<p>This systematic review evaluates the effectiveness of decision-making skill-focused interventions targeting adolescents and young adults on three key outcomes: cognitive abilities, risk behaviors, and career choices. We reviewed 11 studies published between 2014 and 2024 using a pre-post-research design. The interventions include in-person structured curricula (<i>k</i> = 3), in-person counseling sessions (<i>k</i> = 3), and online programs (<i>k</i> = 5). The review indicated that decision-making interventions effectively improve adolescents’ cognitive abilities as well as their career decision self-efficacy and adaptability. The findings related to risk behaviors were mixed. Sex differences occurred both at the initial stage and over time, but these differences were generally small in size. Online interventions were generally less time-intensive than in-person interventions. Applying the NIH Stage Model for Behavioral Intervention Development revealed that all but one study operated at stages II or III. Recommendations were made for future research and practice on decision-making interventions for adolescents and young adults.</p>