizing tendencies and more regret than did women.

Based on the study results, the researchers offered the following recommendation:

[I]t may be helpful to consider … decision making abilities and strategies when treating adults with ADHD [because of] an increased likelihood to feel compelled to explore all possible options when making decisions, and therefore … to experience feelings of regret when they are unable to do so. Improving and becoming confident in decision-making abilities may help [these] adults reduce the mental distress resulting from feelings of regret. Furthermore, reducing the cognitive demand associated with time consuming rigorous decision making may free up much needed cognitive resources for these individuals (p. 10).

Some Strengths and Limitations

Strengths

  • This study examined a subject—decision-making and AD/HD—that has received relatively little attention in the research literature to date.
  • Both a style of decision-making (maximizing vs. satisficing) as well as a difficult outcome (regret) were examined, adding to the usefulness of research results.
  • Both reliability and validity of the study instruments were addressed, supporting the fact that they indeed measure what they purport to measure and are consistent in doing so.

Limitations

  • A convenience sample,such as that used in this study, limits the ability to generalize study results. In fact, given the age of study participants (the majority between 18 and 22), the authors are perhaps too bold in extending their recommendations (above) to any adults with ADHD as opposed to just young adults. Since the frontal lobes of the brain are still developing in young adulthood, and are likely to have an important impact on decision making, different results might have been found in older subjects.
  • Self-report measures are by nature subjective and may be impacted by ADHD symptoms (e.g. inconsistent responses, negativism).
  • While purportedly studying ADHD and decision-making, the number of study participants reporting an actual ADHD diagnosis was very small (5.9%) (p. 6).
  • Although the authors had collected data on prior ADHD diagnosis from each study participant, they did not report on the relationship between an official diagnosis and either maximizing or regret.  This is unfortunate because it might have yielded more useful or applicable results.
  • Since the study’s primary author is a faculty member at the school attended by study participants, and extra credit was offered for participation, the question of bias among participants familiar with his work must be considered.

Implications of this Research for Coaching Practice

  • The concept of maximizing and satisficing may provide one useful lens through which to view the decision-making process.
  • An awareness of the relationship between regret and a maximizing approach to decision making suggests that exploring decision making processes with clients may be valuable in supporting both satisfaction with decisions and overall mental wellness.
  • As the authors suggest, assisting clients in developing decision-making skills and strategies may also free up their cognitive energy for other pursuits.

Questions for Coaches to Consider

  • How do you make various types of decisions?
  • Do your intake materials inquire about a client’s comfort with decision-making?
  • How do you and your clients notice when challenges with decision-making contribute to getting stuck or overwhelmed?
  • What models of decision-making are you familiar with? How do you approach the issue of decision-making skills and strategies with clients?
  • What factors besides satisficing vs. maximizing do you find affect decision-making (e.g. perfectionism, perseveration, low self-esteem, urgency, complexity of the decision, impulsivity)?
  • In this study, maximizing is associated with regret. To what extent could impulsive decision-making be associated with regret?
  • How might you help a client move from maximizing to satisficing?
  • In another 2012 study, Mäntylä, Still, Gullberg and Del Missier explored the relationship of executive functioning (analytic/cognitive) factors and reward-system (motivational/affective) factors with decision making in adults with ADHD, finding that both cognitive and affective process impact decision making abilities. What implications does this additional finding have for your work with clients?

Additional reference

Mäntylä, T.,  Johanna Still, J., Gullberg, S. and  Del Missier, F. (2012). Decision making in adults with ADHD. Journal of Attention Disorders, 16(2) 164–173.

Note: This review was written as a service to ACO members by Elizabeth Ahmann, ScD, RN, ACC, of the ACO Research Committee and represents the perspective of that author. You can contact the author at LizAhmann.com