Indecision in ADHD

We all have to make thousands of decisions every day. Most of these will be small things like what to eat for breakfast or whether or not to bring an umbrella with you when you leave the house. Some of them will change the course of your life, like whether to apply for that dream job you saw listed online or whether to move to a new city. If you struggle with chronic indecisiveness, all of those decisions, regardless of how big or small, will feel impossible to make.

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What Is Indecision?

People with ADHD become indecisive for a lot of reasons, but regardless of the source, it most often takes the following forms:

• Avoiding making a decision until it’s too late
• Difficulty starting a task because you can’t figure out which one to do or where to start
• Making impulsive choices
• Anxiety or fear about making the wrong decision
• Overthinking or overwhelming yourself with more information than necessary to make a choice
• Relying on others to make choices for you
• Second-guessing or failure to commit to a decision

It can make taking tests difficult, for example, since a long series of multiple-choice questions (especially on a topic you aren’t personally interested in) require you to sustain focus, despite a lack of stimulation, and switch quickly between different sets of information to process in order to make a choice.

At work or for students outside the classroom, indecision can make it difficult to finish assignments. Whenever I have multiple tasks of equal importance, for example, I often feel paralyzed with indecision about which one to do first.

No matter what I choose, I end up feeling too guilty about the work I’m not doing at that moment to focus on the task I chose. There were so many weeks where I ended up getting none of them done because I used up all the time agonizing over the decision of which one to start.

It can also be frustrating for friends and family. If you’re chronically unable to make decisions, you might end up causing unnecessary delays, leaving your friends sitting hungry in a restaurant booth while you overanalyze the menu or waiting impatiently outside a movie theater while you struggle to vote on which movie to see.

The Psychological Basis for Indecision in ADHD

In the first case, the decision at hand might not be interesting or consequential enough to motivate a person with ADHD. Even if it is consequential (like a final exam), it might just not be stimulating enough to maintain motivation.

In the second case, low self-esteem can come from a history of impulsive or poor decision-making. It might also just be a general lack of confidence in your own abilities. For example, I often second guess my choices because I worry that it is impulsive or otherwise not reasonable.

After years without diagnosis or effective management tools, I have made my fair share of reckless decisions and mistakes, all of which come bubbling to the surface whenever I am faced with a new decision. While I have gotten better (thanks to strategies mentioned below), that doubt still lingers, making me worry that even the most obviously correct choices are somehow wrong.

The Neurological Basis for Indecision in ADHD

The anterior cingulate cortex is a key region of the brain involved in decision making. It receives a wide variety of input ranging from emotion to sensory response. It uses that to both make decisions and learn from their outcomes so that it can improve its decision-making strategy in the future.

To do that, it requires both positive and negative feedback: a reward response when the outcome of a decision is good and a punishment response when the outcome is bad, or at least not what you wanted.

For people with ADHD, however, that feedback system isn’t functioning properly. A 2018 systematic overview of studies on the neuroanatomical differences in ADHD found consistent evidence of an under-active cingulate cortex.

A 2012 study further pinpoints the problem as a lack of feedback signals needed to activate that region of the brain. The study looked at patients with ADHD and patients with bipolar disorder (BD). Both conditions are often characterized by indecision, impulsivity, and poor decision-making.

To better understand where the decision-making process was going wrong in each condition, researchers looked at two electric markers in the brain. Their data suggested that the brain wasn’t getting the strong “don’t do this” or “do this” feedback it needed to make a confident decision. Without that feedback, the brain struggles to learn decision-making strategies and may over-rely on impulse to compensate.

Tips for Overcoming Indecision

Since chronic indecision in ADHD often comes with feeling overwhelmed or unmotivated (or both), some of the best strategies for overcoming it are the ones that target those feelings. These are some of the methods I find the most helpful.

Amp up the Stakes With Gamification

Earning points provides a dose of instant gratification, and tying those points to rewards gives you a tangible goal to work toward and provides a bigger dose of gratification when you earn that reward. For example, you might earn 1 point for making any decision at all, 5 points if you do it in under 10 minutes, or 10 points if you do it in under five minutes.

Then, you’ll have a set of rewards you can unlock with those points. With 50 points, you can watch Netflix for one hour. 100 points means you can buy a new book. 200 points means you can schedule a day off to paint or draw.

Personalize the points earned to your own perceived difficulty level and personalize the rewards to be things you would actually want to work toward.

In my experience, the best rewards are things that you don’t keep in your house or have easy daily access to—I don’t use watching Netflix, for example. This is because I often lack the impulse control to put off those rewards until I’ve earned them, which makes them less effective as an incentive. My brain knows I don’t actually have to do the hard thing to get the fun thing. My rewards include small outings to places I like (bookstores, restaurants, museums), time off to do creative things, and travel.

Write It Down or Talk Through It Aloud

Writing through a decision helps get my thoughts organized and find clarity. I can write down my options, list out pros and cons, and keep all of those details in view and contained on the page. It stops me from getting lost in thought, sidetracked, or just going in circles over the same points over and over.

If you’re not one for writing, though, I know some can get similar results by talking through the problem out loud. Like writing, talking aloud helps them focus on the decision and organize the details into a coherent narrative.

Use a Decision Wheel

A decision wheel works best for things like figuring out the order to complete tasks or for more minor, less consequential decisions. Make a decision wheel (or use an online spinner) with numbers around it so you can apply it to just about any situation. Then, assign numbers to the tasks on your to-do list for the day or the set of options you’re choosing between. Spin the wheel and go with wherever it lands.

Another way to achieve the same results is to flip a coin or close your eyes and point (at, say, a menu or a list of chores).

Ask for Feedback From Someone You Trust

Reaching out to someone you trust and who knows you well is a great way to get outside perspective when you’re feeling overwhelmed or confused—just remember that the decision, ultimately, needs to feel right to you, too.

Save this strategy for bigger decisions where the outcome could seriously impact your life, though. You don’t need outside perspective every time you can’t decide which ice cream flavor to get or which sweater to wear.