Written Exams With ADHD: Answering Open-Ended Questions

The question paper is in your hand. The topic is exactly the one you studied. You know the answer, you even remember a sentence you read somewhere. But when you put the pen to the paper, the first sentence does not come. You write something, you do not like it, you cross it out. Twenty minutes later there are two paragraphs on the page, and they answer half the question.

This scene does not happen in a multiple-choice exam, because there the knowledge comes to you as options and you only recognize it. In an open-ended question you produce everything yourself: you work out what is being asked, you gather what you know, you put it in order, you turn it into sentences and you write it by hand. In ADHD, the links in the very middle of this chain, that is, planning and ordering, already sit in the places where we struggle.

In this article we are not talking about exam study methods in general but about the stuckness that happens over the paper. For general preparation you can look at the guide on how to study for an exam with ADHD.

Why an open-ended question is a separate difficulty

While you write an answer, three jobs run at once: deciding what to say, turning it into a sentence, checking what you have written. Kellogg's studies on writing show that these jobs compete with one another for attention. In an experiment with university students, the texts of those who made an outline before writing were rated better; the same benefit was not seen in those who began by writing a draft straight away (Kellogg, 1988). The study was on a letter-writing task, not an exam, and the participants were not selected as having ADHD. Still, the idea that taking planning out of the writing lightens the load is very plausible for someone with limited working memory. What I explained in the article on working memory and forgetfulness comes into play right here: as the number of things you hold in mind grows, one drops.

A meta-analysis looking at the writing of students with ADHD reports that these students' written products fall behind their peers in quality and organization (Graham et al., 2016). Here there is a limit I have to be honest about: this is data collected from homework and writing tasks. The timed open-ended exam is not a separately studied area. Most of the suggestions in this article come from writing research, from exam studies and from inferences that I describe as "it seems reasonable." I will try to separate which is which in the text.

Reading the question

The most expensive mistake in an open-ended exam is reading the question halfway. Impulsivity works very sneakily here: you see the topic, what you know comes up, you begin to write. But the question was not "define," it was "compare." Twenty minutes later you have written a lovely answer, but to a different question.

Instead of reading the question twice, working with a pen on the first reading helps. Underline the command word. The ones I see often are these, and each asks for a different shape of answer:

Command	What is expected
Define, explain	What the concept is, a short and proper example
List, enumerate	Point by point, one sentence for each point
Compare	The shared and different sides of the two sides, one by one
Discuss, evaluate	For, against and where you arrive
Show the reasons	The cause and effect link, an explanation for each cause
Give an example	Tying the abstract concept to a concrete event or situation

If there is an "and" in the question, count the parts separately. "Explain its causes and consequences" is two answers. Numbering the parts and writing them at the side seriously reduces the chance of forgetting the second.

There is also the matter of points. Points tell you how much space the answer will take. Writing half a page for a ten-point question and two pages for a twenty-five-point question is usually sensible. Writing little for a high-point question and a lot for a low-point question is a common mistake in ADHD, because a person runs on the question they remember most easily.

The two-minute plan

The plan is a small job done before moving to writing. I divide it into three moves.

The first is emptying out. Write aside, in no order, whatever comes to mind about the question. For the question "Discuss the effects of the Industrial Revolution on urbanization," this looks something like: factory, migration from village to city, housing congestion, cholera, workers' neighborhoods, Manchester, and also dates and names. No looking for order, no thinking about whether it is right or wrong. Thirty seconds. The idea in the article on brain dump is used here on a small scale: when you bring what you hold in mind down onto paper, working memory empties.

The second is grouping. Divide what you dumped into three or four headings: migration and population, housing and health, workers' life, consequences. Each heading will be one paragraph in the answer. Throw out what does not fit a heading, or leave it for the very end.

The third is the opening sentence. A single sentence that turns the question into an answer: "The Industrial Revolution accelerated urbanization, but this speed left housing and health infrastructure behind and produced new problems as well." This sentence stands at the top of the skeleton. It tells you what you are defending and tells the reader what you are answering. If finding the sentence is hard, you can start from the first heading and leave the opening for the end; but most of the time a one-sentence opening makes writing the rest easier.

All of this should not go beyond two minutes. It takes very little room at the edge of the paper. I am not saying that Kellogg's finding can be carried directly to exam conditions, but making an outline is itself one of the best-supported strategies in general writing research. In a meta-analysis comparing writing instruction in adolescents, programs that taught planning and revision strategies were among the ones with the largest effect among the methods compared (Graham & Perin, 2007).

Dividing the time from the start

I described time management for multiple-choice tests in the practice exam article. In an open-ended exam there is another trap: a single question can stretch itself forever. I can add one more thing, I can find one more example, I can rewrite a sentence. The question is not finished, but the time is.

For this, at the very start of the exam, before you begin writing, write a time table in the corner of the paper. Say there is a ninety-minute exam and four questions, twenty-five points each:

Part	Time
Reading all the questions	5 minutes
For each question, plan (2 min) and writing (15 min) and checking (2 min)	19 minutes, 76 minutes for four questions
Last round, blanks and cleanup	9 minutes

Next to each question, write the finishing time: 0:05, 0:24, 0:43 and so on. When the clock reaches that point, move to the next question even if you are in the middle of a sentence. This looks very harsh, but the logic is this: the first few sentences of a question often bring most of the points, and the following minutes add fewer points. Not writing the fourth question at all can cost more than giving ten extra minutes to the first three. I cannot present this as right for every exam, because the marking key changes from teacher to teacher. But no teacher can give points to a question that was never written.

If the answer is left half done when the time is up, do not leave it blank. Write the remaining headings as a skeleton: two or three short points. The person grading often rewards this too with some points; still, this depends on the teacher, and it makes sense to ask beforehand how the course is assessed.

Seeing the clock can be a problem too. For someone with time blindness, a wall clock is often not enough during an exam, because looking at the clock does not occur to you. If a small analog watch is allowed on your desk, use it; if not, writing the finishing time of each question at the side works as a kind of reminder. The general logic of this is in the article on time blindness.

I know it but I cannot pull it together

This is the situation in which an open-ended exam feels worst. The knowledge is with you, but it is like a tangle. You pull from one end, everything comes at once, and you do not know which to say first.

I think the real solution to this is not in the exam but before the exam. Because you did not learn the knowledge "in order" while studying, you have to put it in order in the exam. While studying, start asking yourself this question: if this topic were asked, what would the skeleton of my answer be? Write three or four headings on paper within two minutes. If you cannot, it means you have not studied the topic enough yet, and learning this before the exam is much better news.

If the tangle feeling is still there in the exam, there are two simple ways. The first is chronology or sequence: if you are telling an event, go by time; if you are telling a process, go by stages. Using the topic's own order instead of looking for an order reduces the decision load. The second is to write the easiest heading first. If the first paragraph flows, the second flows too; trying to make the first sentence of the whole answer perfect keeps you in place. This is not a research finding but a suggestion I draw from the general logic of writing: to start, write the easiest sentence instead of waiting for the best sentence.

You can also think of pulling together a written answer as a template. I have written four templates below. All of them can be written on the edge of the paper in a single line.

Definition question: definition, distinguishing feature, example, importance.

Comparison question: shared aspects, features of the first side, features of the second side, the real cause of the differences.

Discussion question: view A and its basis, view B and its basis, which is stronger and why.

Event or case question: event, problem, relevant rule, applying it to the event, conclusion. It resembles the pattern often used in solving cases in law faculties and can be adapted to other fields too.

A template is a mold, not the answer itself. But facing a blank page, a mold reduces the decision to begin.

The moment your mind goes blank

You read the question, and what you thought you knew has vanished. This is common with both anxiety and ADHD, and the causes pile on top of each other: under pressure working memory narrows, your recall strategy breaks down, and telling yourself "I can't do it" makes it worse. I explained the mechanism of this in the article on test anxiety.

I try a few steps. First stop for twenty seconds and breathe out slowly. This is not a relaxation technique, it is a way of telling yourself "nothing extraordinary is happening right now." Then write the key words of the question on the paper. Three words written side by side become a cue for recall. Then write the smallest thing that comes to mind: a definition, a name, an example. Writing often triggers recall. For this mechanism I have no study with participants who have ADHD; it is a suggestion based on the general knowledge that recall is made easier by cues.

If it still does not come, leave the question and move to the next. The tension of the first question does not have to be carried to the second. That something falls into place when you return to the question is a frequently told experience, but I know of no study showing how common this is in ADHD.

There is also a method that belongs to before the exam. In the study by Ramirez and Beilock, students wrote about their worries related to the exam for ten minutes just before the exam. In students with high test anxiety this raised exam performance; the study was also repeated in a classroom setting in high school (Ramirez & Beilock, 2011). It is not a study with participants who have ADHD. But its cost is a sheet of paper and ten minutes, and it has no side effects. If your anxiety is high before the exam you can consider trying it; together with sleep and the morning preparation, the preparations in the article on the morning of the exam work here too.

Handwriting fatigue

Writing by hand on an exam paper for two hours is an unaccustomed job for most of us today. The fingers tire, the handwriting deteriorates, the speed falls and you cannot keep up with the speed of thought. In the study by Vekaria and Peverly with university students, the handwriting speed of students with ADHD was lower than that of their peers (Vekaria & Peverly, 2018). The sample was small and ADHD rested on self-report; still, it suggests that handwriting is truly a bottleneck for some of us. In the note-taking article I looked at the same study from another angle.

What can be done when handwriting is a problem is simple. Holding the pen comfortably, the choice of pen (a loosely flowing ballpoint makes long writing easier), writing in short numbered points instead of sentences, leaving wide gaps between lines so that you can add later. You do not have to write paragraph by paragraph; even if the teacher does not say "you may write point by point," a readable and orderly sequence of points is often understood better than a paragraph. It is best to ask the teacher beforehand: "Is there any objection to my writing the answers in numbered points?"

If the problem is serious, exam accommodations come onto the agenda too: typing on a computer, extra time, a separate room. I wrote about their framework in Turkey in the article on exam accommodations; the application process has to be started beforehand, and in exam week it is too late.

Working with past questions

This is, I think, the most effective part of preparing for the exam. Because an open-ended exam is a skills exam: taking knowledge out of memory, putting it in order and writing it. Going into the exam without rehearsing this is like entering a race without ever having run.

That testing yourself increases lasting learning is a finding replicated in laboratory and classroom studies. In the study by Roediger and Karpicke, those who read the text one more time remembered better in the short term, but a week later those who had tried to recall the text in writing remembered more (Roediger & Karpicke, 2006). In the review by Dunlosky and colleagues too, practice tests are among the highly useful techniques (Dunlosky et al., 2013). These are not studies specific to ADHD, but there is nothing suggesting that it works differently in ADHD on this point.

Let me explain how to use past questions in three steps.

First step, skeleton practice. Take the past questions you have, in order, and for each one make only a two-minute skeleton. Do not write the answer, only the skeleton. You can get through ten questions in twenty minutes. This practice lets you both scan the topic and see for which question you cannot make a skeleton. The ones you cannot are the topics that need to be studied.

Second step, the full answer. Once or twice a week, write one question in real conditions: book closed, timed, by hand. When you finish, compare with your notes. What did you skip, in what order did you write, where did you go over time. Write this note on one page; this page will be what you read the day before the exam.

Third step, the answer bank. A single file that keeps your own skeleton for each topic. In the last week before the exam, most of the revision is to rebuild the skeletons in this file closed-book. I explained the logic of spaced repetition in the article on memorization and spaced repetition, and skeleton practice fits it very well.

If you cannot find past exam questions, make up questions yourself from the topics the teacher emphasized in class or from the end-of-chapter questions in the book. Making up the question is also a kind of study: thinking about how a topic could be asked is a way of understanding it. Asking the teacher or upper-year students in the department for past questions is also an option, but there is no rule about this; some teachers share them, some do not.

The first and last minutes of the exam

Knowing in advance what you will do when you go into the exam reduces the decision load at that moment. The order I use is as follows, and it does not rest on evidence, it is only an arrangement I find useful:

In the first five minutes, read all the questions. Put small marks at the side: which is easy, which is hard, which has many points. Then write the time table. Then begin with the question you are most confident about; going into writing with an easy answer to warm up lowers the risk of getting stuck on the first question. I would not want to generalize this order, because some people want to solve the hardest question while the mind is fresh. What to watch here is that the order is a conscious choice, not an automatic following of the order on the question paper.

Save the last five minutes. Not for reading and correcting, but for seeing which answers were left half done and adding short skeletons to them. Careless mistakes are usually caught in the last read: a missing "not," a wrongly written date.

If the exam coincides with the effect of your medication, it makes sense to talk with your doctor about medication times in relation to the exam time.

What I am left with

What is hard in an open-ended exam is not the knowledge but the order of getting it onto the paper. I find accepting this comforting, because then the solution too stops being "study more" and becomes "practice taking it out." Instead of reading the same topic three times, reading it once and making its skeleton twice does, I think, much more work.

In a written exam, giving time to the two-minute plan will be the easiest thing to give up. Since the time you have is limited, starting to write at once is tempting, but an answer written without a plan is open to changing direction midway and saying the same thing twice. Be sure to try this part, even with a past question this week.

I would also like to add this: when you hit a blank, it is not a weakness of character. It is a situation often met with anxiety and with ADHD, in which recall gets harder under pressure. Skipping a question and coming back is not leaving the exam, it is managing the exam. If you need the accommodations your teacher or department offers, see that too as part of managing the exam. If the knowledge is with you, every tool you can use to get it onto the paper is legitimate.