Anna has been struggling in school. For as long as she can remember she's had a particularly hard time with math and exams. While years ago her peers memorized the answers to arithmetic problems like "What is 7 + 3?", Anna still finds herself counting her fingers. And although Anna studies very hard, she continues to receive bad grades on her exams in other classes as well. Frustrated with her difficulties in school, Anna seeks testing for a learning disability. Her formal diagnosis? Mild attention deficit hyperactivity disorder (ADHD) and dyscalculia (a math-learning disability).

Armed with her new diagnoses, Anna receives an Individualized Education Program (IEP) to help her learn more effectively at school. But she continues to face difficulties with exams and concentrating in math class, leading her to become even more frustrated. "I'm so bad at math and tests that even my IEP doesn't help," she thinks.

What's Going On With Anna?

While it may be tempting to think there is something wrong with Anna's IEP, other explanations do exist. It may be possible that Anna simply doesn't have ADHD or dyscalculia, but that she struggles with test anxiety and math anxiety instead. Yes, she took a formal assessment, but therein lies the problem. For many individuals with test or math anxiety, taking the assessments may trigger their anxiety, leading to poor performance.1, 2, 3 After all, these are a series of tests that include math problems. Thus for these individuals, the results may underestimate their abilities, misdiagnosing them with learning disabilities.4

A substantial amount of research indicates that greater math or test anxiety is significantly associated with lower scores on the math and working memory sections of cognitive assessment tests such as the Weschler Adult Intelligence Scale (WAIS), the Weschler Intelligence Scale for Children (WISC) and the Wide Range Achievement Test (WRAT).1, 2, 3 Additionally, in a recent study, researchers found that test anxiety and math anxiety were associated with worse performance on the Iowa Gambling Task (IGT), a cognitive task assessing decision-making that is used to diagnose a variety of disorders, including ADHD and brain damage.5

Misdiagnosis Possible

This research is important because if you experience math or test anxiety, cognitive assessments typically used to evaluate learning disabilities may underestimate your abilities related to working memory and decision-making. In turn these may lead to a misdiagnosis.

Lower working memory scores and impaired decision-making on assessment tests typically point to a diagnosis of ADHD. Given that the treatment plan for ADHD is very different for math or test anxiety, a misdiagnosis of ADHD would likely result in little to no change in school performance, leading to even more frustration and anxiety and exacerbating the problem. In sum, if you experience anxiety regarding math or test-taking, let assessors and clinicians know. This information can help them formulate an accurate diagnosis and enable them to create an effective treatment plan.


Date of original publication:


1. Buelow, M. T. & Frackey, L. L. (2013) Math Anxiety Differentially Affects WAIS-IV Arithmetic Performance in Undergraduates. Archives of Clinical Neuropsychology, 28, 358-362.

2. Birnbaum, M. & Pinku, P. (1997). Effects of test anxiety, information organization, and testing situation on performance on two test formats, Contemporary Educational Psychology, 22, 23-38.

3. Gass, C. S., Howell, S., Ardern, H., Dowd, A., MacKenzie, K., Levy, S. (2005). Test anxiety in relation to performance on measures of attention and executive function. Archives of Clinical Neuropsychology, 20, 921.

4. Gass, C. S., & Curiel, R. E. (2011). Test anxiety in relation to measures of cognitive and intellectual functioning. Archives of Clinical Neuropsychology, 26, 396-404.

5. Buelow, M. T. & Barnhart, W. R. (2017). The influence of math anxiety, math performance, worry, and test anxiety on the Iowa gambling task and balloon analogue risk task. Assessment, 24, 127-137.