Behavioural and Neurodevelopmental Disorders (ODD and ASD)
Autism (ASD) and Oppositional Defiant Disorder (ODD), with some discussion on Stuttering, Childhood Bedwetting and Dyslexia
*I suggest reading this article on a web page, not as an email. Click the title of the article and it will open the article.*
This article is on “behavioural disorders” such as Oppositional Defiant Disorder “ODD”, and I will also discuss autism “ASD” which is often referred to as a neurodevelopmental disorder, like ADHD. There will also be a brief note on stuttering, dyslexia and childhood bedwetting.
I’ve already written articles about conditions that can be considered to be anxiety disorders, neurological disorders and neuropsychiatric disorders. It’s often difficult to draw a line between what is a “neurological”, “psychiatric” or “behavioural” disorder, but these labels are largely not important and are simply just an exercise in categorizing.
For example, I currently already have specific articles on:
I also have a series on neurodegenerative disorders called “Maintain Your Brain”. It has three parts and so far Part I on ALS, MS and HD is out. The other parts will be on Parkinson’s and Dementia. I also have a premium article on brain fog.
Soon I will release an article on “Psychiatric Disorders” which will cover Schizophrenia, Bipolar, PTSD and Eating Disorders.
First, I want to be clear that I fully understand that many people do not consider autism (“ASD”) to be a disorder or a health condition in general. When I write about autism in this article I am talking about how to lessen the negative symptoms associated with ASD, such as irritability, aggression, anxiety, overall social discomfort and so on. This article is not suggesting that autism is something that needs to be “cured” but even if someone doesn’t feel their autism is a disease or a “bad thing”, surely it is understood that certain symptoms autistic people deal with are undesirable and thus utilizing things to improve these symptoms can drastically improve the lives of people with autism. This is especially true of autistic children in school, where they may have a very hard time, especially due to potential extreme aggression.
I hope no one is offended by the inclusion of ASD in this article, it’s not my intention to offend but rather to write about how certain approaches can benefit people with ASD.
Irritability and Aggression
One thing that many of these disorders have in common is that they can often involve high levels of aggression and irritability. In fact, when it comes to behavioural disorders such as ODD, or when it comes to autism and ADHD it’s arguable that the worst part is the extreme aggression. This is especially true when children with these disorders are having trouble in school. Being disruptive in school as a child is typical, but when the aggression and irritability become extreme it goes beyond mere classroom disruptions. For example, children who are violent in class, throwing chairs, flipping tables, screaming at the teacher and overall terrorizing the class are all examples of extreme irritability and aggression that are not being dealt with correctly.
Many children who may be exhibiting extreme levels of aggression may be on certain medications that exacerbate this aggression, such as any of the stimulant medications like methylphenidate (Concerta, Ritalin, foqualin etc..) or amphetamines. Furthermore, many children may be medicated specifically for aggression, but the medication can be “worse than the disease”, as it were. This is often certainly the case if SSRIs, antipsychotics/neuroleptics and atypical antipsychotics are used. Also, benzodiazepines are sometimes used, but these medications are extremely habit-forming and are not appropriate for extended periods of time and thus they are of little use.
There can be some medications that seem to help immensely with extreme aggression and moodiness in children, such as amantadine and clonidine, and these medications are fairly harmless when it comes to side effects. They have been used for childhood disorders (often off-label, but not always) for a long time now and it is clear they are fairly safe. So, if a troubled child needs to be medicated then it would be wise to talk to the doctor about these safer and effective meds. Having said that, medication is often not necessary.
More on that point, these disorders often do not require medication and various other methods can be employed to achieve the desired result of a less irritable and aggressive child. Diet and lifestyle changes plus the utilization of various nutritional supplements can be extremely helpful. When it comes to dietary supplements there are many options that can elicit the desired response, these can include amino acids (taurine, theanine, agmatine, glycine…) minerals (magnesium, molybdenum, zinc, manganese, lithium orotate…), vitamins (vitamin B6, riboflavin, thiamine, vitamin D…), herbal supplements (pycnogenol, ginkgo biloba…), and potentially even hormonal supplementation (pregnenolone, DHEA, progesterone…).
Starting with dietary changes, it seems that many people benefit from avoiding opioid compounds in their diet. Gluten and A1 dairy (conventional dairy) are classic examples of opiod-containing foods. This can be avoided if your children consume goat dairy, or “A2 cows dairy”. This is because the “A1 casein protein” is the main problem when it comes to dairy. There are many reasons why opioid-like compounds in foods can worsen mood, and this is likely in part due to the gut inflammation they cause and increases in certain hormones like prolactin. It’s also very important to avoid foods with a lot of artificial colourings, and certain chemicals and harmful food additives such as talc and titanium dioxide. These harmful food additives are thought to be connected to ADHD, ASD and many other disorders. Also, heavy metals like cadmium and lead are thought to be involved as well. The practical way to avoid these additives is to make sure your child primarily eats the food you prepare. Cereal, candy and other packaged foods typically contain at least some of these very harmful additives.
Vitamin A is a very important nutrient to consume for combating the negative symptoms associated with autism. As such, it’s best to try to consume high vitamin A foods such as beef liver, dairy and egg yolks (or whole eggs - never just the egg white).
Retinol Palmitate supplementation may be required, also zinc is required for the activation of retinol into retinoic acid so consuming enough zinc is also important. If getting zinc from food is difficult (oysters, lamb/beef, and cheese) then zinc carnosine is the best zinc supplement option. This is because zinc carnosine supplies zinc while also having many other benefits such as helping to correct leaky gut, prevent ulcers from forming and other digestive benefits. NAD levels are also important for vitamin A activation, and as such vitamin B3 may be useful.
When it comes to supplementation, as mentioned earlier, it’s best to utilize certain amino acids, minerals, vitamins, herbal and even hormonal supplements when indicated. The most effective over-the-counter supplement for irritability and aggression is likely lithium orotate. This form of lithium is a low dose and seemingly very safe, it is different than the high doses of lithium carbonate which is a prescription form that is used primarily for bipolar disorder. There are a plethora of reasons why lithium orotate is helpful and you can read about the amazing benefits of nutritional lithium in the very thorough book “Nutritional Lithium, a Cinderella Story” by psychiatrist Dr. Greenblat. Some reasons are, that lithium lowers PUFA in the brain leading to less inflammation, lithium can normalize glutamate, it helps with the utilization of vitamin B12, increased BDNF and it can help to lower excess ammonia. Ammonia is very harmful to the body and is often involved in mental, psychiatric and psychological related disorders.
Lithium orotate has also been shown by Dr. James Greenblatt to be useful for Disruptive Mood Dysregulation Disorder (DMDD). Also, he has described how it’s very useful for preventing road rage. If you’ve ever gotten so angry while driving where you’ve left your car, you may benefit from some lithium orotate. One case study had someone with bad road rage and a bad temper take 5mg of lithium orotate for a month, and then 10mg (5mg, 2x a day) after, and the road rage incidents were markedly reduced.
Manganese and molybdenum can also be helpful, as a deficiency in either of these can lead to glutamate issues, which increases irritability. In addition, molybdenum is able to help with sulphur issues, and this is very important because without molybdenum you can have excessive sulphite (harmful) and too little sulphate (beneficial). Molybdenum is also important for the utilization of riboflavin, and there is evidence that ASD involves a “functional B2/riboflavin deficiency” so getting enough vitamin B2 and molybdenum in the diet is key. Zinc supplementation is recommended by many for ASD, partly because of its ability to increase metallothionein, which is supposedly low in people with ASD. Selenium is also a very important nutrient to consume and it is high in egg yolks, seafood and organ meats. Lastly, iodine is a very important nutrient for people with ASD, potatoes, dairy, and seafood could all be decent sources.
Magnesium is also a great mineral for aggression and irritability for many reasons, one of which is magnesium is an NMDA blocker. Agmatine, an amino acid, is also extremely beneficial for these types of issues, and it seems to potentially be very beneficial for autism. Agmatine, like magnesium (and the drug amantadine), is an NMDA blocker, among other things. Agmatine is likely the most beneficial amino acid for this group of disorders, and Ray Peat Ph.D. has written favourably about agmatine in his newsletter on autism. Agmatine has also been found to be lower in people with autism. I personally think that supplementing with agmatine may be one of the best things to take for someone with ASD.
Having said that, other amino acids, like glycine, taurine and theanine are also extremely helpful. Glycine, for example, is able to help reduce the startle response, helps improve sleep and often can help improve mood, and thus it can be useful for reducing irritability and aggression. Taurine and theanine are extremely helpful, they are GABA-promoting, and thus calming, and plus theanine is a mast cell stabilizer, so can help reduce things like histamine.
There is some evidence that autism involves having low levels of GABA, which would make sense as GABA is generally considered a very “calming” neurotransmitter. Vitamin B6, taurine, theanine and herbs like lemon balm can all help increase GABA.
For more information on this check out my article on the balance of glutamate and GABA
When it comes to helpful vitamin supplementation, vitamin D, vitamin B6 (P5P form), thiamine, riboflavin, and vitamin B12 are all extremely helpful. Vitamin B6 has the potential to be one of the most beneficial vitamins for these types of issues. I’ve written about B6 extensively in my previous articles, but the best article to read from me on B6 is The Dance of Glutamate and GABA. In that article, I discuss the right form and dose of B6, for most people. For example, P5P seems to be the best form, and the best dose typically seems to be 5-15mg a day, but most supplements contain 50mg. This dose, 50mg, does not seem to be harmful for most, but it is likely higher than necessary. So, a liquid B6 P5P would be the best, as you can easily control the dose, and the drops can simply be dropped into any drink for the child. Keith Littlewood sells a liquid P5P in his online shop Balanced Body Mind. Dr. Carl Pfeiffer suggested vitamin B6 and zinc supplements for ASD.
Quinolinic acid is thought to play a large role in ASD (and probably in all behavioural disorders). Vitamin B6 helps tryptophan turn into beneficial things such as niacin (vitamin B3). Without enough vitamin B6 tryptophan goes down certain pathways and eventually becomes quinolinic acid. Thus, vitamin B6, by preventing excess quinolinic acid from being produced, can be very helpful for autism. You can check quinolinic acid with an OAT test (organic acid test).
Some people consider ASD to be involved with issues with riboflavin (vitamin B2) and vitamin B12. Getting enough vitamin B12 and B2 is very important for autistic children, but if it is too difficult to obtain these nutrients consistently from food, then it may be a good idea to supplement. (Lithium orotate helps with the utilization of vitamin B12, and is likely one reason why lithium is so beneficial for ASD and behavioural disorders). A high-fat diet can deplete vitamin B2, and B2 can be difficult to get in the diet as it is very rich in organ meats, which many people do not eat these days. Vitamin B12 is also very high in organ meats like beef liver, but it is also available in seafood, especially shellfish, and red meat.
Furthermore, vitamin D seems to be extremely beneficial for many of these issues, for a variety of reasons. Also, vitamin D deficiency is common in children with ASD. Thiamine helps as well, likely due in large part to its ability to help the body utilize glucose, which is extremely beneficial for essentially every health ailment, plus it helps to lower ammonia. It also improves digestion and has many other benefits. There is some evidence that a crucial enzyme needed for the proper utilization of glucose, PDH “pyruvate dehydrogenase” is impaired in autism. Thiamine and magnesium supplementation can help improve PDH function. Biotin is also often deficient in autistic kids, and biotin is important for another glucose-utilizing enzyme, pyruvate carboxylase.
Of course, many of these nutrients can easily be obtained in the diet. For example, manganese is high in pineapple, mussels and maple syrup, molybdenum is high in liver, gluten-free oats and legumes like peas. However, other minerals, like lithium, are difficult to get in the diet and thus supplementing with lithium orotate, when indicated, can be a good idea.
There are certainly different herbal supplements that can be very helpful for irritability and aggression, however, these would not be my go-to first line of supplementation. I would rather utilize the beneficial amino acids, minerals and vitamins first. Having said that, calming herbs that increase GABA can be very helpful, such as valerian root, lemon balm and chamomile. Gingko Biloba and Pycnogenol seem to be helpful as well especially when it comes to concentration and focus.
When it comes to hormonal supplementation, many people may be wary of using them. However many of the OTC hormonal supplements are very safe and can be extremely beneficial for people. Having said that, I agree that their use is probably better reserved for adults with these groupings of health issues. Pregnenolone, DHEA and progesterone can all be very beneficial especially when it comes to things like autism. Pregnenolone and progesterone can both help to increase allopregnanolone, which is a neurosteroid that is thought to be deficient in people with ASD. When using progesterone, it’s best to use progesterone dissolved in vitamin E. Ray Peat, Ph.D. has written about the benefits of progesterone dissolved in vitamin E in his various articles, newsletters and books (one relevant book is “From PMS to Menopause”).
There is a large intestinal “gut” component to ASD and behavioural disorders. Chronic intestinal inflammation can lead to many behavioural, mood, skin and autoimmune conditions. This is especially true when combined with intestinal permeability commonly referred to as “leaky gut”. Bacterial overgrowth is a typical cause of intestinal inflammation, and gram-negative bacteria contain something called “endotoxin” or lipopolysaccharide “LPS” which can create many problems, especially when it gets into the bloodstream. Part of how endotoxin leads to so many issues is that it activates toll-like receptors such as TLR4. Essentially, when TLR4 is activated there is an immune response leading to lots of inflammation and chronically activated TLR4 can certainly contribute to a plethora of issues, including ASD and behavioural disorders. Furthermore, parasitic infections and overgrowth of fungi such as candida can also be involved here.
As such, certain TLR4-blocking substances can be useful, as they will prevent the activation of TLR4. However, an ever better approach would be to reduce the bacterial overgrowth so there is less endotoxin and less TLR4 activation. Many people are nervous about antibiotics and that is understandable, later in the article I will mention the great benefits of a certain antibiotic “minocycline” which at low doses is less of an antibiotic and more of a potent anti-inflammatory. Having said that, many people would likely rather utilize natural antibacterial, antifungals and antiparasitics. Some examples would be monolaurin, caprylic acid (both from coconut oil), oregano oil, thyme tea, Ceylon cinnamon, olive leaf extract, vitamin B2, clove, black walnut hull and wormwood. Furthermore, it may be a good idea to also use a binder such as activated charcoal as when you kill off a lot of bacteria in the intestines there is a “die off” and the activated charcoal, as an ADsorbent (not ABsorbent) can grab the “debris”, so to speak, and help you excrete it.
I talk about this in detail in my article on Autoimmunity and my article on Acne.
Of course, it’s also very important to make sure there are regular bowel movements and no constipation. Ray Peat’s daily raw carrot salad (grated raw carrots, olive oil, vinegar and salt) is a very good idea. When done daily it can help clean up the intestines and can help promote bowel movements. Furthermore, utilizing some safe laxatives such as aloe vera juice and Cascara Sagrada would be a good idea if there are slow bowels or any constipation. I also want to briefly mention that a lot of chronic constipation is simply a result of a low metabolic rate/poor thyroid function. Optimal energy production is needed for all the digestive processes, including regular bowel movements, stomach acid production, digestive enzyme production and so on.
In addition to heavy metals contributing to these conditions, such as lead, cadmium, mercy, iron and metals like aluminum there also seems to be a mould connection. Mould can worsen symptoms of these disorders and as such it’s imperative that people check their homes for mould and also make sure they clean everything thoroughly, including water bottles and baby bottles and such.
Excessive serotonin seems to be a factor in autism. ASD children seem to have very high levels of serotonin in the brain. Further to this point, anti-serotonin drugs, such as bromocriptine, have been used to reduce autistic symptoms. Moreover, excess estrogen also seems to be a problem.
SSRI drugs during pregnancy cause child autism, antiserotonin drugs cure it
SSRI drugs strikingly toxic for fetal brain, may cause autism
Hyperserotonemia confirmed as a cause of autism and insomnia
Elevated maternal estrogen (estradiol) again linked to autism
Some have argued that fever and fever-mimicking such as the use of steam showers, saunas, and infrared saunas can be useful for this grouping of disorders.
Some orthomolecular doctors and researchers have noted that vitamin B6 and zinc can be helpful for antisocial personality disorder, previously known as sociopathy.
Stuttering is usually classified as a speech disorder as opposed to a behavioural disorder or a psychiatric disorder. It is sometimes labelled as a neurodevelopmental disorder. The labelling and categorization do not really matter, to be frank. If stuttering is an issue there do seem to be some approaches that seem promising to stop the stuttering or at least lessen it. For instance, vitamin B1 supplementation has been shown to ameliorate stuttering to some degree. Given how useful B1 is and how safe it is I think it would be a worthwhile experiment to utilize B1 supplementation to try and lessen stuttering. The best form of B1 will likely be one of the fat-soluble ones such as TTFD/allithiamine, also called fursultiamine. Benfotiamine may be useful, and if thiamine HCL is used then high doses will likely be required.
Bedwetting is an issue that some children experience and it can indicate underlying problems. This is especially true when bedwetting continues into the later stages of childhood, and is certainly an issue if a teenager is wetting the bed. Certain nutrients seem to be able to help decrease bedwetting. Vitamin D is one such nutrient, and a vitamin D deficiency may increase the likelihood of bedwetting. Furthermore, vitamin B12 has been shown to help reduce bedwetting. Sometimes a vitamin B12 deficiency is not related to poor consumption of vitamin B12 (vitamin B12 is high in shellfish and small seafood such as sardines, oysters, clams, octopus etc, and organ meats such as liver, also B12 is decently high in red meat) but rather it can be a result of poor utilization of B12 by the cells, lithium orotate is able to increase the cells ability to take in B12, so this supplement may be useful for a bedwetter. The drug clonidine is used successfully in bedwetting, and this drug essentially works by decreasing the production of certain stress hormones. From this, we can glean that high-stress hormones are involved in bedwetting.
Decreased vitamin D levels in children with primary mono-symptomatic nocturnal enuresis
Clonidine may have a beneficial effect on refractory nocturnal enuresis
Dyslexia is a type of learning disability which is typically addressed by employing different teaching methods and it takes a lot of extra work for the person experiencing dyslexia. Ray Peat Ph.D. has written about pregnenolone’s potential positive effect on dyslexia. Also, some have said that dyslexia can be a sign of undermethylation and as such certain supplements like creatine and phosphatidylcholine could be quite helpful, as both of those substances are a major end product of the methylation system. Dyslexia also seems to involve certain deficiencies, such as deficiencies in vitamin D, B12 and certain minerals such as zinc. I also want to mention that many orthomolecular doctors and researchers have noted that ODD often involves undermethylation. The recommendation for undermethylation typically involved increasing calcium, magnesium, manganese, zinc and methyl donors.
“Pregnenolone and DHEA improve memory in old rats, and improve mood stability and mental clarity of old people. Pregnenolone's action in improving the sense of being able to cope with challenges probably reflects a quieting and coordinating of the "sequencing" apparatus of the forebrain, which is the area most sensitive to energy deprivation. This is the area that malfunctions in hyperactive and "dyslexic" children. “ -Ray Peat, Ph.D.
I’d like to share this quote about imbalances commonly seen in violent youth criminal offenders from the book “Nutrient Power”. Calcium can help displace lead, also zinc and histidine may help.
“In contrast, most violent subjects exhibited abnormal levels, especially with respect to copper, zinc, lead, and cadmium. In general, the violent children exhibited higher lead and cadmium levels than did the controls.”
Furthermore, in “Nutrient Power” the author William Walsh PhD explained that ASD and ODD often involve undermethylation. He suggested methylation support, such as supplementing methyl donors and certain minerals like zinc, calcium and manganese.
“The classic chemical signature of ODD is undermethylation, which can be identified using blood tests for SAMe/SAH ratio, histamine, absolute basophils, etc”
“My data confirmed previous reports of disordered metal metabolism, B-6 deficiency, and elevated toxic metals, but the data also produced the surprising finding that more than 95% of autistics exhibited undermethylation.”
A brief note on potential “causes” or contributors to ASD and behavioural disorders
This article is not on the causes or contributors of ASD, ODD, and other disorders. However, I did want to mention some possible contributors that I think people should know about. Tylenol use in children and their mothers while pregnant is likely a contributor to these disorders. If someone is in pain they should look for non-tylenol options in my opinion. SSRIs, excessive PUFA consumption and excess estrogen while pregnant are also all possible contributors Endocrine disruptors and many “food additives” such as food colourings, talc, titanium dioxide etc can also be potential contributors. Heavy metal toxicity such as lead, cadmium, mercury and also metals like aluminum likely play a role in these disorders.
If someone is on an SSRI and is planning on getting pregnant they should talk to their doctor about various other methods they could use instead. Common conditions that SSRIs are prescribed for are depression and OCD, and I have written articles on both of those conditions (linked at the beginning of the article) and have mentioned alternative medications that have been shown to be useful for treating them. Of course, there is also a very heated debate on the role of vaccines and autism (and other conditions such as allergies, asthma, ADHD and so on), I won’t discuss this topic here as, again, this article was not intended to be on “causes” but rather on practical things, one can do. Having said that, I personally believe there is a connection between the use of multiple vaccinations in very young children with these disorders.
A note on the potential use of medications
I appreciate the importance of nuance and context when it comes to different health conditions. For many, if possible, it’s best to try to remedy your illness via multiple approaches. For some people, this can include dietary and lifestyle changes, supplementation with various amino acids, vitamins, minerals, herbal products etc. For others, this may include medications.
My thought process is that if you really feel that your condition (or say your child's condition) requires a medication then it's best to be informed about all the options. This is very important because, in my opinion, often the best medication options are not "on-label". There are many medications that seem to be very useful and quite safe (relatively speaking) but they are used "off-label" for certain diagnosable conditions.
"Off-label" meds are often not known by certain doctors, or if they are known they aren't their preferred choice due to many reasons - but those reasons are not always strictly "health-related" but more so insurance or liability-related.
Two prime examples are the use of amantadine and clonidine for various childhood-related conditions such as ADHD, ODD, OCD and even things like ASD or tic disorders.
For example, there is a lot of evidence that amantadine (and memantine, which is a related medication) can be very helpful and has fewer side effects than stimulants and other medications for many of these childhood psychiatric conditions, but it's used "off-label".
If you feel your child needs medication for their condition (ADHD, ODD, OCD etc...), then it may be prudent to ask your doctor about trialling amantadine and/or clonidine as opposed to a stimulant (methylphenidate, amphetamine etc..) or an SSRI or an antipsychotic/neruoleptic.
Hopefully, the doctor will be open-minded enough to consider using this approach. Especially given the plethora of evidence in favour of certain off-label approaches. Amantadine shows promise for ODD and ASD.
This is a great review on the use of amantadine for various childhood mental-related conditions:
Clonidine also seems to be potentially useful for these conditions:
Another medication that can be helpful is minocycline, used at low doses. When minocycline is used at a low dose it doesn’t really act as an antibiotic, but rather acts more like a potent antiinflammatory. Minocycline is very beneficial for many disorders, including autoimmune disorders, skin issues and neurodegenerative diseases. Bromocriptine is also useful.
Having said all that, as I said earlier, nuance and context are key. Most of the time these conditions may not need medications at all, and there are various non-medication approaches one can take.
Of course, this is not medical advice, I simply want people to have as much information as possible so that when they speak to their doctor they will be well-equipped with all the relevant knowledge to make an informed decision about their options.
List of Useful Supplements:
Agmatine
Glycine, taurine, theanine
Lithium Orotate
I like Keith Littlewood’s product as it’s a liquid and you can control the dose better. Most P5P capsules are 50mg, which is high. With the liquid you can use more reasonable doses such as 10-15mg.
Magnesium
Vitamin B12
Riboflavin
Thiamine, and other B vitamins like Niacinamide
Pregnenolone, Progesterone, DHEA
Vitamin D
Herbal products (lemon balm, chamomile, valerian root…)
Natural antibiotics like oregano oil, monolaurin, Ceylon cinnamon, garlic, and spore-based probiotics (I like CoreBiotic)
Binders, like activated charcoal
Vitamin A and E
Zinc Carnosine
Molybdenum, Manganese and Selenium
Some safer medications
Low dose minocycline
Bromocriptine (and possibly other ergot derivatives like lisuride or metergoline)
Clonidine
Amantadine or memantine
*None of this is medical advice. I am not a medical professional, always talk to your doctor*
If you enjoyed this article, please consider checking out the other articles I’ve written. Also, please feel free to subscribe (it is free to do so) and share the articles with others. Thank you!
BTW: I am a frequent guest on the podcast “Stuff Your Doctor Should Know”.
Discount code DEAN works at:
Ona’s Naturals (progesterone oil, topical progesterone and pregnenolone creams)
LifeBlud (Magnesium products, Taurine, Theanine, B vitamins, Methylene Blue)
Health Natura (oral pregnenolone, Methylene Blue)
I worked with children and young adults in the neurological and behavioral disorder space for several years and there is information in this article that I wish I had know then. Brilliant as usual Constantine. Will share.
Fantastic article Constantine!
I really love the work you are doing.