Unidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME)is a major cause of school absence: surveillance outcomes from school-based clinics

Unidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME)is a major cause of school absence: surveillance outcomes from
school-based clinics
Esther M Crawley,1 Alan M Emond,1 Jonathan A C Sterne2
ABSTRACT
Objective: To investigate the feasibility of conducting
clinics for chronic fatigue syndrome/myalgic
encephalomyelitis (CFS/ME) in schools.
Design: School-based clinical project.
Participants: Children aged 11e16 years were
enrolled in three state secondary schools in England.
Main outcome measures: Number of children newly
diagnosed as having CFS/ME.
Methods: Attendance officers identified children
missing $20% of school in a 6-week term without
a known cause, excluding those with a single episode
off school, a known medical illness explaining the
absence or known to be truanting. Children with
fatigue were referred to a specialist CFS/ME service for
further assessment. The authors compared children
with CFS/ME identified through school-based clinics
with those referred via health services. Outcomes of
CFS/ME were evaluated at 6 weeks and 6 months.
Results: 461 of the 2855 enrolled children had missed
$20% school over a 6-week period. In 315, of whom
three had CFS/ME, the reason for absence was known.
112 of the 146 children with unexplained absence
attended clinical review at school; two had been
previously diagnosed as having CFS/ME and 42 were
referred on to a specialist clinic, where 23 were newly
diagnosed as having CFS/ME. Therefore, 28 of the
2855 (1.0%) children had CFS/ME. Children with CFS/
ME identified through surveillance had been ill for an
amount of time comparable to those referred via health
services but had less fatigue (mean difference 4.4,
95% CI 2.2 to 6.6), less disability (mean difference
 5.7, 95% CI -7.9 to -3.5) and fewer symptoms
(mean difference 1.86, 95% CI 0.8 to 2.93). Of 19
children followed up, six had fully recovered at
6 weeks and a further six at 6 months.
Conclusions: 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.

Article focus
 Hypothesis: many children with CFS/ME remain
undiagnosed and untreated, despite evidence
that treatment is effective in children.
 Research question: are school-based clinics
a feasible way to identify children with CFS/ME
and offer treatment?
Key messages
 1.0% of enrolled children missed $20% of
school because of CFS/ME.
 Fewer than one in five children with CFS/ME had
received a diagnosis and been offered treatment.
 Children with CFS/ME who were detected
through school-based clinics were less severely
affected than children referred via health services
and appeared to do well once treated.
Strengths and limitations of this study
 Children were offered assessment regardless of
how their absence had been classified.
 All children given a diagnosis of CFS/ME were
screened for other medical and emotional causes
of fatigue and were prospectively characterised
and followed up.
 School clinics were conducted in three schools in
the south west, which has a well-established
specialist CFS/ME service. Results may not be
generalisable to regions without a CFS/ME
service or to regions with different socioeconomic
factors that impact on school attendance.

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