ADHD or Anxiety? Adult Evaluation in NYC and New Jersey

Many adults who look for an ADHD evaluation have already been told they have anxiety. Some were treated for it for years and still cannot finish tasks. Others suspect ADHD but wonder whether constant worry is the real reason they cannot focus. Both questions are reasonable, because the two conditions overlap in symptoms and often occur together. This page explains how that overlap is handled during an adult ADHD evaluation with Dr. Shershow, and what treatment research says about the order of care.

Why ADHD and anxiety are hard to tell apart

The National Institute of Mental Health lists the core features of generalized anxiety disorder (GAD) as worry that is hard to control on most days for at least six months, plus at least three of these: feeling restless or on edge, fatigue, trouble concentrating, irritability, muscle tension or sleep problems. Restlessness, poor concentration and trouble sleeping are also everyday complaints in adult ADHD.

The difference is in the pattern and the history, not in any single symptom:

For the symptom-level comparison, see ADHD or anxiety and when ADHD and anxiety occur together.

How often they occur together

In the National Comorbidity Survey Replication, a nationally representative US study, 47.1% of adults with ADHD had an anxiety disorder in the previous 12 months. Social phobia was the most common (29.3%), followed by post-traumatic stress disorder (11.9%), panic disorder (8.9%) and generalized anxiety disorder (8.0%).

The same study found that among adults with ADHD who had received any mental health or substance treatment in the past year, only 25.2% had been treated for ADHD. A 2017 review in BMC Psychiatry adds that ADHD is often diagnosed later in people who also have anxiety, possibly because anxiety can dampen impulsive behavior, and that people with both conditions tend to have more severe anxiety that starts earlier. In practice, many adults arrive with an anxiety history and an ADHD question that was never asked.

How the evaluation separates the two

An evaluation with Dr. Shershow covers current symptoms; childhood, school and work history; health, including medical history, medications, sleep and substances; and other explanations such as anxiety, depression, sleep problems or stress, alone or alongside ADHD. It ends with what the evaluation found and the treatment options that fit. No result is guaranteed in advance: the conclusion may be ADHD, anxiety, both, or something else.

For someone with anxiety, a few questions carry most of the weight:

• Timeline. Were attention and organization problems visible in grade school, before the worry started, or did they appear with a stressful job, a move or a loss?
• Calm periods. When anxiety was well controlled, did the forgetfulness, lateness and unfinished tasks stay the same?
• Content of the distraction. Is attention pulled toward a worry, or does it drift even when nothing feels threatening?
• Substances and sleep. Caffeine, alcohol, cannabis and short sleep can mimic or worsen both conditions.

Self-report screening scales help, but they are not decisive in this group. In a 2018 study of adults with major depression, the number of ADHD screener items a person endorsed rose with their anxiety level, and a positive screen was correct only 21.4% of the time for a full ADHD diagnosis. The authors concluded that neither simple symptom counts nor the screener alone is enough to diagnose ADHD. If you want to try a screener first, the adult ADHD self-test is a starting point for a conversation, not a diagnosis. To get ready, see how to prepare for an adult ADHD evaluation.

What research says about the order of treatment

There is no single required sequence, but published guidance points in a consistent direction:

• Treat the most impairing condition first. The 2017 BMC Psychiatry review summarizes Canadian (CADDRA) guidance for ADHD with an anxiety disorder as treating the most impairing disorder first and considering cognitive behavioral therapy (CBT) alongside.
• Anxiety does not rule out ADHD medication. England's NICE guideline NG87 recommends offering people with ADHD and an anxiety disorder the same medication choices as other people with ADHD (recommendation 1.7.18), with slower dose adjustment and more frequent monitoring when an anxiety disorder is present (1.7.28).
• Non-stimulant options exist. A 2024 American Family Physician review lists atomoxetine, viloxazine and bupropion as options for adults with concurrent anxiety or depression or who cannot take stimulants; bupropion is not FDA-approved for ADHD. In a 14-week randomized trial of 442 adults with ADHD and social anxiety disorder, atomoxetine improved both ADHD and social anxiety scores more than placebo.

Which of these fits depends on what the evaluation finds and on your history with medication. The practice provides medication management when medication is appropriate and ongoing psychiatric follow-up; it does not provide therapy or CBT itself. For how ADHD medicines and anxiety interact, see ADHD medication and anxiety.

If anxiety turns out to be the main problem

Anxiety is something the evaluation considers, not a standalone service of this practice. If the evaluation finds that anxiety explains your symptoms better than ADHD, Dr. Shershow will tell you that directly and talk through the kinds of care that fit, so you can pursue them with your primary care clinician, a therapist or another program.

New York and New Jersey rules that apply to your visits

Dr. Shershow is licensed in both New York and New Jersey, and the rule that matters is where you are physically located during each visit, not your home address. New York's Office of the Professions says a practitioner must hold a New York license when the patient is located in New York, and New Jersey's telehealth law requires a New Jersey license for services provided to a patient in New Jersey. For a video visit you must be in New York or New Jersey at the time of the visit.

If stimulant medication becomes part of the plan and you are located in New Jersey, P.L.2026, c.40 (effective July 8, 2026) applies to adults on a Schedule II stimulant who start by telehealth: an in-person visit within 30 days, a contact at least every three months (in person or by real-time audio-video), and an in-person visit at least once a year. The office will explain how visits are arranged for patients located in New Jersey. In New York, as of October 2026, telehealth prescribing of controlled substances follows the federal telemedicine flexibilities, which run through December 31, 2026.

Details on visit types are on the appointments and telehealth page. For current fees and how insurance works with the practice, call the office or see fees and insurance.

If anxiety becomes a crisis

An evaluation is not emergency care. If you are having thoughts of suicide or a mental health crisis, call or text 988, or chat at 988lifeline.org. The line is available 24 hours a day in both New York and New Jersey. In immediate danger, call 911.