addEventListener, “change” and option selection

You need a click listener which calls addActivityItem if less than 2 options exist:

var activities = document.getElementById("activitySelector");

activities.addEventListener("click", function() {
    var options = activities.querySelectorAll("option");
    var count = options.length;
    if(typeof(count) === "undefined" || count < 2)
    {
        addActivityItem();
    }
});

activities.addEventListener("change", function() {
    if(activities.value == "addNew")
    {
        addActivityItem();
    }
});

function addActivityItem() {
    // ... Code to add item here
}

A live demo is here on JSfiddle.