6. Thinking blocks / decision-making problems with ADHD

Thought blocks are a temporary restriction of cognitive performance that is often caused by acute stress. They occur with roughly the same frequency in ADHD with hyperactivity/impulsivity (ADHD-HI, ADHD-C) and ADHD with predominant inattention (ADHD-I).
Decision-making problems seem to occur more frequently in ADHD-I. High noradrenaline levels block the prefrontal cortex (PFC). This blockage leads to decision-making problems, as the PFC is important for weighing up options. Thinking blocks can also be symptoms of severe stress.

• 6.1. Thinking blocks as an ADHD symptom
• 6.2. Decision-making problems as an ADHD symptom
• 6.3. Neurophysiological correlates of mental blocks and decision-making problems
• 6.4. Thinking blocks as symptoms of stress

6.1. Thinking blocks as an ADHD symptom¶

Thought blocks are a temporary impairment of cognitive performance (formal thought disorder), which is usually caused by a high acute stress load.

Exam blackouts are a typical example of mental blocks.
Thinking blocks occur with about the same frequency in ADHD-HI as in ADHD-I.

6.2. Decision-making problems as an ADHD symptom¶

Decision-making problems means problems with making decisions, not problems with the quality or correctness of decisions made.

Decision-making problems appear to occur significantly more frequently in ADHD-I than in ADHD. This suggests that the different manifestations have different neurophysiological correlates.

While ADHD-HI is increasingly correlated with overly spontaneous, overly impulsive decision-making, the ability to make a decision is often severely impaired in ADHD-I. Even simple decisions can trigger the feeling of being overwhelmed.

6.3. Neurophysiological correlates of mental blocks and decision-making problems¶

High noradrenaline levels block the PFC via alpha-1 adrenoceptors and shift behavioral control to posterior brain regions.²³⁴⁵ As the PFC is very important for weighing up multiple decision options, blocking the PFC naturally leads to increased decision-making problems.
Decision-making problems must be distinguished from difficulties in the perception of time.⁶

For more details, see ⇒ Neurophysiological correlates of mental blocks and decision-making problems

6.4. Thinking blocks as symptoms of stress¶

Thinking blocks are also known as symptoms of severe stress.⁷⁸ The most pronounced form is thought blocking.