ADHD, Anxiety, and College: Why the First Few Weeks Can Feel Impossible

Written by Dr. Colleen Reichmann, owner and clinical director of Wildflower Therapy

There is something about the first few weeks of college that can make even the most independent student feel like they have suddenly forgotten how to function. And this can happen to neurotypical and neurodivergent kids alike, but there is, of course, a higher likelihood of general overwhelm in this first few weeks for college students who have ADHD.

I see this SO often in my work with college students. Kids who did well in high school, who managed their executive functioning generally well, and who maybe even have a diagnosis of ADHD and an established skillset for coping- they arrive on campus feeling excited and confident, only to find themselves soon overwhelmed (sometimes by the very basic tasks of daily life) They cannot seem to get themselves to class on time. Their assignments are piling up. They are forgetting to eat, losing their keys, staying up too late, or spending hours staring at an assignment without knowing how to begin.

And then the anxiety kicks in. And the self-blame/shame.

“Everyone else seems to be handling this. Why can’t I? What’s wrong with me? Maybe I am not cut out for college…”

I think it’s important to name that for students with ADHD, the transition to college can be particularly rough. They are not imagining it. It genuinely is harder than it tends to be for other kids. And when ADHD and anxiety occur together, the first few weeks of a semester can feel next to impossible.

Why college can be so different for students with ADHD

One of the things I try to help students understand is that struggling in college does not necessarily mean that they are less capable than they were in high school. College simply removes many of the external structures that may have been supporting them.

In high school, there is often a predictable schedule. Teachers remind students about assignments. Parents may help with morning routines, meals, transportation, medication, laundry, and keeping track of important dates. There are frequent opportunities to make up missed work or receive reminders about what is due.

College asks a student to manage much more of this independently.There may be five classes, each with a different syllabus and different expectations. There may be several assignments due weeks from now rather than tomorrow. Nobody may notice if a student skips class. Nobody is necessarily going to remind them to go to bed, eat lunch, start their paper, or bring their laptop to class.

For someone with ADHD, this can place enormous demands on executive functioning.

(Important note here: executive functioning is NOT the same thing as intelligence, motivation, or maturity.)

A student can be incredibly bright and deeply committed to succeeding while still struggling to organize, prioritize, initiate tasks, estimate how long something will take, transition between activities, or remember what they need to do next. This distinction is critical to understand. I have seen students become their own worst bullies because they interpret an executive functioning difficulty as a character flaw.

Why the beginning of the semester can be especially hard

So the first few weeks of college involve an enormous amount of novelty, right? New buildings. New people. New professors. New routines. New food. New expectations. New social dynamics. Sometimes a completely new city.

(Even students who do not have ADHD can find this overwhelming…)

But for a student with ADHD, all of that novelty can make it much harder to establish a routine. The brain is being asked to process and organize a tremendous amount of information at once, while simultaneously managing the everyday responsibilities of adulthood.

There is also a strange paradox that I see frequently: the beginning of the semester can look deceptively manageable.The assignments may not seem difficult yet. The student may have plenty of free time. There may not be any major exams on the calendar.

So kids can sometimes think, “Hey! I have plenty of time. I’ll do it later.”

Then a few weeks pass. Suddenly there are three papers, an exam, a group project, laundry that has not been done in two weeks, a half-empty meal plan, and six unread texts from friends.

That is often when anxiety begins to intensify.

ADHD and anxiety can create a difficult cycle

ADHD and anxiety can feed one another.

A student may procrastinate because initiating a task feels overwhelming. Then, as the deadline approaches, their anxiety increases. The anxiety makes it even harder to concentrate or get started. They avoid the assignment because it feels uncomfortable, which creates more anxiety later.

Eventually, they may pull an all-nighter and finish the work in a panic.

When this happens repeatedly, students can begin to develop a very painful belief about themselves: I only work when I am under extreme pressure.

I often tell students that this does not mean they are lazy or that they simply need to “try harder.” Their brains may genuinely be relying on urgency and adrenaline to provide the stimulation necessary to initiate a task.

The problem is that this strategy is so. freaking. exhausting.

Over time, it can contribute to chronic stress, sleep disruption, burnout, and a growing sense that college is something they are constantly trying to survive rather than experience.

Sometimes anxiety is the first thing people notice

Another reason ADHD can be missed in college students is that anxiety may be more visible than the underlying executive functioning difficulties.

A student may come to therapy saying, “I am so anxious about school.”

Then when I start asking questions, I may hear about procrastination, difficulty estimating time, forgetting assignments, trouble transitioning between activities, losing belongings, inconsistent sleep, difficulty keeping up with basic routines, or spending hours trying to begin a task.

Sometimes the anxiety is partly a response to all of these experiences.

Imagine repeatedly feeling like you are falling behind despite working incredibly hard. Eventually, of course, you may become anxious about school.

That does not mean the anxiety isn’t real though! It simply means it can be helpful to look underneath it and into the why of it all.

The social transition matters, too

I also think we sometimes underestimate how much of the college transition is social.

For a student with ADHD, making friends, navigating a roommate relationship, remembering plans, responding to texts, figuring out where they fit socially, and managing the constant stimulation of campus life can require a tremendous amount of executive functioning.

There may also be rejection sensitivity, difficulty reading social cues, impulsivity, or a tendency to become intensely focused on a new friendship or relationship. A student who is struggling socially may then become anxious about being left out or not belonging.

And when they are already overwhelmed academically, there may be very little emotional bandwidth left to navigate those challenges.

What actually helps?

I can tell you what doesn’t help first- simply telling a college student with ADHD how to “get organized.”

That kind of advice assumes that organization is the solution when in reality, accessing the skills to be able to organize may be the area where the student is struggling.

What does help? Creating external structures that reduce the number of things their brains have to hold onto.

This can mean looking at their week and what it actually looks like rather than what they wish it looked like. We might identify the specific point where a task tends to break down. Is it remembering the assignment? Knowing where to start? Estimating the time? Getting off the phone? Switching from one activity to another?

Once we understand the actual problem, we can work on a strategy that addresses that problem.

Sometimes this means creating a much more concrete routine. Sometimes it means breaking assignments into very small steps. Sometimes it means using body doubling, academic support, disability accommodations, reminders, or visual schedules. And sometimes the most important work is helping a student let go of the belief that needing these supports means they are failing.

Because I will say this with my whole chest, and you cannot convince me otherwise at this point: They. Are. Not. Failing. They are up simply against a brain that requires more creativity and effort in order to accel in a place like college.

So instead of being indicative of failure or laziness, supports are just what allow a student’s actual abilities to become visible.

When should a college student consider therapy?

I don’t think a student needs to be in crisis before they deserve support.

In fact, I would much rather see a student early in the semester when they are saying, “I feel like I’m struggling to keep up,” than several months later when they are failing classes, sleeping poorly, barely eating, withdrawing socially, and feeling completely overwhelmed.

Therapy can provide a place to understand the relationship between ADHD, anxiety, perfectionism, self-esteem, and executive functioning. It can also be a space where a student doesn’t have to spend the entire session proving that they are capable.

Sometimes students need practical help building systems that work with their brains rather than against them. Sometimes they need help managing anxiety or perfectionism. Sometimes they need to process the emotional experience of becoming more independent from their parents. Often, it is some combination of all of these things.

A Beginning Struggle Does Not Mean This Will Be Their Forever

One of the most important things I want parents and students to know is that a difficult first semester does not tell us what a student is capable of long-term.

College is a massive developmental transition. For students with ADHD, it can be the first time that the supports and structures around them change dramatically all at once.

That can expose challenges that were previously hidden. But it can also be an opportunity!

With the right support, students can begin to understand how their brains work, identify the environments and structures that help them thrive, and develop strategies that make independence feel much more manageable.

If your college student has suddenly gone from “doing fine” to feeling overwhelmed, anxious, disorganized, or unable to keep up, I would encourage you not to immediately assume that they aren’t trying hard enough.

Sometimes the question isn’t, Why can’t they handle college?

It is, What does this student need in order to handle college in a way that actually works for them?

That is a very different question-and often a much more helpful place to begin.

Therapist for College Students in Philadelphia and the Main Line

At Wildflower Therapy, we specialize in helping kids, teens, and adults who are struggling with things like anxiety, depression, eating disorders, body image concerns, and perfectionism. We have many clinicians who specifically specialize in working with college students, and who deeply understand the intersection of ADHD with each of those struggles. We understand how frightening it can feel to be the student who is struggling or a parent wondering whether your child is struggling.

If your child will be attending Villanova, Saint Joseph’s, Temple, Drexel, UPenn, Bryn Mawr, Haverford, Swarthmore, or another college in the Philadelphia area, please know that we’re here to help, and can see them in person in Philadelphia or Devon. Or, if they are attending college elsewhere in Pennsylvania (and a handful of other states), we can see them virtually.

If you’re worried (even if you’re not sure your child would agree to therapy yet), we invite you to schedule a complimentary consultation call.