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Invited Commentary

Teen with Psychiatric Diagnoses Improves After Eliminating Medications and Initiating Endurance Sports Training

Rundell, M. Beth; Rundell, Kenneth W. PhD, FACSM

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Current Sports Medicine Reports: January 2020 - Volume 19 - Issue 1 - p 6-7
doi: 10.1249/JSR.0000000000000678
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Recent evidence supports the notion that aerobic exercise improves mental illness symptomology, alone or as supplemental treatment to medication (1). Studies with Attention Deficit Hyperactivity Disorder (ADHD) (2–7), Bipolar 2 (8), schizophrenia (8,9), depression (10), and autism spectrum (1,11) have all demonstrated positive benefits on behavioral, physical, and cognitive outcomes.

This Invited Commentary reports potential pitfalls in diagnosis and subsequent treatment of a child by the traditional methodology most commonly used in the field of psychiatry. Most critical to this article is the discovery of the benefits of a rigorous aerobic exercise program, resulting in positive outcomes not achieved by medication by this patient. We describe a child who had seven different psychiatric diagnoses by multiple psychiatrists with more than 25 different medications prescribed over a 6-year period. Negative responses to medication over this period were met with either increases in medication or an alternate “cocktail.” This trial-and-error approach resulted in numerous negative physical, psychological, emotional, and social experiences for the patient and his family. Out of desperation to identify a functional baseline, but against medical advice, the parents slowly removed medication from the child and then initiated an aerobic exercise program; with great surprise, symptoms decreased, quality of life improved, and overall mental capacity increased, including the ability to learn, which previously had been impossible. The child developed a passion for mountain bike racing and is now an international elite racer at age 19 years, National Interscholastic Cycling Association (NICA) coach, USA Cycling Official, and gives lectures across the country.

History

To offer some history, at 2 years there was a noted severe language delay; otherwise normal developmental benchmarks were achieved. Speech therapy was initiated but produced little progress. Upon starting kindergarten, there was immediate difficulty in the classroom. Still largely unintelligible, academic distress was expressed by behavioral outbursts. The child was placed in a learning support classroom. The child was referred for evaluation and the parents sought opinions from mental health and medical professionals both locally and statewide. Extensive psychiatric and academic evaluations produced diagnoses that ranged from expressive language delay and ADHD, to pervasive developmental disorder — not otherwise specified, then Tourette's, childhood schizophrenia, bipolar disorder, and obsessive-compulsive disorder. With behaviors worsening, the child was moved from school to school and placed in more and more restrictive environments. The child was hospitalized several times and was eventually recommended for long-term residential treatment. The child was hearing voices; he had developed a constant (two to four times per minute) throat-clearing tic and needed a full-time aide to prevent him from hurting himself or others. His behaviors at school included defecating in the timeout room, throwing a trash can out a window, knocking tables over, ripping posters off the walls, stabbing the teachers/drivers with writing utensils, and so on. Academically, the child was unable to progress, and comprehensive educational assessments showed scores within poor limits and above only 2% of his same-aged peers.

During the course of his treatment, the child was prescribed dozens of medications, beginning at age 6 years. Parents enforced medication compliance. Various combinations were tried over a period of 6 years, including Risperidone, olanzapine, quetiapine, aripiprazole, olanzapine, clonazepam, guanfacine hydrochloride, sertraline hydrochloride, citalopram hydrobromide, fluoxetine, clomipramine, bupropion, methylphenidate, escitalopram, dextroamphetamine, atomoxetine, divalproex sodium, buspirone, lamotrigine, haloperidol, chloropromazine, oxcarbazepine, and lithium. With little improvement in behavior, placement in a long-term residential treatment facility was imminent. The parents, entirely frustrated, decided to begin a slow taper of medication to reassess and better define core issues. After several months, behavioral and cognitive function began to improve. The child was capable of better self-control, the internal voices and tic began to fade, and finally went away altogether. The child was then released from the restrictive educational setting and was admitted to the DePaul School for Dyslexia at age 12 years; at that time the child was completely illiterate. Without a single behavioral outburst, the child was able to attend classes geared for his level, and finally learned how to read, write, and do math. The child progressed through classwork to academically achieve about a 6th grade level. The child was then able to return to his “home” district and enter the public educational system.

At about age 15 years, the child expressed an interest in cycling and obtained a mountain bike. A local team for 6th through 12th graders had formed to prepare riders to compete in the growing NICA, and the child joined. Quickly picking up the technical skills and responding well to aerobic training, the child competed at the junior varsity level, finishing the season in second place overall. The following year, the child competed at varsity level and won the NICA state championships as well as the USA Cycling (USAC) Junior State Championships. As a junior rider and now as a senior rider, he competes in elite races as a category 1 men's rider, and last summer, with a factory sponsorship, he won the New Jersey H2H Mountain Bike Racing series category 1 men's division (as a USAC junior) and is now competing as an Elite Union Cycliste Internationale sports governing body racer. He has become a volunteer coach for his youth team (now that he has moved on as a men's racer), and he has recently passed the certification program to become a USAC race official.

Although this scenario may be unique to this individual, the child clearly did not respond positively to traditional treatment for any of the seven diagnoses he received. Only when medication was removed, and a rigorous aerobic exercise program was initiated was significant improvement noted in the child's mental status. This Invited Commentary supports the need for extreme caution when prescribing medication to children as well as the positive effects of the inclusion of an aerobic exercise program in treatment of mental illness.

The authors declare no conflict of interest and do not have any financial disclosures.

References

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