Adult ADHD Evaluation After 50 in New York and New Jersey

Adults in their 50s, 60s and 70s ask about ADHD for different reasons. Some recognized themselves when a child or grandchild was diagnosed. Some have managed for decades and find that retirement, a new job or the loss of a partner who handled the calendar has made the gaps obvious. Others are worried that new forgetfulness means something else. This page covers how often ADHD goes unrecognized in older adults, how an evaluation tells lifelong ADHD apart from later-life memory change, the heart and blood pressure questions that come before stimulant medication, and Medicare and drug-cost programs in New York and New Jersey.

ADHD after 50 is common and rarely diagnosed

A 2020 meta-analysis of 20 studies of adults aged 50 and older found that 2.18% met ADHD criteria on validated research scales, but only 0.23% had a clinical ADHD diagnosis and 0.09% were being treated. In the CDC's 2023 national survey, adults aged 50 to 64 made up 10.6% of US adults with a current ADHD diagnosis, and adults 65 and older made up 4.9%. In other words, many older adults with lifelong symptoms have never been assessed.

A late diagnosis can still be useful. People describe it as an explanation for a lifetime of missed deadlines, job changes or strained relationships, and it opens treatment options that may help with what is still hard today. The guide to ADHD in adults over 50 covers this in more depth.

Lifelong ADHD or later-life memory change?

This is the central question at this age, and the history usually answers it. ADHD criteria require several symptoms to have been present before age 12. Mild cognitive impairment, as the National Institute on Aging describes it, means more memory or thinking problems than other people of the same age, and its risk rises with age. NIA lists signs such as losing things often, forgetting appointments and having more trouble finding words than peers, and notes that some memory and thinking problems come from treatable conditions.

These patterns can overlap, and sleep problems, depression, medications and medical conditions can cause attention trouble at any age. Dr. Shershow's evaluation covers medical history, medications, sleep and substances for that reason. If the history points to new decline rather than lifelong ADHD, the next step is a medical and cognitive workup, and that is what the evaluation's findings would say. The practice does not provide neuropsychological testing.

One more piece of research gets attention: a 2023 Israeli cohort study of 109,218 adults aged 51 to 70 at the start found that an adult ADHD diagnosis was associated with a higher risk of later dementia (adjusted hazard ratio 2.77). It was an observational study, so it shows an association, not that ADHD causes dementia, and the authors saw no clear increase in risk among people treated with stimulants.

Heart and blood pressure before stimulants

Cardiovascular questions matter more after 50. The current Adderall XR label tells prescribers, before starting treatment, to assess for cardiac disease with a careful history, a family history of sudden death or ventricular arrhythmia, and a physical exam. It states that stimulants may raise blood pressure by a mean of about 2 to 4 mmHg and tells prescribers to monitor for high blood pressure and fast heart rate. The same label says the drug has not been studied in older adults.

A 2024 Swedish study of 278,027 people with ADHD aged 6 to 64 found that each additional year of ADHD medication use was associated with a 4% higher risk of cardiovascular disease, mainly high blood pressure and arterial disease. It was a case-control study that shows association, not cause, and it did not include people over 64. The practical points:

• Bring a current medication list, recent blood pressure readings and any cardiology records.
• Tell the evaluating psychiatrist about any personal or family history of heart disease, arrhythmia or sudden death.
• Expect blood pressure and heart rate to be checked during treatment. Nonstimulant options also exist and are part of the discussion.

More detail is in ADHD medication and heart safety.

Medicare and drug costs in New York and New Jersey

Medicare Part B covers outpatient mental health care, including psychiatric evaluation and medication management, and after the Part B deductible you generally pay 20% of the Medicare-approved amount. Medicare pays nothing for services from a provider who has opted out of Medicare, except in emergencies, so it is worth asking any clinician how they work with Medicare. Call the office to ask how Medicare works with the practice.

For prescriptions, both states have programs that work alongside Medicare Part D:

See Medicare and ADHD care in New York and Medicare in New Jersey.

Which state's rules apply

Dr. Shershow is licensed in New York and New Jersey, and video visits must take place while you are physically in one of them. If you split the year between New York or New Jersey and another state, visits cannot happen while you are in another state, so plan around travel. For patients located in New Jersey, P.L.2026, c.40 requires adults started on a Schedule II stimulant by telehealth to have an in-person visit within 30 days, a contact every three months, and an in-person visit at least once a year; the office will explain how visits are arranged. New York had no in-person rule of its own as of October 2026 and follows federal DEA telemedicine flexibilities, which run through December 31, 2026.

To start, call the office or use the call-back form. The adult ADHD evaluation page describes what the assessment covers.