The Telegraph, Wednesday Dec 14, 2011
Chronic fatigue syndrome is ‘major’ cause of school absence: research
By Rebecca Smith, Medical Editor
13 Dec 2011
Chronic fatigue syndrome may be ten times more common than previously thought and be one of the major reasons children are absent from school, researchers have said.
A study has found that one per cent of schoolchildren aged between 11 and 16 had CFS, which is also known as myalgic encephalitis or ME.b Previous estimates had suggested only about 0.1 per cent to 0.5 per cent of children suffered from the condition. Most are undiagnosed and untreated, despite evidence that treatment is effective in youngsters, the researchers found. The condition is a ‘major cause’ of school absence, they said.
Chronic fatigue syndrome can result in severe, disabling fatigue and affects mental and physical functioning. It may include insomnia, low mood and
muscle pain or headaches. Previous studies have found that an acute illness, often viral infection, appears to occur in two-thirds of children who go on to develop CFS. Researchers from Bristol University looked at 2855 schoolchildren of which 461 had missed more than 20 per cent of school in six weeks. In over half of the cases, the reason for the absence was known but in 146 it remained unexplained and most of those attended a clinic at school. Of the 2855 children in the sample, 28 were found to have CFS.
The researchers found these children tended to have less fatigue and fewer symptoms than those normally picked up through health services. They also seemed to make quick progress. Of 19 children followed up, six had fully recovered after six weeks and a further six had fully recovered after six months. Lead author Dr Esther Crawley, writing in the journal BMJ Open, said: “Chronic fatigue is an important cause of unexplained absence from school. “Children diagnosed through school-based clinics are less severely affected than those referred to specialist services and appear to make rapid progress when they access treatment. “There are several possible reasons why children missing significant amounts of school with chronic fatigue syndrome/ME are not identified. “Those with moderate/mild symptoms may not see their GP or may not be recognised as having the condition if they are seen. “Alternatively, GPs and paediatricians may not be aware of specialist services or feel that their child’s condition is sufficiently serious to warrant a referral.” Treatment can include graded exercise, cognitive behavioural therapy (CBT), slowly returning to normal routines of sleeping and eating and reintegration at school.
Matthew Hotopf, professor of general hospital psychiatry at the Institute of Psychiatry, Kings College London, said a key message from the study was that CFS is not uncommon as a cause of recurrent school absence and “therefore something to actively look for”. Dr Charles Shepherd, medical adviser to the ME Association said: “We welcome the key messages to come out of this research because many children with ME/CFS are still having great difficulty in obtaining a diagnosis and as a result are not receiving the educational and social support that they require.”In some cases, this results in children being forced to carry out tasks that are not going to help their recovery. “Paediatricians and GPs, some of whom are still unaware of the fact that ME/CFS occurs in children and adolescents, clearly require training in how to diagnose and manage what can become a complex and serious neurological illness.”
Matthew Hotopf, Professor of General Hospital Psychiatry, at the Institute of Psychiatry, Kings College London, said: “I think the key messages are
that CFS is not uncommon as a cause of recurrent school absence, and therefore something to actively look for. “A lot of fatigue presenting in the school clinics is related to psychiatric disorder (depression), but about half looks like chronic unexplained
fatigue. “There’s everything to play for in terms of outcome for CFS in kids ”“ the evidence from clinic samples of children and adolescents is that the short to middle term outcome is markedly better than in adults and a high proportion recover. “This study demonstrates that about 2/3 had recovered by six months, and that’s a really important message for families and GPs.”
Peter White, Professor of Psychological Medicine, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London said: “This well conducted study shows that schoolchildren who miss school without
explanation fall between the stools of school and the health service, and do so for two main reasons: emotional ill health and chronic fatigue syndrome (CFS). “Both of these can delay or even prevent a child from reaching their educational and personal potential. As the authors suggest, we now need to confirm whether screening followed by treatment, such as provided in this study, can benefit these children.”
Trudie Chalder, Professor of Cognitive behavioural Psychotherapy, at King’s College London and Director CFS Research and Treatment Unit, at South London and Maudsley NHS Trust, said: “The recovery rate of children with CFS/ME is good. “It is important to treat early to prevent worsening disability. Good outcomes can be expected if children are referred to secondary care and given the right sort of support and advice. All very good news for children with CFS/ME and their families.”
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