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Primer text from The College of William & Mary

ADHD is one of the most commonly diagnosed conditions of children (Centers for Disease
Control 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 list
three types of ADHD and the accompanying characteristics.

Primer text from The College of William & Mary

ADHD is one of the most commonly diagnosed conditions of children (Centers for Disease
Control 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 list
three types of ADHD and the accompanying characteristics.


Predominantly inattentive type.
The student may:
o submit inaccurate or incomplete work,
o have difficulty attending to conversations, activities, or tasks,
o be easily distracted,
o have difficulty following directions,
o frequently lose materials, and/or
o have difficulty organizing tasks and materials.


Predominantly hyperactive/impulsive type.
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/or
o 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).

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.

EDTA with cap

1ml Paediatric EDTA
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

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.

EDTA with cap

1ml Paediatric EDTA
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

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School interventions
should include a team approach across multiple settings, consisting of both preventive and intervention strategies.
Interventions must be based upon assessment data that includes information about the student’s strengths and needs as well as the environmental conditions in which her characteristics of ADHD occur.
Progress monitoring and strategy adjustments are critical to the success of any intervention plan (Wolraich & DuPaul, 2010).
Number of Directions: Give a minimal number of directions or steps at a time.
If necessary, have students repeat the directions to the teacher or a peer partner.
Form of Directions: Provide written directions or steps, or a visual model of a
completed project. Teach students how to refer to these items as reminders of
process steps to complete tasks. This strategy is particularly helpful for long-term
projects.
Written Assignments
Many students with ADHD have particular challenges with written work due to finemotor
skills difficulties, motor planning issues, and difficulty alternating their attention
from a book to their written responses.
Students with ADHD may also need assistance breaking a larger task or project into smaller, more workable units.

School interventions
should include a team approach across multiple settings, consisting of both preventive and intervention strategies.
Interventions must be based upon assessment data that includes information about the student’s strengths and needs as well as the environmental conditions in which her characteristics of ADHD occur.
Progress monitoring and strategy adjustments are critical to the success of any intervention plan (Wolraich & DuPaul, 2010).
Number of Directions: Give a minimal number of directions or steps at a time.
If necessary, have students repeat the directions to the teacher or a peer partner.
Form of Directions: Provide written directions or steps, or a visual model of a
completed project. Teach students how to refer to these items as reminders of
process steps to complete tasks. This strategy is particularly helpful for long-term
projects.
Written Assignments
Many students with ADHD have particular challenges with written work due to finemotor
skills difficulties, motor planning issues, and difficulty alternating their attention
from a book to their written responses.
Students with ADHD may also need assistance breaking a larger task or project into smaller, more workable units.

Organizational Supports for ADHD Students - ADDED