ADHD, anxiety, and university students

adhd, anxiety + university students

By Keisha Ruane and Joyce Chong, Clinical Psychologist

Disorganisation, frustration, and anxiety – whilst university offers students with ADHD freedom to study subjects that align with their interests, the reality is that university can present challenges for those with ADHD. Indeed, the absence of structure at university (compared to high school) means that success at university requires:

• The ability to juggle various aspects of your life – studies, friendships, paid work, volunteer work/internships, family, self-care, sport;

• The ability to plan and organise studies – researching and writing assignments, studying for exams, completing lab work, and doing all of these across multiple units;

• Knowledge and organisational ability when it comes to organising studies and checking your learning against unit objectives;

• Being able to stay on track (sustaining focus) whilst resisting impulses to engage in more exciting and interesting tasks (inhibition).

What is ADHD and how does it affect university students?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopment condition affecting the brain’s ability to regulate stimulation, motivation, and self-directed behaviour (American Psychiatric Association, 2013).

With its absence of structure, university can be particularly challenging for students with ADHD as success depends not just on intelligence but, more importantly, on the ability to independently manage unstructured time, focus, prioritise tasks, and maintain momentum (Weyandt & DuPaul, 2013). Consider:

• The student who has a deadline in a few weeks but finds studying boring and chooses instead to hang out with friends.

• The student who can’t keep track during lectures nor at the direction of their tutor who gives them multi-step instructions (e.g. “First you have to define AI in the assignment, then you have to outline the components of X, then you have to explain how AI is being used in this field, then you have to discuss the ethical implications of using AI”).

• The student who experience paralysis in the face of a mountain of notes when studying for exam – Where do they start? What do they prioritise?

• The student who start tasks at the last minute, believing they ‘work better under pressure’ but in reality, they are just working but at a highly stressed pace.

Requirements of students at university — staying on top of complex assignments, managing unstructured time, and navigating shifting academic and social demands - often clash directly with executive function difficulties experienced by those with ADHD. These aren’t signs of laziness or lack of motivation—they reflect a genuine breakdown between intention and action, known as executive dysfunction (Dvorsky & Langberg, 2014).

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ADHD, Executive Functioning, and juggling the mental load

What lies at the core of ADHD? Executive functioning plays an important role in understanding the impact. It refers to the brain’s ‘management system’ and encompass higher-order cognitive skills that regulate thoughts, behaviours, and emotions in order to reach a goal (Barkley, 2012; Diamond 2013). In ADHD, these functions often operate less efficiently. Key areas affected include:

Planning, organisation + ADHD

Successful completion of a unit requires planning and organisation:

• Regularly summarising contents of lecture and integrating it with the lecture readings

• Understanding, researching, and integrating information to complete assignments.

• Accelerating studying when nearing exams, understanding how to hold a significant amount of information

• Monitoring progress with studying – having awareness of whether they are progressing towards their goal and, if not, developing ways to compensate for this.

Students with ADHD may struggle to plan long-term projects, break tasks into manageable steps, or initiate work independently (Antshel & Russo, 2019). Even when motivation is present, the inability to sequence and prioritise often results in procrastination, missed deadlines, or rushed submissions (Dvorsky & Langberg, 2014).

attention, inhibition, + adhd

Successful completion of a unit also involves a great degree of control over attention and inhibition:

• Students need to be able to focus (and sustain) attention on the task they are to complete, whilst simultaneously…

• Being able to inhibit distracting or irrelevant information so that they can focus on task completion.

• ADHD often results in difficulty persisting through tasks until completion, frequently getting sidetracked, or being easily distracted by external or internal stimuli. These attentional difficulties are often seen together with impulsivity or difficulty inhibiting immediate responses (Diamond, 2013).

Working Memory + Adhd

• Higher-level thinking and problem-solving required at university requires the ability to hold and manipulate information over short periods of time and relies heavily on working memory – a memory system with limited capacity (Baddeley & Hitch, 1974)

• Students with ADHD often experience difficulties with recall, tracking what is covered in a lecture, and integrating new information with existing knowledge (Fried et al., 2019). This can lead to overwhelm when everything is deemed ‘to be learned’ and it feels hard to retain information.

adhd + the mental load

Overall, ADHD is associated with increased mental load – the invisible, ongoing cognitive effort it takes to manage responsibilities, deadlines, and daily tasks. Importantly, mental load is not just about the number of tasks, but the cognitive effort required to manage them (Mattfeld et al., 2014). Students with ADHD often hold a heavier mental load as their brain’s capacity to handle the mental load is reduced (Antshel & Russo, 2019, Weyandt & DuPaul, 2013) because:

• Working memory is more easily exhausted, leading to cognitive exhaustion

• Information processing is slower and more effortful

• The brain’s attention networks fatigue more quickly under pressure

Even seemingly simple tasks become mentally draining, creating a mismatch between academic expectations and cognitive reality (Mukherjee, et al., 2021). This mismatch between the brain’s processing capacity and the demands of academic life can lead to:

• Task paralysis (you know what to do, but can’t start),

• Avoidance (you feel overwhelmed and disengage)

• Burnout (from constant overexertion and prolonged compensatory effort)

Recent neuroimaging research found that under high cognitive load, ADHD led to both reduced task performance and decreased neural efficiency in key brain networks responsible for attention and control - in short, ADHD brains were working harder — but less effectively. This reflects a neurological reality, not a motivational deficit (Fisher et al.,2023).

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ADHD and Anxiety – a common link

It’s estimated that up to 65% of individuals with ADHD also meet criteria for an anxiety disorder (Katzman et al., 2017). For students, anxiety can arise not only due to difficulties with the task of studying, but also from fears of negative evaluation (Mohamed & Borger et al., 2020):

• Students fear being judged for their impulsivity, forgetfulness, or appearing “disorganised.”

• ADHD is often linked with rejection sensitivity — a heightened emotional reaction to perceived disapproval or criticism. This can make even small interactions feel overwhelming (Ramsay, 2017).

• Past experiences of embarrassment or perceived failure can result in intense anxiety in social and academic settings, reinforcing feelings of inadequacy.

This creates a frustrating feedback loop (Dorr & Armstrong, 2018; Kwon et al., 2018; Mohamed et al., 2020; Tuckman., 2007):

1. ADHD impairs the student’s ability to effectively and proactively manage their studies.

2. Falling behind in their studies, together with the increased effort required to focus, can trigger anxiety, shame, or fear of judgement. This in turn can erode their sense of capability and foster the belief that they’re ‘not good enough’

3. Anxiety increases the mental load and emotional reactivity — making it even harder for the student to sustain focus. Disengagement from studies, social withdrawal, perfectionistic avoidance, or deteriorating mental health can follow.

4. Anxiety and overwhelm from falling behind in studies further limit executive functioning, reinforcing difficulties with studies and contributing to further emotional distress.

‘Capable but inconsistent’ is a sentiment experienced by some ADHD students  - they know they’re intelligent and motivated but keeping up with the demands of university feels impossible.

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Help for students with ADHD and anxiety

Studying at university is challenging enough – throw in ADHD and the difficulty factor is amplified. Draw on the following 5 tips to help:

1.Understand your ADHD

The ADHD experience is diverse, and a one-size-fits-all approach to studying is unlikely to help. It’s vital that the support you receive is tailored to the impact of your ADHD. Spend some time exploring how ADHD affects your studies – your unique pressure points, what strengths and coping skills you already have in place – and set up a tailored plan to help you stay on track.

2. Assemble your team

A good support team is essential to helping you stay on track with your studies. Consider:

-A GP who is ADHD- and mental-health aware, who can coordinate your care and link you in with supports and assist with requests for adjustments at university.

-A psychiatrist to monitor and tailor your medication (if this is the path that you choose) to facilitate the study process.

3. Work with, not against your ADHD

ADHD affects planning, attention, and working memory, so rather than trying to double down in these areas, focus on externalising these functions to reduce mental load. Lists, planners, reminder apps, setting time limits (to help with time blindness when you’re in a state of hyperfocus) and removing distractions from your study environment all help you to focus on the task of studying.

4.Create structure in your days

Remember the days of high school when you had a set routine and the classroom structure enforced focus? Recreating some of this structure with routines can reduce mental energy spent on decision making and also reduce anxiety from analysis paralysis. Some tips include:

-Using a daily planner and reminders to help you stay on track

-Having an accountability partner/body double to hold you to task

-Increase the novelty factor to stay engaged and focused for longer (use sensory stimulation or change environments)

-Set shorter deadlines to create a sense of urgency and reduce procrastination.

5. Practise self-compassion

Yes, staying on track at university can seem challenging, particularly for those with ADHD. However, being hard on yourself and engaging in critical self-talk about how you ‘should’ be doing better only lowers your mood and motivation and increases your anxiety when it comes to studying. Instead, recognise:

• It’s okay to seek support and lean in on the know-how of those who can help.

• Celebrate the positives of your ADHD – creativity, hyperfocus, and high energy.

University is only ONE part of your life, and is only a part of your life for a few years. There’s so much more to you than just your studies.

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help for adhd + anxiety in university students

If you’d like a more tailored approach when it comes to ADHD, anxiety, and your university studies, reach out – our team of psychologists can help you build a plan for organisation and stay on track, and help with managing anxiety around your studies. We recommend linking in before the start of the semester to build a plan, followed by regular check-ins throughout the semester to help you stay on track with assignments, ongoing study, and exam preparation. Below are some of our psychologists who help with ADHD support (please note they do not provide ADHD assessments or diagnoses).

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REFERENCES

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Antshel, K. M., & Russo, N. (2019). Executive functioning and the impact of attention-deficit/hyperactivity disorder (ADHD) in young adults. Journal of Clinical and Experimental Neuropsychology, 41(7), 653–667. https://doi.org/10.1080/13803395.2019.1617981

Baddeley, A. D., & Hitch, G. (1974). Working memory. In G. H. Bower (Ed.), Psychology of learning and motivation (Vol. 8, pp. 47–89). Academic Press. https://doi.org/10.1016/S0079-7421(08)60452-1

Barkley, R. A. (2012). Executive Functions: What They Are, How They Work, and Why They Evolved. Guilford Press.

Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135–168. https://doi.org/10.1146/annurev-psych-113011-143750

Dvorsky, M. R., & Langberg, J. M. (2014). Predicting impairment in college students with ADHD: The role of executive functions. Journal of Attention Disorders, 23(13), 1624–1636. https://doi.org/10.1177/1087054714548037

Fisher, J.T., Hopp, F.R., Weber, R. (2023). Cognitive and perceptual load have opposing effects on brain network efficiency and behavioral variability in ADHD. Network Neuroscience, 7, 1483–1496. doi: https://doi.org/10.1162/netn_a_00336

Fried,R., Abrams, J., Hall, A., Feinberg, L., Pope, A., Biederman, J. (2019) Does working memory impact functional outcomes in individuals with ADHD: A qualitative and comprehensive literature review. Journal of Attention Disorders, 23, 1592-1599. https://doi.org/10.1177/1087054717730 

Johnson, K., Poulton, A., Bowen, J., Dalton, B., & Maxwell, R. (2024). W53. Evaluation of an ADHD study skills group for university students with ADHD. European Neuropsychopharmacology, 87(Suppl. 1), 129–130. https://doi.org/10.1016/j.euroneuro.2024.08.262

Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: Clinical implications of a dimensional approach. BMC Psychiatry, 17, 302. https://doi.org/10.1186/s12888-017-1463-3

Kwon, S.J., Kim, Y. & Kwak, Y. (2018). Difficulties faced by university students with self-reported symptoms of attention-deficit hyperactivity disorder: a qualitative study. Child Adolesc Psychiatry Ment Health 12, 12. https://doi.org/10.1186/s13034-018-0218-3

Mohamed, S. M. H., Börger, N. A., & van der Meere, J. J. (2020). Executive and Daily Life Functioning Influence the Relationship Between ADHD and Mood Symptoms in University Students. Journal of Attention Disorders, 25(12), 1731-1742. https://doi.org/10.1177/1087054719900251 (Original work published 2021)

Mukherjee, P., Hartanto, T., Iosif, A.-M., Dixon, J. F., Hinshaw, S. P., Pakyurek, M., Van Den Bos, W., Guyer, A. E., McClure, S. M., Schweitzer, J. B., & Fassbender, C. (2021). Neural basis of working memory in ADHD: Load versus complexity. NeuroImage: Clinical, 30, 102662. https://doi.org/10.1016/j.nicl.2021.102662

Ramsay, J. R. (2017). The relationship between ADHD and anxiety: Treatment implications. Current Psychiatry Reports, 19(12), 109. https://doi.org/10.1007/s11920-017-0855-8

Weyandt L., DuPaul G. J., Verdi G., Rossi J. S., Swentosky A. J., Vilardo B. S., . . . Carson K. S. (2013). The performance of college students with and without ADHD: Neuropsychological, academic, and psychosocial functioning. Journal of Psychopathology and Behavioral Assessment, 35(4), 421–435.

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