The Psychology of Decision
The Psychology of Decision
The Psychology of Decision
Contents
1. Theoretical Perspectives on Decision Making 186
1.1 Normative and Descriptive Theories 186
1.2 Dual-Process Theories 190
1.3 Role of Noncognitive Processes in Decision Making 192
1.4 Developmental Perspectives on Decision Making 196
1.5 Summary of Theoretical Perspectives on Decision Making 198
2. Decision Making and IDD 199
2.1 Research on Decision Making with Individuals with ID 200
2.2 Research on Decision Making with Individuals with WS—A Singular
Disorder Associated with ID 206
2.3 Research on Decision Making with Individuals with ASD 208
2.4 Summary of Decision-Making Research with Individuals with IDD 211
3. A Pathways Model of Decision Processing 212
4. Conclusion 218
References 222
Abstract
This chapter overviews general theoretical advances including developmental perspec-
tives in the study of decision-making behavior and their applicability in understanding
how individuals with intellectual and developmental disabilities (IDD) approach inter-
personal decisions in their lives. Of particular importance are the theoretical explications
of the roles of cognitive and noncognitive processes (e.g., motivation and emotion), and
the contextual demands of different decision tasks, as possible loci of the decision-
making difficulties observed in individuals with IDD. Extant decision-making research
with individuals with IDD is summarized and a Pathways of Decision Processing model
is outlined for the systematic study of their decision-making processes and building
adaptive decision-making strategies. The chapter examines distinct disability-specific
patterns of decision-making difficulties associated with underlying etiologies and phe-
nomenological characteristics of the subtypes of IDD, with implications for the need for
International Review of Research in Developmental Disabilities, Volume 47 # 2014 Elsevier Inc. 185
ISSN 2211-6095 All rights reserved.
http://dx.doi.org/10.1016/B978-0-12-800278-0.00006-3
186 Linda Hickson and Ishita Khemka
that, sometimes, heuristics can be faster and more accurate than more complex
decision-making strategies based on more complete information.
Detailed information processing can sometimes be subverted during
decision making by the presence of biases, such as framing effects. The man-
ner in which a decision problem is “framed” may also alter the way in which
a decision is approached. The framing of a problem can affect the weighting
of the different attributes of the problem. This might bias the decision-maker
to attend to selected attributes of a problem and affect the decision outcome.
Kahneman (2011) has provided descriptive examples of how people assign
differential values to situations that are framed as either gains or losses.
carried out: (1) goal setting, (2) information gathering, (3) decision structur-
ing, (4) making a final choice, and (5) evaluating the process.
More recently, the focus of the theoretical literature has been shifting
away from an emphasis on deliberative, stage- or phase-based models.
Kruglanski and Gigerenzer (2011) have pointed out that deliberative deci-
sions are not necessarily more successful than intuitive decisions. In both
cases, it depends on the match between the decision rules and the situation,
and on the processing capacity of the individual decision-maker. These
issues have been explored most thoroughly in the literature on dual-process
theories of decision making.
intelligence, but reflective processes are not. He went on to suggest that the
continuous processing disruptions associated with ID would be most appar-
ent in the domain of algorithmic processing and the more discontinuous
processing disruptions associated with ASD would be more apparent in type
1 processing.
An interesting example of the primacy of intuition-based processing is
provided by Klein’s (1998, 2009) research on the decision making of experts
who were called upon to make important decisions on a regular basis as part
of their jobs. When Klein interviewed and observed the experts, who
included fire ground commanders, military leaders, and nurses in neonatal
intensive care units, he reported that the experts did not typically structure
a decision to search for multiple alternatives. Instead, they tended to catego-
rize a decision as an example of a prototype and then implement an appli-
cable solution based on their memory of past experiences. Klein concluded
that expert decision-makers tend to “satisfice,” employing the first solution
accessed that will work in a given situation, rather than seeking an optimal
solution. In a joint effort to explore the sources of intuition, from their dis-
parate theoretical orientations, Kahneman and Klein (2009) agreed that the
primary source of intuitive decisions is memory. Expert intuitions are based
on extensive experience in a domain, but intuitions also may arise from sim-
plifying heuristics, often resulting in inaccurate or biased decisions. Truly
expert decisions must be based on adequate experience with an environment
that affords sufficient regularity to provide valid cues.
Glockner and Witteman (2010) elaborated further on the nature of intu-
itive processes in decision making, suggesting that there are four different
types of processes underlying intuition: (1) associative intuitions—based
on simple learning and retrieval of feelings of liking or disliking or of pre-
viously successful actions; (2) matching intuitions—involving matching of
possible decision actions to learned exemplars and prototypes; (3) accumu-
lative intuitions—based on quick, automatic processes involving integration
of memory traces with currently available information; and (4) constructive
intuitions—the automatic construction of consistent representations based
on integration of memory traces with currently available information.
Glockner and Witteman suggested that future research should focus on
understanding these underlying processes rather than continuing the debate
on whether intuitive or deliberative processes result in the best decisions.
New research is also beginning to shed light on the relation between type
1 and type 2 processing and whether and to what extent the two processes
operate sequentially/serially or simultaneously during decision making.
192 Linda Hickson and Ishita Khemka
1.3.1 Motivation
Fiske (1992), Kruglanski (1989), and Shah and Kruglanski (2000) have
argued that cognition and motivation constitute two important components
of decision making that interact with each other to produce different
types, or degrees, of motivational input that affect the extent and direction
Psychology of Decision Making 193
1996). In addition, the manner wherein specific goals are pursued can vary
considerably across individuals and situations. In effect, the goals provide the
constraints within which various motivational and personal characteristics
may express themselves to inform the identification and evaluation of deci-
sion alternatives.
1.3.2 Emotion
Decision making, especially in social situations, cannot be understood with-
out considering emotional and contextual variables (Argyle, 1991; De
Martino, Kumaran, Seymour, & Dolan, 2006; Parkinson & Simons,
2009). Recent advances in the neuroscience of affect and emotion have con-
tributed substantially to our growing understanding of the neural basis of
decision making (Delgado, Phelps, & Robbins, 2011). For example, the
neuroscience of social decision making has begun to yield important insights
about the neural mechanisms that support decisions about trust and confor-
mity to social norms (Rilling & Sanfey, 2011).
Neuropsychologists have studied the impact of relationships between
emotional control and reasoning capacities in relation to people’s ability
to resolve everyday problems (e.g., Frith & Singer, 2008; Rath, Simon,
Langenbahn, Sherr, & Diller, 2003). It is assumed that the initial,
problem-orientation phase of decision making is primarily affective in
nature. In situations that call for decision making under uncertainty, the
integration of emotional contextual information into the process can serve
as a useful heuristic. Some theorists have viewed the role of emotion in
decision making as largely negative (e.g., De Martino et al., 2006;
Martin & Delgado, 2011). Others, however, have challenged this assump-
tion and suggested that intuitive/emotion-based decisions may
“incorporate important social insights” (Frith & Singer, 2008, p. 3884).
Frith and Singer pointed out that effective social decision making relies
on understanding the emotions and intentions of others and is aided by
the mirror system, empathy, and “theory of mind”. Frijda (1986) has
affirmed the valuable input of emotions in helping decision-makers to pri-
oritize goals and in generating a state of action readiness needed to respond
to relevant concerns in a particular situation. This shift in emphasis that
acknowledges the central role of emotions in decision making has been ter-
med the “emotion revolution” by Weber and Johnson (2009). They pro-
posed that emotional, or affective, processes, described as automatic or
effort-free, can serve the following four functions in decision making:
Psychology of Decision Making 195
(1) spotlighting key information, (2) providing new information, (3) serv-
ing as a common currency, and (4) serving as a motivator.
An extensive and growing body of research has examined the effects of
emotions and affect specifically on information processing and decision
making (for reviews, see Clore, Schwarz, & Conway, 1994; Delgado
et al., 2011; Eagly & Chaiken, 1993; Epstein, 1994; Fiedler, 2000; Isen &
Geva, 1987; Lazarus, 1999; Martin, 2000; Zajonc, 1980). Studies on affect
and emotions have emphasized that emotional appraisals may affect the
degree to which people engage in systematic versus heuristic or intuitive
processing. Variations in information processing may be explained in terms
of differences in individual emotional appraisals (e.g., happiness or sadness)
of decision-making situations (Keltner, Ellsworth, & Edwards, 1993;
Tiedens & Linton, 2001). Recent research has emphasized the necessity
of examining differences in processing based on more diverse sets of emo-
tions, within positive and negative affective states. For example, studies (e.g.,
Bodenhausen, Kramer, & Susser, 1994; Lerner, Goldberg, & Tetlock, 1998)
have shown that although feelings of sadness promote systematic processing,
anger fosters more heuristic processing.
The effectiveness of decision making may decline in situations of high
stress, anxiety, or emotion ( Janis & Mann, 1977; Keinan, 1987). Other
effects on the choice of decision strategies may come from people’s emo-
tional reactions to the decisions they make. For example, once a decision
has been made in a particular situation, the decision-maker may consider
what would have happened if she/he had chosen differently. This would
lead her/him to experience certain emotions (e.g., joy or regret), which,
in turn, may affect her/his response to other decision tasks. It is rational
and adaptive to account for emotional reactions and assume that the expe-
rience will inform individual decision-making routines in the future.
Schwarz and Clore (1996) mentioned that self-regulatory focus serves as a
moderating factor in interpreting and internalizing emotions associated with
past experiences. For example, in the event that goals are not met, individ-
uals who are promotion-focused may perceive failure as the absence of a
desired outcome and hence feel dejection or disappointment. In contrast,
prevention-focused individuals may view the failure as the presence of
unwanted outcomes, reacting in an agitated or threatening manner. Such
distinctive emotional reactions tied to regulatory mechanisms are assumed
to serve as information signals and impact the individual’s encounter
with the decision-making situation. Several studies (e.g., Kalisch, Wiech,
Herrmann, & Dolan, 2006; Ochsner & Gross, 2005) have shown that
196 Linda Hickson and Ishita Khemka
than adolescents who believed that they were playing alone (Smith,
Chein, & Steinberg, 2014). Neuroimaging studies have associated the
effects of peer influence with heightened activity in the areas of the brain
that reflect the valuation of rewards (Chein, Albert, O’Brien, Uckert, &
Steinberg, 2010).
Advances in developmental neuroscience (see Casey, Giedd, & Thomas,
2000; Keating, 2004; Spear, 2000) have pointed to sizeable changes in both
the structure and functional aspects of brain development throughout the
course of adolescence. Specific changes are observed in multiple regions
of the prefrontal cortex with rapidly expanding linkages to the whole brain
leading to enhanced connectivity and communication among different brain
regions. These changes support improvements in various aspects of execu-
tive functioning, including metacognition, long-term planning, self-
regulation, and the coordination of affect and cognition, resulting in
increases in adolescents’ efficiency of information processing and reasoning.
Martin et al. (2002) and Spear (2000) have also highlighted that there is
improved connectivity between regions of the prefrontal cortex and several
areas of the limbic system during adolescence, a restructuring that further
shapes the ways in which individuals evaluate and respond to risk and
reward. Steinberg et al. (2009) have demonstrated that future-orientation
variables such as planning ahead and anticipation of long-term consequences
are embraced in the cognitive control system and they mature gradually
from younger adolescence to adulthood. Whatever the underlying pro-
cesses, there is broad consensus that older adolescents show perceptible
improvements in deductive reasoning and enhanced efficiency and capacity
for information processing (Wigfield, Byrnes, & Eccles, 2006). As a result of
these gains, the core of the change is expressed in adolescents eventually
becoming more self-regulated and self-directed.
involve cognitive and/or social limitations that may affect either decision-
making competence or style. However, within the broad IDD category,
disability-specific characteristics associated with specific conditions may
affect decision making in particular ways.
The American Association on Intellectual and Developmental Disabilities
(American Association on Intellectual and Developmental Disabilities, 2010)
defines ID as a condition “characterized by significant limitations both in
intellectual functioning and in adaptive behavior as expressed in conceptual,
social, and practical adaptive skills.” Although ID is itself a global term
encompassing a range of conditions with known and unknown etiologies,
most of the existing research on decision making has focused on identifying
and remediating difficulties in heterogeneous ID samples in response to
alarming statistics on the social vulnerability of this diverse group. Research
studies linking disability-specific patterns of decision making to specific disor-
ders associated with ID, such as WS, remain scarce, although evidence is
emerging regarding the specific vulnerabilities of individuals with singular
types of ID (Fisher, Moskowitz, & Hodapp, 2013).
According to the most recent DSM-V diagnostic criteria (American
Psychiatric Association, 2013), ASD is defined as consisting of persistent
deficits in social communication and social interaction accompanied by
restricted, repetitive patterns of behavior that emerge during the early devel-
opmental period. Levels of social anxiety are often high in individuals with
ASD, typically exceeding levels in the general populations (e.g., Lecavalier,
Gadow, DeVincent, Houts, & Edwards, 2009; White & Roberson-Nay,
2009). Studies investigating decision making in individuals with ASD have
begun to yield important information about their decision-making patterns.
In the following sections, available research on decision making in indi-
viduals with ID, WS, and ASD will be discussed in turn.
(alternative ways to handle the problem)? (3) What could happen if. . . (for
each alternative)? and (4) What is the best thing for (name of protagonist) to
do in this situation? As can be seen, this approach addresses when and how to
apply a systematic type 2 approach involving hypothetical, algorithmic
processing to consider possible alternatives and their potential consequences,
and which, according to Stanovich (2011), is the ability most likely to be
impaired in individuals with ID. The results of the evaluation study indi-
cated that the 18 women in the intervention group obtained significantly
higher posttest scores than the 18 women in the randomly assigned control
group on the key criterion measure of independent, prevention-focused
decision making in situations of abuse.
The original ESCAPE curriculum was subsequently modified so that it
would be appropriate for teaching self-protective decision-making strategies
to men as well as women. The efficacy of this revised, ESCAPE-DD
(Khemka & Hickson, 2008), version of the curriculum was evaluated in a
recent study involving 58 adults with mild and moderate ID (Hickson,
Khemka, Golden, & Chatzistyli, 2012). Participants were randomly assigned
to either an intervention group, who received ESCAPE-DD, or to a wait-list
control group, which was given delayed access to the curriculum upon com-
pletion of posttesting. Subjects completed individual pretests and posttests
consisting of six vignettes depicting situations involving sexual, physical,
and verbal abuse. After each vignette was read to them, subjects were asked
to respond to one comprehension question (What is happening in this story?) and
one decision-making question (What should (name of protagonist) do?).
Results indicated that, on the posttest, subjects in the intervention group
produced significantly more comprehension responses that accurately iden-
tified situations as involving abuse or violation than subjects did in the con-
trol group. Subjects in the intervention group also produced significantly
more effective decision-making responses reflecting attempts to avoid or
escape from the abuse than subjects did in the control group. Overall,
approximately 84% of the intervention group’s posttest responses consti-
tuted reasonable attempts to avoid or escape from the abuse situation, while
only 63% of the control group’s posttest responses represented such
attempts. When responses to the decision-making questions were catego-
rized further to look at responses that indicated an effort to be safe now by
verbally resisting, physically fleeing, or calling for immediate help to avoid
or escape from the threatened or ongoing abuse, a significant difference
favoring the intervention group was found. This finding suggested that
adults who participated in the intervention were producing more responses
Psychology of Decision Making 205
with the potential to actually stop the abuse from happening than were the
adults in the control group.
A significant positive correlation was found in this study between
effective decision-making scores and IQ. Correlational analyses were also
conducted to examine relationships between posttest safe-now decision-
making scores and mastery of each of the four decision-making strategy
components measured during the final training session. A significant positive
correlation was obtained for only the third step—evaluation of possible con-
sequences. Interestingly, mastery levels were the lowest for this step, with
only 70% of the sample reaching mastery. Mastery levels for the other three
steps (problem identification, generation of alternatives, and selection of a
decision action) ranged between 80% and 90% and correlations with safe-
now posttest responses were low and not significant. It is important to note
that evaluation of consequences is the component of decision making that
relies most heavily on extensive hypothetical thinking and is, as suggested by
Stanovich (2011), most likely to be affected by the cognitive limitations of
individuals with ID.
Given the importance of peer group influences on adolescent social
interactions and hence their interpersonal decision-making skills (e.g.,
Gardner & Steinberg, 2005), our recent work with adolescents has empha-
sized the study of decision making in the context of peer pressure. Most
studies in the developmental literature have focused on the negative effects
of peer influence during adolescence in terms of risky behaviors or peer vic-
timization. Only a few researchers have acknowledged the impact of neutral
or positive peer pressure (Barry & Wentzel, 2006; Ellis & Zarbatany, 2007;
Steinberg & Silverberg, 1986). In our research, we have chosen to take a
broad view of peer influence that includes both positive and negative peer
pressure, with the goal of not only preventing risky decision making but also
fostering age-appropriate prosocial interactions and positive personal rela-
tionships. As Mounts and Steinberg (1995) have pointed out, norms and
values may vary across adolescent peer groups, and sometimes the influence
of peers can be adaptive, encouraging socially desirable behavior (e.g., pos-
itive peer pressure to do well in school, avoid drugs, not rush into sexual
relationships). Accordingly, in the decision-making scenarios used in our
adolescent studies (e.g., Khemka, Hickson, Zealand, & Mallory, 2011;
Khemka, Hickson, Mallory, & Zealand, 2013), we have attributed motives
to peers that manifest in a positive or prosocial manner (e.g., encouraging
peer to finish homework before going out) as well as motives that are clearly
negative (e.g., pressuring peer to use drugs).
206 Linda Hickson and Ishita Khemka
body of work (e.g., Boujarwah, Hong, Arriaga, Abowd, & Isbell, 2010).
One study that included some participants whose cognitive levels were
comparable to those of the ID samples discussed in previous sections
(Verbal IQ ¼ 57–101) suggested that the generation of alternatives may be
an area of particular difficulty for individuals with ASD because of their
well-documented issues with flexibility. The authors of this study, Ruble,
Willis, and Crabtree (2008), reported that more than half of their participants
improved in their ability to generate multiple solutions to problems after
participation in a cognitive/behavioral social skills group.
In an often-cited study by De Martino, Harrison, Knafo, Bird, and Dolan
(2008), young adults with ASD (Mean IQ ¼ 112.1) showed significantly less
sensitivity to a contextual-framing effect (financial tasks presented in either a
gain or a loss frame) in a decision task and revealed a more logical pattern of
decision making, in comparison to age- and IQ-matched young adults with
typical development. Although the pattern of decision making for the indi-
viduals with ASD demonstrated logical consistency, it implied reduced
behavioral flexibility and difficulty with incorporating emotional cues into
the decision process. Psycho-physiological evidence collected in this study
(skin conductance response measuring emotional sensitivity) corroborated
evidence from previous studies by De Martino et al. (2006) and
Kahneman and Frederick (2007). It pointed toward a potential core neuro-
biological deficit in ASD that interfered with the ability to integrate emo-
tional context easily into the decision-making process. This deficit is
noted to assume considerable importance during social interactions
in situations of uncertainty when information about others is often ambig-
uous and the need to absorb emotional contextual information into the deci-
sion process outweighs the need for standard inferential reasoning processes.
For optimal decision making in uncertain social environments, the ability to
incorporate a broad range of contextual cues into the decision process is
interpreted to operate as an “affect heuristic” that allows the decision-maker
to evaluate multiple sources of critical and subtle information and to make
rapid responses without having to necessarily engage in a demanding or
enhanced analytic process (Stanovich & West, 2002). On this basis, a failure
by individuals with ASD to deploy an affect heuristic in complex and uncer-
tain social contexts might limit their intuitive reasoning mechanisms and
thereby their social competence.
Luke et al. (2012) compared the decision making of adults with (Mean
Verbal IQ ¼ 116.4) and without ASDs (Mean Verbal IQ ¼ 114.2) and found
distinct differences in the experiences of the two groups. In the absence of
210 Linda Hickson and Ishita Khemka
limited in their emotional awareness, and may need extra regulatory struc-
ture and added supports, and for much longer into their life span, than their
counterparts without disabilities, for whom regulatory supports may become
less necessary with increasing age.
Research based on the study of the etiology of disorders and the resulting
phenotype–genotype associations will surely over time help to elucidate
more clearly the variations in typical and atypical developments of brain,
learning, and behavior, and therefore, decision making. However, with
extant literature still limited in this area, we have focused on the functional
outcomes of genetic and biological factors for decision making by identify-
ing individual differences in the basic processes of cognition, motivation,
and emotion underlying decision making (see Hickson & Khemka, 2013).
Research supports the relevance of each of the three basic processes in
the decision-making difficulties of individuals with IDD. For example, cog-
nitive limitations may include not only reduced processing capacity and
memory but also limitations in the comprehension required for fully under-
standing the nature of a situation requiring a decision (e.g., friendly or
threatening) (Khemka et al., 2013). Motivational differences that may affect
decision making include goal priorities and the relatively weak personal
agency beliefs that have been described as “learned helplessness” in individ-
uals with IDD (e.g., Jenkinson, 1999). There is evidence that emotional pat-
terns, similar to those observed in individuals with IDD (e.g., Wishart,
Cebula, Willis, & Pitcairn, 2007), also play a key role in decision making.
Decision-making effectiveness in individuals with IDD may be limited by
difficulties in accurately identifying the emotions and intentions of others
(emotional context) as well as a lack of the emotional self-regulation needed
to formulate a reasoned response in the face of a threatening situation.
The research with individuals with various forms of IDD indicated that
there were disability-specific ways in which difficulties with these basic pro-
cesses interfered with decision-making effectiveness. A listing of some of the
sources of decision-making difficulty associated with each of these basic pro-
cesses that have been associated with ID, WS, and ASD to date is provided in
Table 6.1.
evolving frameworks, we have drawn upon the body of empirical work with
individuals with IDD as well as the theories discussed in Section 1 of this chap-
ter, especially the descriptive and dual-process theories (e.g., Kahneman,
2011; Selten, 2001; Simon, 1986; Stanovich, 2010, 2011).
Although there is a growing understanding of the sources of difficulty
that can interfere with the decision making of individuals with IDD, knowl-
edge is incomplete about the full constellation of processes that individuals
with IDD employ when faced with the opportunity to make a decision,
especially one involving risk in the real world. Given the wide range of deci-
sion performance differences among individuals with IDD, it is reasonable to
assume that there is no single developmental trajectory by which less nor-
mative to more normative decision-making behavior evolves in individuals
with IDD. Given the strong claims (Albert & Steinberg, 2011; Jacobs &
Klaczynski, 2002) that competence in judgment and decision making does
not necessarily develop along a unidirectional, linear trajectory progressing
developmentally from initial intuition (type 1) to later mature deliberative
thinking (type 2) with age, it is reasonable to explore multiple pathways
or modes of decision processing for individuals with IDD.
In addition, the application of naturalistic decision-making models (see
Greitzer, Podmore, Robinson, & Ey, 2010; Klein, 1997) to explain how
individuals make rapid decisions in emergency or time-critical situations
lends credence to the effectiveness of subconscious, automatic information
processing in arriving at in-the-moment good decisions without having to
engage in a deliberative evaluative process. The findings also underline that
rapid decision making is primed by memory structures and experience that
facilitate recognition and matching of novel situations to previously encoun-
tered situations and subsequent recall of cues, actions, and expectations.
Over time, experience and long-term memory builds up to create nonco-
nscious, instinctive knowing patterns in decision responding (see Allen,
2011; Hammond, 2010; Sinclair, 2010).
The most recent version of our framework, the Pathways of Decision
Processing model shown in Fig. 6.1 (see Hickson & Khemka, 2013 for a
detailed description), offers a working model that can be applied with indi-
viduals with and without disabilities across a range of social decision-making
situations, ranging from everyday decisions about activities with peers to
more complex decisions about interpersonal interactions that may involve
abuse, negative peer pressure, or bullying. It is assumed that most adults
without disabilities possess a full repertoire of decision-making strategies that
allow them to shift flexibly among the four pathways as needed when faced
with various types of decisions. The model thus provides a structure for
Pathways of decision processing
Reasoned
Pathway 3 Pathway 3 reflective
Regulatory and
Intuitive automatic inhibitory
controls Use of DM strategy
DM strategy
Biological/neurological/developmental
Figure 6.1 Pathways of decision processing. From Hickson and Khemka (2013).
216 Linda Hickson and Ishita Khemka
4. CONCLUSION
It is clear that decision making is a much more complex process than
that which we envisioned when we began our work in this area over 15 years
ago. However, thanks to the high level of interest and activity in decision-
making research and theory in multiple fields, including economics, psychol-
ogy, and neuroscience, we now know much more about the processes that
underlie effective decision making and the ways in which it can get derailed
for individuals with various forms of IDD. There is a range of functioning for
individuals with IDD, with their level of decision participation in everyday life
varying from complete dependency on others for decision making to virtually
independent levels of autonomy and decision making. Our research is aimed
at finding ways to enable people with IDD to have as much choice and control
as possible over their lives. Providing them with a repertoire of effective
decision-making strategies may enhance their interpersonal relationships, sup-
port their personal safety, and make it possible for them to be involved in their
Psychology of Decision Making 219
safety goals during decision making needs to be explored. For both individ-
uals with ASD and WS, research is needed to expand their repertoires of
motivations/goals for application in social interaction situations.
Systematic studies of ways in which decision making may be affected dif-
ferently by the underlying conditions of these and other specific forms of IDD
are still relatively sparse. Thus, we currently have only limited understanding
of how specific etiological factors predispose individuals to adaptive or dys-
functional decision styles. However, as shown in Table 6.1, the emerging evi-
dence does suggest that distinct difficulties are associated with underlying
etiologies and behavioral phenotypes. This creates a pressing need to perform
group comparison studies (ID, singular types of ID, ASD) to verify and expli-
cate the nature of disability-specific differences in decision processing in terms
of the roles of key cognitive (e.g., comprehension, processing capacity), moti-
vational (e.g., personal agency beliefs, goal prioritization), and emotional fac-
tors (e.g., anxiety, recognition of emotional context and regulation of
emotions) deemed essential in decision making.
The Pathways model suggests that, moving forward, the next generation of
research studies needs to explore the potential of differentiated intervention
programs to effectively address the decision-making difficulties and the unique
social vulnerabilities of individuals with various forms of IDD, especially dur-
ing adolescence. Intervention efforts designed to provide individuals with
IDD with effective decision-making skills for protecting themselves from vio-
lence and abuse should draw upon current insights from a range of disciplines
(e.g., psychology, genetics/medical, developmental neuroscience).
Differentiated models of decision making for specific groups with ID and
ASD are needed so that the different mechanisms underlying the develop-
ment and course of decision-making behavior in these groups can be
highlighted. Longitudinal studies are needed to track the development of
perspective taking and decision making in these groups, especially during
the adolescent years. Longitudinal studies are also needed to answer the crit-
ical question of whether individuals with ID, WS, or ASD and other specific
forms of IDD can, over a period of time, develop decision-making profiles
that reflect more adaptive social-behavior outcomes. Ultimately, the ability
of people with IDD to acquire and apply effective decision-making strate-
gies in real-life situations will indicate the extent to which decision making is
a learned skill that can be improved with effective instruction. Further
research will be needed to determine the potential of targeted interventions
to enhance the real-life decision-making capacity of individuals with IDD in
ways that result in meaningful improvements to their quality of life.
222 Linda Hickson and Ishita Khemka
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