ADHD and Test Anxiety: Forgetting What You Know in the Exam

The paper is set in front of me, I read the first question, and the information that was there a second ago is gone.

It is not even a topic I did not study. I reviewed it last night, I could have explained it to someone. But now there is a white blank in my mind, and in the middle of that blank a single sentence goes round: "You knew this."

As a child my grades were not low. I did my homework the last night, but I did it; when I was squeezed in exams, I sped up. To someone looking from outside I was not a student who experienced test anxiety. This is also a side effect of the quiet presentation of ADHD: the panic is inside, nobody sees it, and you do not put a name on it either.

In this article I want to talk about that blank. Why it happens, where ADHD stands in it, and what I am left with on exam day.

Where anxiety pulls attention

The framework I find most useful for understanding test anxiety is attentional control theory. According to the theory, anxiety weakens the goal-directed attention system and increases the likelihood that attention is steered by stimuli coming from outside (Eysenck et al., 2007). An anxious mind has difficulty saying "solve this question"; it is more easily caught by the signals "your heart sped up, the clock is moving, the person next to you has started writing."

Now let us put this on top of ADHD. Holding attention where you want it and working memory are already among the first areas that are hard in ADHD. Anxiety asks for a share from the same resource. I could not find a study that directly measures these two loads magnifying each other at exam time; so I say this as my own interpretation: for someone with ADHD, the price of anxiety may come earlier than for someone living the same anxiety, because there is less to share at the table from the start.

The information is not erased. The road to it closes for a while.

Does anxiety really affect grades

It does. A meta-analysis bringing together thirty years of research found, in the data of 238 studies, that test anxiety was negatively associated with many measures of achievement, from standardized tests to grade point average. In the same analysis, self-esteem came out as one of the strong predictors of test anxiety; the perceived difficulty of the exam and the weight of its consequences were also related to anxiety (von der Embse et al., 2018).

The self-esteem finding touched something in me. Someone with ADHD walks into an exam carrying, together with that period's topic, the expectation "I'll forget again" that has built up over the years. In the glossary there is a close concept: anticipatory anxiety.

As for data specific to ADHD, Prevatt and colleagues compared 473 university students with ADHD and 200 without. Students with ADHD reported significantly more anxiety, and this anxiety was concentrated in the academic area more than in life in general. First-year students were more anxious than upper-year students (Prevatt et al., 2015). What is measured here is academic anxiety more than test-specific anxiety; but the direction points to the same place.

Separating the alarm of being unprepared

I have to say one thing honestly: part of my anxiety before exams was justified.

Someone who studies on the last night really does walk into the morning exam with missing knowledge. Then the racing of the heart is an alarm reading the situation correctly. The cycle I described in the article on panic productivity closes exactly here: the urgency of the last minute gets me started, and the same urgency locks me up at exam time.

So I learned to ask myself two separate questions. The first: am I really ready? The second: am I this scared even when I am ready? If the answer to the second question is often "yes," the matter may be more than the study routine. I covered how ADHD and anxiety intertwine in the article on ADHD and anxiety. If anxiety also narrows your life outside exams, talking to a specialist is a really good step.

Does extra time solve everything

The best-known exam accommodation in ADHD is extra time. For a long time I thought this was the magic solution too.

The study by Lovett and Leja shook this thought a little. They looked at the reading comprehension performance of university students under different time limits. Students with more ADHD symptoms and executive function problems benefited less from extra time; students' own estimates of their time needs also did not predict the benefit (Lovett & Leja, 2015).

I do not read this as "extra time does not work." Time is a right, and for some people it really makes a difference. What I read is this: an extra forty minutes, if you do not know how you will use those forty minutes, also means forty minutes to scatter in. The general list of accommodations is in the article on ADHD at school and university; here I want to look more at the structure that carries the time.

Two things that may help while preparing

Testing yourself beforehand. In a study with middle school and high school students, most of the students who did retrieval practice (recalling information from memory with short questions) regularly in lessons reported that it both helped their learning and made them feel less tense in exams (Agarwal et al., 2014). The logic feels very close to me: not living the exam for the first time in the exam. If you have done the movement of pulling information out of memory twenty times before, the moment of the exam stops being an unfamiliar stage. I explained the details of this method in the article on memorization and spaced repetition.

Reinterpreting bodily arousal. Jamieson and colleagues told some of the participants preparing for the graduate entrance exam (GRE) that arousal before the exam could help performance. The group that received this information did better on the math section of a practice exam than the control group; the real exam scores they reported later were also higher than the controls' on the math section (Jamieson et al., 2010). Giving the pounding heart another meaning instead of trying to stop it was not tested in a sample with ADHD; still, the cost of trying is almost zero.

The first-three-minutes rule. When you get the paper, instead of starting the first question right away, spend three minutes. Dump the formulas, dates and keywords you are holding in your mind into a corner of the paper. Then read all the questions quickly and put a small mark next to the ones you know. When the blank comes, you have a place to return to.

What I tell myself in the exam

When the blank came, the worst thing I did was to wait stubbornly on that question. The longer I waited, the more anxiety grew, and the more it grew, the further the information went.

Now I have a rule: if I look at a question for two minutes and nothing comes, I mark it and move on. Solving another question both saves time and gives the mind the message that "something is still working." Often when I come back, the road has opened again.

There is also a sentence I say to myself: "My heart is fast because my body cares about this." It may sound silly. But it tires me far less than the sentence "Why can't you calm down."

The week before the exam

Trying to manage anxiety on the exam morning always felt to me like being late. The real work starts a week earlier, and in ADHD the biggest enemy of this week is the exam still sitting in the "not now" region.

The routine I find worth trying goes roughly like this. With a week to go, I write the topics on a single sheet; not all of them, only their headings. Next to each heading I put one of three marks: I know it, I half know it, I don't know it at all. This sheet makes the anxiety concrete. The feeling of "I know nothing" usually turns into the fact "I don't know these three headings," and three headings are far less frightening than everything.

In the following days, at the end of each session, I close the book and ask myself a few questions on that day's topic. What I cannot answer becomes the first job of the next day. On the night before the exam, I try not to learn anything new and only go over these questions once more. Sleep is part of this plan too; I pay the price of not sleeping on the last night with my attention at exam time.

After the exam

There is also the time after the exam. The moment I hand in the paper, my mind starts lining up the questions I lost in the blank, and this lining up often turns into an indictment.

Now, instead of that indictment, I try to write two questions. In which question did I lock up, and what happened at that moment? What can I do differently at that moment next time? The answers usually come out small: I did not skip the question, I did not use the first three minutes, I did not sleep the night before. Small answers can be changed. The sentence "I always fall apart in exams anyway" cannot be changed, because it is built like a verdict.

People sometimes write the verdict of one moment onto their whole life. Not being able to show what you know in the exam does not mean you do not know it. I confused this for years and read every blank as a decision about my intelligence. Yet what was being measured in that minute was where my attention was, more than my knowledge.