ADHD: Neurological Insights and Implications
Intro
Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental condition that profoundly affects millions of individuals globally. Despite its commonality, the complexities surrounding its diagnosis, treatment, and underlying causes necessitate a detailed examination. This article takes a neurological perspective to enhance understanding of ADHD, with an emphasis on its neurobiological mechanisms and their implications for daily life.
In addressing ADHD, it is significant to recognize the myriad impacts on functionality and development. The presentation of symptoms often varies widely among individuals, further complicating the diagnostic criteria. This creates a need for thorough research into ADHD and effective treatment modalities, as well as consideration of comorbid conditions that often accompany it.
As we advance through the following sections, we will uncover key contributions from recent research, highlighting advancements in understanding the biological underpinnings of ADHD. We will also discuss the methodologies employed in current research studies and how these can shape future approaches to diagnosis and treatment.
Intro to ADHD
Attention Deficit Hyperactivity Disorder (ADHD) represents a significant area of concern in psychological and neurological research. Understanding ADHD is critical for educators, clinicians, and families as it deeply impacts both educational attainment and social interactions. This section sets the foundation for a clearer understanding of ADHD's definition, prevalence, and its overarching implications on daily life.
Currently, ADHD affects millions worldwide. Thus, exploring its neurological basis provides insights that can help inform treatment and management strategies. This insight is not only beneficial for those diagnosed but also for parents, teachers, and peers who interact with individuals affected by ADHD. By understanding the core of ADHD through a detailed examination of its definition and epidemiological data, professionals can foster more effective support systems and interventions.
Definition and Overview
ADHD is a neurodevelopmental disorder typically characterized by patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development. These symptoms can manifest differently, and the severity can vary from person to person. Research indicates that this disorder is not merely a childhood condition; it persists into adulthood for many individuals. The American Psychiatric Association defines ADHD as a pattern that includes at least six symptoms of inattention and six symptoms of hyperactivity-impulsivity.
ADHD can notably disrupt academic achievement and create challenges in maintaining social relationships and managing daily responsibilities. The complexities of ADHD arise from the interaction of genetic, environmental, and neurological factors, leading to a wide range of behavioral effects.
Epidemiological Data
The prevalence of ADHD is significant across various populations. Recent studies suggest that approximately 5% of children globally are diagnosed with ADHD, with symptoms often presenting in early childhood. Researchers have observed that the onset of ADHD symptoms frequently aligns with educational demands around the age of five to seven years.
Key points about the epidemiology include:
- Gender Differences: Research shows that boys are diagnosed with ADHD more frequently than girls, with ratios typically ranging from 2:1 to 4:1. However, it is crucial to acknowledge that the symptoms may manifest differently in girls, often leading to underdiagnosis.
- Geographical Variations: The diagnosis rates of ADHD can vary by region, with some areas reporting higher rates due to varying awareness and diagnostic criteria.
- Longitudinal Studies: Evidence suggests that approximately 60% of children with ADHD will continue to experience symptoms into adulthood, impacting life in varying degrees.
In summary, the introduction to ADHD provides essential context for understanding the disorder’s manifestations and effects. This foundation is vital to delve deeper into the neurological mechanisms underlying ADHD, allowing for a more comprehensive examination of its symptoms and implications.
Neurological Mechanisms of ADHD
Understanding the neurological mechanisms of Attention Deficit Hyperactivity Disorder (ADHD) is essential. This section sheds light on specific brain structures and the role of neurotransmitters. Knowledge in this area helps unravel the reasons behind ADHD symptoms and offers insights into potential treatment strategies.
Brain Structure Anomalies
Prefrontal Cortex
The prefrontal cortex is crucial in many cognitive functions. This brain region primarily handles decision-making, impulse control, and organization. A common finding in individuals with ADHD is structural and functional abnormalities in the prefrontal cortex. These anomalies may result in difficulties in sustaining attention and controlling behavior.
The key characteristic is the variability in its size and functionality among those with ADHD. This specificity makes it a vital choice for this article because it directly connects to core symptoms. The unique feature of the prefrontal cortex is its role in executive functions. Underdevelopment in this area can lead to challenges in planning and oversight, impacting daily life.
Basal Ganglia
The basal ganglia are also significant in managing motor control and cognitive functions. Research indicates that individuals with ADHD often show differences in the structure and operation of this brain region. The basal ganglia help regulate attention and the motivation to start tasks.
A notable characteristic of the basal ganglia is its involvement in reward processing. This information is useful, as individuals with ADHD may struggle to find motivation for certain tasks. Its unique feature relates to the modulation of movement and behavior, playing a dual role in both hyperactivity and attention deficits. This can be both advantageous and disadvantageous because while it highlights ADHD's complexity, it complicates treatment strategies.
Cerebellum
The cerebellum's role in coordination and timing makes it another critical aspect when discussing ADHD. Research shows structural differences in the cerebellum among those affected. These differences particularly influence motor control and can lead to issues related to balance and coordination.
A key characteristic of the cerebellum is its extensive connections with other brain areas. This characteristic makes it a pivotal choice for understanding ADHD. The unique advantage is that improved cerebellar function could lead to better overall functioning in ADHD. However, the downside is that it may also contribute to the clinical picture of ADHD, making diagnosis and treatment more intricate.
Neurotransmitter Imbalances
Dopamine Dysfunction
Dopamine dysfunction is a central neurotransmitter issue observed in ADHD. Dopamine plays a significant part in reward, motivation, and attention. Individuals with ADHD often have atypical dopamine pathways, resulting in challenges with sustaining focus and regulating impulses.
The key characteristic is its direct influence on behavior. This relevance makes dopamine a crucial element in this article. The unique feature is that restoring dopamine levels can often mitigate ADHD symptoms. However, focusing too much on dopamine overlooks other critical neurotransmitters involved in ADHD.
Norepinephrine Activity
Norepinephrine activity also plays a vital role in ADHD. It is connected to arousal, alertness, and attention. Abnormal levels can correspond to symptoms like distractibility and hyperactivity.
The characteristic of norepinephrine in this context is that it impacts attention and response to stimuli. This aspect makes it a valuable topic for discussion. The unique feature is the relationship it has with the brain's stress response. This could either be a beneficial factor in treatment discussions or a disadvantage if it exacerbates anxiety symptoms in some individuals.
Symptoms and Diagnosis of ADHD
Understanding the symptoms and diagnosing ADHD play pivotal roles in managing this complex condition. They provide essential insights into how ADHD manifests in individuals, which guides interventions and support. Recognizing the core symptoms helps in tailoring treatment approaches and addressing the unique challenges that those with ADHD face. The diagnostic criteria offer a framework that aids clinicians in distinguishing ADHD from other mental health disorders, ensuring that individuals receive appropriate care and resources.
Core Symptoms
Inattention
Inattention is one of the hallmark symptoms of ADHD. It manifests as difficulties in sustaining attention, following through on tasks, and organizing activities. Individuals may appear forgetful, easily distracted, and struggle to complete assignments. This characteristic is crucial for this article, as it sheds light on a significant barrier to academic and occupational success. Inattention can impact various life aspects, leading to frustration for the individual and those around them. Its unique feature is that it is not merely a lack of focus; it results from neurological differences in how information is processed. This misalignment can create disadvantages in traditional environments where sustained attention is critical.
Hyperactivity
Hyperactivity is another core symptom often observed in individuals with ADHD. It is characterized by excessive movement, fidgeting, and restlessness. This symptom is particularly significant for this article because it illustrates the behavioral aspect of ADHD. Hyperactivity can disrupt social and academic settings, as individuals may struggle to conform to expected norms. The unique feature here is the tendency for individuals to engage in high activity levels without an appropriate context, which can be challenging for peers and adults to understand. While hyperactivity can foster creativity and spontaneity, it can also create challenges in settings that value calmness and order.
Impulsivity
Impulsivity refers to acting without forethought, which can lead to hasty decisions and risky behaviors. It plays a crucial role in ADHD and is a significant concern for this article as it affects social interactions and decision-making processes. A key characteristic of impulsivity is its unpredictability; individuals may interrupt conversations or make choices without considering long-term consequences. This behavior can result in negative outcomes, but it can also lead to moments of innovation and spontaneity. The unique feature here lies in the inability to delay gratification, often leading to consequences that are not immediately apparent.
Diagnostic Criteria
DSM-5 Criteria
The DSM-5 criteria outline specific guidelines for diagnosing ADHD. This framework is important as it ensures consistency and accuracy in diagnosis across different healthcare providers. The key characteristic of these criteria is that they require a comprehensive evaluation of the individual's behavior across multiple settings, such as home and school. This approach acknowledges the complex nature of ADHD. One advantage of the DSM-5 criteria is its reliance on observable behaviors, which can help to minimize subjective biases. However, it may also lead to underdiagnosis due to variations in symptom expression.
Assessment Tools
Assessment tools are integral to diagnosing ADHD. They include standardized questionnaires, behavior rating scales, and behavioral observations. The significance of these tools lies in their ability to gather systematic data that informs the diagnostic process. A key characteristic of assessment tools is their empirical basis, providing scores that can highlight areas of concern. Utilizing these tools can facilitate a more accurate diagnosis, leading to better treatment outcomes. However, one drawback is that reliance on tools alone may overlook important contextual factors influencing behavior.
Comorbid Conditions Associated with ADHD
Attention Deficit Hyperactivity Disorder (ADHD) does not occur in isolation. It frequently coexists with various other conditions, which complicates both diagnosis and treatment. Understanding the comorbid conditions associated with ADHD is crucial for a comprehensive approach to managing the disorder. Some common comorbidities include anxiety disorders, learning disabilities, and conduct disorders. These conditions can exacerbate the challenges faced by individuals with ADHD and must be carefully considered during clinical evaluation.
Anxiety Disorders
Anxiety disorders are one of the most prevalent comorbid conditions seen in individuals with ADHD. It is estimated that a significant portion of children and adults with ADHD also experience anxiety disorders, such as generalized anxiety disorder, social anxiety disorder, or specific phobias. The relationship between ADHD and anxiety can be bidirectional; ADHD symptoms can lead to increased anxiety, while anxiety can further aggravate ADHD symptoms. This overlap presents unique challenges in treatment, as some stimulants used for ADHD may heighten anxiety symptoms.
Addressing anxiety in these patients often requires a multi-faceted approach, including medication and psychosocial interventions. Cognitive-behavioral therapy (CBT) is particularly effective in treating anxiety disorders among individuals with ADHD. By focusing on both the emotional and behavioral aspects of their condition, individuals can learn effective coping strategies and develop better emotional regulation skills.
Learning Disabilities
Learning disabilities frequently appear alongside ADHD, affecting an individual’s academic performance and self-esteem. Conditions like dyslexia, dyscalculia, and specific learning disorders can hinder educational achievement. The overlapping symptoms of ADHD and learning disabilities can create a complicated picture for educators and parents. For instance, a child with ADHD may have difficulty concentrating, which could be misinterpreted as lack of effort or unwillingness to learn, whereas it could stem from an underlying learning disability.
Early identification of learning disabilities is vital. Tailored interventions, such as individualized educational plans, can help manage these conditions. A collaborative approach that includes teachers, parents, and mental health professionals can facilitate the necessary support that these children need to thrive academically.
Conduct Disorders
Conduct disorders are another significant comorbidity associated with ADHD. These disorders encompass a range of antisocial behaviors, including aggression toward people and animals, destruction of property, deceitfulness, or serious violations of rules. The presence of conduct disorders can complicate the treatment of ADHD, as behavioral issues may overshadow the attention and impulse control difficulties.
Effective intervention requires a comprehensive behavioral approach, which may include family therapy and behavioral modification techniques. Recognizing early signs of conduct disorder in children with ADHD can lead to more effective interventions and better long-term outcomes.
Ending
Understanding these comorbid conditions is essential for effective diagnosis and treatment of ADHD. By recognizing the interconnectedness of ADHD with anxiety disorders, learning disabilities, and conduct disorders, professionals can tailor interventions that address the full spectrum of challenges faced by individuals with ADHD.
Impact of ADHD on Daily Life
Understanding the impact of Attention Deficit Hyperactivity Disorder (ADHD) on daily life is crucial. It extends beyond the clinical setting, affecting various aspects of living. Individuals dealing with ADHD face distinct challenges, and recognizing these can foster better outcomes.
Academic Performance
For students with ADHD, academic performance becomes challenging. Difficulty in focusing often leads to problems in completing assignments and keeping up with peers. They may experience inconsistent grades, stemming from issues with organization and time management. The distractions present in a classroom can intensify the struggle, making it hard for these students to concentrate during lectures or discussions.
- Attention Issues: Students with ADHD often miss important information.
- Impulsivity: This can lead to incomplete tasks and assignments.
- Organizational Challenges: Many have trouble organizing materials and deadlines.
Additional support through tailored educational approaches can assist in alleviating these issues. Programs that include individualized teaching strategies show promise in improving academic outcomes.
Social Relationships
Social relationships for individuals with ADHD tend to be complex. The impulsive behavior associated with ADHD can result in difficulties forming and maintaining friendships. They might interrupt conversations or seem inattentive, which can frustrate peers. Consequently, this can lead to misunderstandings or social isolation.
- Communication Barriers: Difficulty in deciphering social cues.
- Impulsivity: Can lead to conflict or frustration in friendships.
- Difficulty in Empathy: Sometimes misunderstood as indifference.
Encouraging open discussions and social skills training can create a supportive environment. These strategies can enable individuals with ADHD to navigate their social worlds more effectively.
Occupational Challenges
In the workplace, individuals with ADHD often encounter several hurdles. Time management and fulfilling job responsibilities become more challenging, impacting productivity. Common tasks might take longer to complete due to difficulties in maintaining focus.
- Disorganization: Many struggle with keeping their workspace and tasks in order.
- Interruptions: May occur frequently, leading to lost work time.
- Frustration with Repetitive Tasks: These can be especially difficult to manage.
Providing a supportive work environment can help those with ADHD succeed. Flexibility in task assignments and clear communication are beneficial elements to consider.
The challenges faced by those with ADHD in daily life highlight the necessity for understanding and supportive measures. Adjustments in educational and work settings can lead to significant improvements in their experiences.
Treatment Options for ADHD
Understanding the treatment options for Attention Deficit Hyperactivity Disorder (ADHD) is vital. These options significantly affect the quality of life for those affected by this condition. The two main categories of treatment are pharmacological treatments and psychosocial interventions. Each offers various techniques and strategies that target the core symptoms and comorbidities associated with ADHD. By exploring these treatments, one gains insights into how they address individual needs and contribute to better outcomes.
Pharmacological Treatments
Pharmacological treatments for ADHD typically involve medication designed to modify brain function. These treatments can enhance attention, focus, and impulse control, addressing the core symptoms of the disorder.
Stimulants
Stimulants are the most widely used medications for treating ADHD. These drugs increase levels of neurotransmitters like dopamine and norepinephrine in the brain. The key characteristic of stimulants is their fast-acting nature, often producing noticeable improvements in symptoms within hours. This immediacy makes them a popular choice among clinicians. One unique feature of stimulants is their ability to be titrated, allowing for dose adjustments based on individual responses.
However, there are disadvantages. Some patients may experience side effects, including insomnia, decreased appetite, and increased anxiety. Moreover, the potential for misuse is a concern. Despite these drawbacks, stimulants remain the primary treatment option due to their effectiveness.
Non-Stimulants
Non-stimulants offer an alternative to traditional stimulant medications. These drugs tend to work by affecting neurotransmitters differently, often leading to a gradual onset of effects. A key characteristic of non-stimulants is their lower risk of abuse. This makes them a beneficial choice for individuals who may have a history of substance use disorder. Unlike stimulants, non-stimulants may have a longer duration of action, providing more consistent symptom management throughout the day.
The unique feature of non-stimulant medications is their application for those who cannot tolerate stimulants. While generally less effective than stimulants, they can provide relief with a different side effect profile. However, the slower onset and need for consistent use can sometimes disappoint patients looking for immediate improvement.
Psychosocial Interventions
Psychosocial interventions encompass a variety of therapeutic approaches that address the environmental and behavioral aspects of ADHD. These interventions can be essential complement to medication, especially for individuals seeking holistic treatment.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is a structured approach that helps individuals identify and modify negative thought patterns and behaviors. This therapy’s focus on practical skills and behavioral strategies significantly benefits those with ADHD. A key characteristic of CBT is its goal-oriented nature, which helps individuals set and achieve specific targets in their daily lives. CBT remains a beneficial choice for people with ADHD because it empowers them with tools to manage their symptoms actively.
One unique aspect of CBT is its adaptability to individual needs, including techniques that can be introduced to parents or caregivers. While effective, the therapy's success often depends on the willingness of the individual to engage actively in the process. Additionally, completing sessions may take time, making it a longer-term option compared to medication.
Parent Training Programs
Parent Training Programs aim to equip parents with tools to manage their child’s behavior and support their ADHD treatment effectively. These programs focus on teaching parents strategies to reinforce positive behaviors while managing challenges. A key characteristic of these programs is their structured approach, providing parents with clear rules and routines.
These training programs are beneficial as they enhance the child’s environment, allowing for better behavior management. One unique feature is the involvement of parents in their child’s treatment, fostering stronger family relationships. However, the potential downside is the required commitment and time from parents, which may not always be feasible.
Challenges in ADHD Research
The study of Attention Deficit Hyperactivity Disorder (ADHD) presents a variety of challenges that researchers must navigate. Understanding these challenges is vital for advancing knowledge about the disorder, its symptoms, and effective treatments. Several specific elements contribute to the complexity of ADHD research.
One primary challenge is the variability in symptoms. ADHD is not a one-size-fits-all diagnosis. Instead, it manifests differently across individuals. Some may struggle more with inattention, while others may exhibit hyperactivity or impulsivity. This inconsistency can complicate both diagnosis and treatment options, making it difficult for professionals to establish comprehensive interventions tailored to each individual. Comprehensive assessments often reveal overlapping symptoms with other conditions, leading to diagnostic confusion. Hence, researchers face obstacles in categorizing ADHD, which limits the development of standardized treatment protocols.
Another significant challenge is stigma and misconceptions surrounding ADHD. Many people still view the disorder through a narrow lens, attributing it to poor parenting or lack of discipline rather than recognizing its neurobiological foundations. These misconceptions contribute to social stigma that can affect treatment-seeking behaviors among individuals with ADHD and their families. Improving public understanding is crucial for fostering an environment where individuals feel comfortable seeking help.
Last, the need for interdisciplinary collaboration in ADHD research is essential but often lacking. Researchers from various fields such as psychology, neuroscience, and education must work together to fully explore ADHD's complexities. Without this collaboration, advancements in understanding the disorder may remain fragmented. As ADHD continues to evolve in public discourse and scientific exploration, addressing these challenges will enhance future research initiatives, ultimately leading to better intervention strategies and improved outcomes for individuals affected by this disorder.
"Understanding ADHD requires a holistic approach that merges biological, psychological, and social perspectives."
Variability in Symptoms
The variability in symptoms presents numerous challenges in ADHD research. Clinical manifestations can differ greatly among individuals diagnosed with ADHD, creating a broad spectrum that complicates both diagnosis and treatment.
Key factors contributing to this variability include:
- Age and developmental stage: Symptoms can evolve as individuals grow. For instance, impulsivity may be more pronounced in younger children and may decrease with age.
- Cultural and contextual influences: The perception and interpretation of ADHD symptoms can differ greatly across cultural backgrounds. This context may influence how symptoms are diagnosed and treated.
- Comorbid conditions: Many individuals with ADHD also experience other mental health disorders. This overlap can obscure the primary ADHD symptoms, making it challenging for clinicians to treat them effectively.
Recognizing the nuances in ADHD symptomatology is essential for researchers to develop effective models of understanding the disorder and implementing proper clinical practices.
Stigma and Misconceptions
The stigma associated with ADHD significantly influences research and treatment approaches. Many hold misconceptions that label ADHD as mere behavioral problems rather than a complex neurological disorder. This stigma can lead to several negative consequences:
- Resistance to diagnosis: Families may avoid seeking help due to fear of judgment or misunderstanding.
- Misunderstanding of treatment: People may view pharmacological treatment as unnecessary or harmful, resulting in reluctance to explore effective options such as stimulants or therapy.
- Impact on self-esteem: Individuals can internalize negative societal perceptions, leading to diminished self-worth and increased anxiety regarding their condition.
Addressing stigma requires collaboration among researchers, educators, and healthcare professionals to promote accurate information about ADHD and encourage open dialogues within communities. Enhancing awareness will not only aid in research efforts but will also help individuals to feel more accepted and supported.
Future Directions in ADHD Research
Understanding ADHD is an evolving process. Ongoing research opens the door to new possibilities in how we perceive and manage this disorder. The significance of exploring future directions in ADHD research lies in the potential to uncover more effective interventions and to deepen our understanding of its complex nature. It is critical not only to focus on the existing knowledge but also to challenge and expand it. This can lead to better outcomes for individuals with ADHD.
Genetic and Environmental Factors
Research increasingly emphasizes the interplay between genetic and environmental factors in ADHD. Studies have shown that genetics can play a significant role in its development. Certain genes related to dopamine transport and receptor functioning have been associated with ADHD. Moreover, identifying these genetic markers can enable targeted approaches in treatment.
However, genetics alone does not tell the whole story. Environmental influences are equally important. Factors such as prenatal exposure to tobacco smoke, toxins, and family dynamics can contribute to the risk of developing ADHD. Future studies should focus on how these elements interact with genetic predispositions. Understanding this interaction is vital for developing comprehensive prevention strategies and intervention plans.
Neuroimaging Studies
Neuroimaging studies offer a unique window into the workings of the brain in ADHD patients. Technologies like fMRI and PET scans can reveal structural and functional differences in brain regions associated with impulse control, attention, and behavior regulation. The prefrontal cortex, for example, often shows activity patterns in ADHD individuals that differ from those without the disorder.
Such visual evidence enhances our understanding of ADHD's neurological basis. Future research should aim to refine these imaging techniques to pinpoint specific changes in brain structures over time. This could allow for monitoring of treatment effectiveness and the progression of the disorder.
Furthermore, integrating neuroimaging data with genetic information can provide a more holistic view of ADHD. This combined approach may identify specific biological markers that indicate susceptibility and guide tailored treatment plans.
"The integration of genetics, environment, and neuroimaging is essential for a comprehensive understanding of ADHD."
Future directions in ADHD research, therefore, hold immense promise. By focusing on genetic and environmental factors and advancing neuroimaging studies, researchers can foster a more nuanced and effective approach to ADHD. This will ultimately enhance diagnosis, treatment, and the quality of life aspects for individuals impacted by this disorder.
Epilogue
The conclusion of this article on Attention Deficit Hyperactivity Disorder (ADHD) serves as a vital synthesis of the various elements examined throughout the text. Here, it is essential to reiterate the complexities of ADHD, focusing on its neurological underpinnings, the implications for daily life, and the evolving landscape of treatment options.
Summary of Key Findings
Throughout this article, certain key findings have emerged regarding ADHD that warrant emphasis:
- Neurological Basis: Research indicates that specific brain structures, such as the prefrontal cortex and basal ganglia, exhibit anomalies in individuals with ADHD. These differences can help explain the challenges faced in attention regulation and impulse control.
- Neurotransmitter Involvement: The article has highlighted the role of imbalances in neurotransmitters like dopamine and norepinephrine. These chemicals are crucial in regulating mood and attention, making their dysfunction pivotal to understanding ADHD symptoms.
- Comorbidity: ADHD frequently coexists with other conditions, such as anxiety disorders and learning disabilities. Understanding these relationships is fundamental in tailoring effective treatment plans.
- Impact on Life: The consequences of ADHD extend beyond mere symptoms. Academic performance, social relationships, and occupational challenges often suffer, leading to increased levels of frustration and a sense of inadequacy for those affected.
Final Thoughts
In closing, the exploration of ADHD from a neurological perspective offers significant insights that can enhance our understanding of the disorder. The implications of this research should extend into practical applications, informing stakeholders like educators, clinicians, and family members.
It is clear that ADHD is not just a childhood disorder; it affects individuals throughout their lives. By recognizing the specifics discussed in this article, it becomes apparent that better awareness and tailored interventions can improve the quality of life for those living with ADHD. Awareness campaigns, educational programs, and focused research must continue to evolve, together with a push for destigmatization and a greater understanding of ADHD's complexities.
"To truly support individuals with ADHD, it is important to look beyond the symptoms and understand the underlying mechanisms. Knowledge is the first step towards empowerment."
The future of ADHD research holds promise. As we piece together the genetic, environmental, and neurobiological factors that contribute to this disorder, we will be better positioned to develop effective treatments and support systems. The path forward is not without challenges, but the potential for positive change is significant.
