Undiagnosed chronic fatigue syndrome (CFS/ME)
key reason for time off school
[Unidentified Chronic Fatigue Syndrome/myalgic encephalitis (CFS/ME) is a major cause of school absence: surveillance outcomes from school based clinics 2011; doi 10.1136/bmjopen-2011-000252]
Undiagnosed chronic fatigue syndrome, known as CFS/ME, may account for up to one per cent of non-truanting children who take extended time off from school, suggests research published in BMJ Open.
Previous estimates have suggested that the prevalence of CFS/ME among children is between 0.1% and 0.5%, say the authors.
They base their findings on just under 3000 pupils aged 11-16 at three secondary schools in the south west of England, where specialist CFS/ME services are well established.
Children who had missed more than 20% of schooling over the course of six weeks were included in the study, with the exception of those missing school for a defined episode of ill health, those with a known medical reason to explain their absence, and those known to be truanting.
Some 461 children had missed more than 20% of school over a six week period. Three of these children had done so because they had CFS/ME. Of the remainder, the reason was unexplained in 146.
Of these, 112 attended a clinical review at school: two children had already been diagnosed with CFS/ME, which was not known to the school; and 42 others were referred on to a specialist clinic, where 23 were newly diagnosed with CFS/ME.
This adds up to 28 out of 2855 children with CFS/ME, equivalent to 1% of the school roll, who had missed more than 20% of schooling over a six week period.
The authors also compared the children referred to specialist services via school based clinics with 604 children referred to these services by healthcare professionals.
There was no difference in how long either group of children had had their CFS/ME, which was an average of just over 18 months. But those picked up in the school based clinic had less fatigue, less disability, and fewer symptoms than their peers referred to specialist services.
Children identified by school based clinics also seemed to make rapid progress. Six of the 19 children whose health was subsequently monitored, had fully recovered after six weeks, and a further six had fully recovered after six months.
"There are several possible reasons why children missing significant amounts of school with chronic fatigue syndrome/ME are not identified," say the authors.
"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," they explain.
And they conclude: "This project suggests that undiagnosed chronic fatigue syndrome/ME may be an important and under-appreciated cause of school absence in children aged 11-16 years."
Source: British Medical Journal Open
