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What is Attention Deficit Hyperactivity Disorder?
Classroom Interventions for Attention Deficit/ Hyperactivity Disorder Considerations Packet

Primer text from The College of William & MaryADHD is one of the most commonly diagnosed conditions of children (Centers for DiseaseControl and Prevention, 2015). 

In a 2016 Centers for Disease Control and Prevention study, scientists found that 6.1 million children aged 2-17 years living in the U.S. had been diagnosed with attention-deficit/hyperactivity disorder (ADHD), which is similar to previous en

Ages 6-11: Approximately 2.4 million children
Ages 12-17: Approximately 3.3 million children


The diagnostic term attention deficit/hyperactivity disorder (ADHD) refers to individuals who display patterns of inattention, impulsivity, and overactive behavior that interfere with daily functioning (American Psychiatric Association [APA], 2013).
The Diagnostic and Statistical Manual (DSM) V (APA, 2013) criteria for diagnosing ADHD listthree types of ADHD and the accompanying characteristics.
The student may:o Appear to be in constant motion,o frequently fidget or move in his or her seat,o become restless during quiet activities,o leave his or her seat when expected to remain seated,o interrupt others and classroom activities,o talk excessively, and/oro fail to follow classroom procedures (e.g., blurt out answers without raising hand).
Combined type. The student may exhibit symptoms that include behaviors from both categories above.
In order for a student to be diagnosed with ADHD, symptoms must appear before age 12 and be exhibited across at least two settings. They must also have adverse effects on academic performance, occupational success, or social-emotional development (APA, 2013). 

To add to the complexity of the diagnosis, children with ADHD are likely to have co-existing emotional, behavioral, developmental, learning, or physical conditions (Wolraich & DuPaul, 2010). 

A gynecologic oncologist treats gynecologic cancers, such as uterine, ovarian, and cervical cancers.A pediatric oncologist treats cancer in children. Some types of cancer occur most often in children and teenagers. This includes certain brain tumors, leukemia, osteosarcoma, and Ewing’s sarcoma. Types of cancer more common in children sometimes also occur in adults. In these situations, an adult may decide to work with a pediatric oncologist. A hematologist-oncologist diagnoses and treats blood cancers, such as leukemia, lymphoma, and myeloma.

Department of Haematology
Notes

Full blood counts are performed on automated equipment and provide haemoglobin concentration, red cell indices, white cell count (with a differential count) and platelet count.
The presence of abnormal white cell and red cell morphology is flagged by the analysers.
Blood films may be inspected to confirm and interpret abnormalities identified by the cell counter, or to look for certain specific haematological abnormalities.
Grossly abnormal FBC results and abnormal blood films will be phoned through to the requestor.
There is no need to request a blood film to obtain a differential white count. It is, however, important that clinical details are provided to allow the laboratory to decide whether a blood film, in addition to the automated analysis, is required.
Under some circumstances a differential is not routinely performed, e.g. pre-op, post-op, antenatal and postnatal requests.
Full Blood Counts are performed at CGH and GRH
See also: Reticulocyte Count

The FBC comprises the following tests
Standard

Haemoglobin (Hb)
White Blood Count (WBC)
Platelet Count (Plt)
Red Cell Count (RBC)
Haematocrit (HCT)
Mean Cell Volume - Red cell (MCV)
Mean Cell Haemoglobin (MCH)

Differential White Cell Count (where applicable)

Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

And if appropriate

Blood Film

Sample Requirements
2ml or 4ml EDTA sample or a Paediatric 1ml EDTA sample.

 

Sample Storage and Retention

Pre analysis storage: do not store, send to laboratory within 4 hours.
Sample retention by lab: EDTA samples are retained for a minimum of 48 hours at 2-10°C
Transport of samples may affect sample viability, i.e. FBC results will degenerate if exposed to high temperatures, such as prolonged transportation in a hot car in summer.

This test can be added on to a previous request as long as there is sufficient sample remaining and the sample is less than 24 hours old.
Turnaround Times

Clinical emergency: 30 mins
Other urgent sample: 60 mins
Routine: within 2 hours

Reference Ranges


If references ranges are required for paediatric patients please contact the laboratory for these.

Parameter Patient Reference Range Units Haemoglobin Adult Male 130 - 180 g/L   Adult Female 115 - 165 g/L Red Cell Count Adult Male 4.50 - 6.50 x10^12/L   Adult Female 3.80 - 5.80 x10^12/L Haematocrit Adult Male 0.40 - 0.54 L/L   Adult Female 0.37 - 0.47 L/L Mean Cell Volume Adult 80 - 100 fL Mean Cell Haemoglobin Adult 27 - 32 pg White Cell Count Adult 3.6 - 11.0 x10^9/L Neutrophils Adult 1.8 - 7.5 x10^9/L Lymphocytes Adult 1.0 - 4.0 x10^9/L Monocytes Adult 0.2 - 0.8 x10^9/L Eosinophils Adult 0.1 - 0.4 x10^9/L Basophils Adult 0.02 - 0.10 x10^9/L Platelet Count Adult 140 - 400 x10^9/L

  Hemoglobin (Hb) is the protein contained in red blood cells that is responsible for delivery of oxygen to the tissues. To ensure adequate tissue oxygenation, a sufficient hemoglobin level must be maintained. The amount of hemoglobin in whole blood is expressed in grams per deciliter (g/dl). The normal Hb level for males is 14 to 18 g/dl; that for females is 12 to 16 g/dl. When the hemoglobin level is low, the patient has anemia. An erythrocytosis is the consequence of too many red cells; this results in hemoglobin levels above normal.
The hematocrit measures the volume of red blood cells compared to the total blood volume (red blood cells and plasma). The normal hematocrit for men is 40 to 54%; for women it is 36 to 48%. This value can be determined directly by microhematocrit centrifugation or calculated indirectly. Automated cell counters calculate the hematocrit by multiplying the red cell number (in millions/mm3) by the mean cell volume (MCV, in femtoliters). When so assayed, it is subject to the vagaries inherent in obtaining an accurate measurement of the MCV (see Chapter 152).
Both the hemoglobin and the hematocrit are based on whole blood and are therefore dependent on plasma volume. If a patient is severely dehydrated, the hemoglobin and hematocrit will appear higher than if the patient were normovolemic; if the patient is fluid overloaded, they will be lower than their actual level. To assess true red cell mass, independent radionuclide evaluation of the red cells and plasma (by 51Cr and 131I respectively) must be performed.


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Technique

Hematocrit
If the hematocrit must be determined quickly, as is often the case when a patient hemorrhages, it may be necessary to measure the hematocrit directly without the use of an automated counter. The materials needed are:


Lancets


Alcohol prep pads


Gauze pads


Microhematocrit tubes (heparinized)


Sealant ("Seal-Ease," "Crit-Seal," etc)


Microhematocrit centrifuge


Microhematocrit reader


If venipuncture is required: tourniquet, syringe, tube containing anticoagulant (EDTA, citrate)


For hematocrits obtained by fingerstick, wipe the fingertip pad of the fourth finger of the nondominant hand with the alcohol prep pad. Make certain the area is allowed to dry. Prick the fingertip with the lancet. Place the hematocrit tube near the incision site and allow the blood to flow via capillary action into the hematocrit tube until it is two-thirds to three-fourths full or to a predesignated mark on the tube. Avoid "milking" the finger if possible; this causes the expression of tissue fluids and may result in a falsely low hematocrit. Always fill at least three tubes. For hematocrits obtained by venipuncture, draw a sample of blood into the tube containing anticoagulant and mix well. Dip the hematocrit tube into the blood and allow the blood to rise to the desired two-thirds to three-quarters level. Because blood cells naturally sediment, a prior thorough mixing of the blood in the tube is necessary to ensure accurate reading.
After cleaning the outside of the hematocrit tubes of excess blood, invert the tube slowly so that the blood migrates just short of the bottom end of the tube. Seal the bottom of the tube with sealant. Make certain that little or no air is interspersed in the column of blood. If the seal is incomplete, leakage will occur during centrifugation and false readings will be obtained.
Place the tubes in a microhematocrit centrifuge and spin for 3 to 5 minutes at high speed. A shorter spin will not allow for complete sedimentation.
Using either a hematocrit reader or any ruled apparatus, measure the length of the column of the packed red cells and divide it by the length of the whole column of blood (cells and plasma), as in Figure 151.1. To obtain the hematocrit, multiply this number by 100%. Average all readings obtained from the different microhematocrit tubes.


Figure 151.1
Microhematocrit tube after sedimentation. The hematocrit is a ratio of the packed cells to total volume.


Example: If the column of packed red cells measures 20 mm and the whole blood column measures 50 mm, the hematocrit is 20/50 = 0.4 or (0.4 × 100%) = 40%.


Hemoglobin
Hemoglobin determinations will usually be performed by an automated cell counter from a tube of well-mixed EDTA-anticoagulated blood filled to a predetermined level. In this assay, all forms of hemoglobins are converted to the colored protein cyanomethemoglobin and measured by a colorimeter. An inadequate sample, whether due to insufficient volume or inadequate anticoagulation, may give false readings. If it is necessary to determine the level of anemia quickly, the hematocrit is an easier, more convenient test.


Hemoglobin Electrophoresis
Hemoglobin electrophoresis measures the mobility of hemoglobin in an electric field; it can therefore detect only those abnormalities in hemoglobin that alter the charge. Electrophoretic mobilities are affected by pH and by the medium in which the test is conducted. Screening tests typically use a hemolysate of anticoagulated blood electrophoresed on cellulose acetate at pH 8.6 to 8.8. If necessary, a further electrophoresis in starch gel at pH 6.2 to 6.8 is performed. At that stage, the work will usually be performed by a specialized laboratory.
Hemoglobin electrophoresis will not readily assess situations where there are neutral amino acid substitutions or where the hemoglobin is normal but the constituent chains are not produced in equal numbers (thalassemias). The diagnosis of alpha thalassemia of a mild to moderate degree cannot be made by hemoglobin electrophoresis; the diagnosis of beta thalassemia may be made by inference from an increase in the Hb A2.
A standard electrophoresis would look like Figure 151.2.


Figure 151.2
A standard hemoglobin electrophoresis (cellulose acetate, pH 8.6).





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Basic Science
The molecular weight of hemoglobin is approximately 64,500 daltons. Hb is composed of two pairs of dissimilar chains, α and β, each defined by a specific amino acid sequence and incorporating an iron-containing heme group. Two α–β dimers combine to form a hemoglobin tetramer. This allows for the "heme–heme" interaction necessary for effective oxygen uptake (deoxyhemoglobin → oxyhemoglobin) and delivery (oxyhemoglobin → deoxyhemoglobin). The oxygen affinity of hemoglobin is a function of this heme–heme interaction and of pH (Bohr effect), and is a measure of how many hemoglobin molecules have oxygen bound to them for a given level of oxygen tension. In a normal individual the major hemoglobin is Hb A, constituting approximately 97% of the total hemoglobin. Variations and/or amino acid substitutions in these chains exist. Some are deleterious to the normal function of hemoglobin, whereas others may have relatively normal oxygen affinity and stability. Hemoglobins containing different types of chains make up the remainder of the hemoglobin content in red cells (α2δ2 = Hb A2 approximately 2%; α2γ2 = Hb F approximately 1%).
Substitutions in the normal hemoglobin amino acid sequence may result in hemoglobins that have different sub-unit interactions and varying affinities for oxygen. For example, a substitution of the sixth amino acid on the beta chain causes Hb S, or sickle hemoglobin. Hb S has a lower oxygen affinity and surrenders its oxygen more readily. Hb F, a normal minor hemoglobin constituent, has a higher oxygen affinity.
If the oxygen dissociation curve is abnormal, the body will adjust the hemoglobin level to ensure adequate oxygen distribution to the tissues. Thus in a rare disease like hemoglobin Hotel Dieu, the difficulty in extracting oxygen from a variant hemoglobin with increased oxygen affinity could result in a lack of oxygen for the tissues (tissue hypoxia) and a compensatory erythrocytosis. The smaller fraction of oxygen released from the hemoglobin is thereby offset by the increased number of hemoglobin molecules. Similarly, in sickle cell anemia, the decreased oxygen affinity allows these patients more tissue oxygen at any given hemoglobin level.  Testing.

The book description is the pitch to the reader about why they should buy your book. It is sales copy to get them to see that the book is for them (or not), and then make the purchase. ... In many cases, the description is the factor that solidifies in the reader's mind whether the book is for them or not.

 
 
Response Accommodations
 
Educators should understand that students with disabilities often encounter barriers when they access the general education curriculum. The Every Student Succeeds Act (ESSA) and the Individuals with Disabilities Education Improvement Act (IDEA) require that educators provide appropriate accommodations to students with disabilities to address these barriers. Careful consideration of a student’s strengths and needs can help guide the identification and selection of an accommodation that is likely to benefit a student.
 
RE: https://microcredentials.digitalpromise.org/explore/response-accommodations
 

Accessing and Using Your FCPS Parent View Account for 24-7 Learning. In preparation for FCPS 24/7 Learning Parent Overview. Click here to view an ... This link is the Lemon Road Students 24/7 Learning Course

Cooperative LearningCarefully structured cooperative learning groups in which each student is assigned a role and has clear expectations for desired outcomes are very helpful for students with ADHD. The more structured the cooperative activity, the more likely it is that these students will succeed.Sharing Strategies Think, Pair, Share/Square Share/Group Share: Using thisapproach, students work with peer partners to discuss the lesson, check each other’swork, and share strategies.Partner Reading Student partners take turns reading orally and listening to each other. Peer partners can also be helpful with discussing answers to comprehension questions, spelling, proofreading, and solving