A Pediatric Case Definition for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome.

Page Range: 1 - 44 DOI: 10.1300/J092v13n02_01 Leonard A Jason, David S. Bell, Kathy Row, Elke L. S. Van Hoof, Karen Jordan, Charles Lapp, Alan Gurwitt, Teruhisa Miike, Susan Torres-Harding, Kenny De Meirleir.

For a diagnosis chronic fatigue syndrome (CFS), most researchers use criteria that were developed by Fukuda et al. (1994), with modifications suggested by Reeves et al. (2003). However, this case definition was established for adults rather than children. A Canadian Case Definition (ME/CFS; Myalgic Encephalomyelitis/CFS) has recently been developed, with more specific inclusion criteria (Carruthers et al., 2003). Again, the primary aim of this case definition is to diagnose adult CFS. A significant problem in the literature is the lack of both a pediatric definition of ME/CFS and a reliable instrument to assess it. These deficiencies can lead to criterion variance problems resulting in studies labeling children with a wide variety of symptoms as having ME/CFS. Subsequently, comparisons between articles become more difficult, decreasing the possibility of conducting a meta-analysis. This article presents recommendations developed by the International Association of Chronic Fatigue Syndrome Pediatric Case Definition Working group for a ME/CFS pediatric case definition. It is hoped that this pediatric case definition will lead to more appropriate identification of children and adolescents with ME/CFS.

Full PDF version: A Pediatric Case Definition for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome.

 
Pediatric Chronic Fatigue Syndrome and Muchausen-by-Proxy: A Case Study

Page Range: 45 - 53 DOI: 10.1300/J092v13n02_02 E. Van Hoof, P. De Becker, K. De Meirleir

Pediatric chronic fatigue syndrome (CFS) posits even more challenges for professional caregivers in comparison with adult CFS samples. Most children with CFS display a decrease in school attendance and a decrease in social activities. As several conditions such as school phobia, primary psychiatric disorders or family disturbance present the same characteristics, the diagnostic process appears more complex. Family disturbance, moreover, is often specified as child abuse, neglect or even Muchausen-by-proxy. As skepticism is frequently associated with a diagnosis of CFS, patients and parents must fend for themselves fighting allegations of child abuse and neglect. This case study illustrates what happens when such allegations are put forward.

 
Psychosocial and Physical Impact of Chronic Fatigue in a Community-Based Sample of Children and Adolescents.

Page Range: 55 - 74 DOI: 10.1300/J092v13n02_03 Susan R. Torres-Harding, Karen Jordan, Leonard A. Jason PhD, Renee Arias.

Background:

Few studies have examined the problem of chronic fatigue in children and adolescents and its potential impact on functioning. Chronic fatigue may have a negative impact on school functioning, family activities, psychological well-being, physical functioning, and severity of medical symptomatology.

Objectives:

This study compared psychosocial, family, and physical functioning between a randomly selected community based sample of 36 children and adolescents with chronic fatigue and a group of 21 children and adolescents without fatigue.

Methods:

Children and parents completed a comprehensive medical history questionnaire and questionnaires assessing psychological functioning, family functioning, and school attendance.

Results:

Results indicated that children with chronic fatigue tended to have more difficulties in overall physical and psychological functioning, as measured by the Child Health Questionnaire and the Child Behavior Checklist. In addition, children in the chronic fatigue group experienced disruptions in a range of activities and reported more severe physical symptomatology when compared to children without fatigue.

Conclusions:

Findings suggest that children and adolescents with chronic fatigue may have a range of associated difficulties, including limitations in physical and psychosocial functioning and a negative impact on the ability to engage in normative activities.

 
SHORT ARTICLE

Prevalence of Pediatric Chronic Fatigue Syndrome in a Community-Based Sample.

Page Range: 75 - 77 DOI: 10.1300/J092v13n02_04 Karen M. Jordan, Leonard A. Jason PhD, Cynthia J. Mears, Ben Z. Katz, Alfred Rademaker, Cheng-Fang Huang, Judith Richman, William McCready, Penny M. Ayers, Kari K. Taylor

 
THEORY USED IN CLINICAL PRACTICE

Guidelines for the Diagnosis of Pediatric Chronic Fatigue Syndrome: Things Parents Need to Know.

Page Range: 79 - 88 DOI: 10.1300/J092v13n02_05 S. D. Bell, E. Van Hoof

In this special issue of the Journal of Chronic Fatigue Syndrome, chronic fatigue syndrome (CFS) in children and adolescents is specifically addressed. It is a topic long overdue. It is my sincere hope that the criteria presented here will begin a process of rigorous clinical testing and refinement so that pediatricians and other medical providers will come to have a reliable and accepted way of making the diagnosis of ME/CFS in a person under 18 years of age. This short review is meant for parents and other caregivers as a brief summary of the guidelines that may be of value. The primary role of these guidelines is to present a strict and rigorous definition that can be tried and tested. This summary is to make the process of diagnosis somewhat easier for parents and caregivers alike until the testing process is completed. Therefore, for more detailed symptom description and exclusionary illness description, I would refer the reader to the primary article. Professional caregivers and clinicians may offer this article available to inform parents with a child or/ adolescent suffering from CFS.

 
Recognizing Pediatric CFS in the Primary Care Practice: A Practicing Clinician's Approach.

Page Range: 89 - 96 DOI: 10.1300/J092v13n02_06 Charles W. Lapp MD.

Pediatricians and primary care physicians may be uncomfortable diagnosing Chronic Fatigue Syndrome in children because a good diagnostic tool has not been available. Deferring a diagnosis, however, may lead to apprehension, over-utilization of medical resources in a search for validity, a delay in treatment, and possibly inappropriate coping techniques. This case-based article discusses symptoms and signs seen in adolescent patients with CFS, evaluation of suspect cases, and both current and future diagnostic case definitions.

 
REVIEW

Chronic Fatigue Syndrome in Children and Adolescents

Page Range: 97 - 115 DOI: 10.1300/J092v13n02_07 James M. Oleske MD, MPH, Kenneth J. Friedman PhD, Kenneth R. Kaufman MD, MRCPsych, Donna Palumbo LCSW, Jonathan Sterling MA, Terri Lynn Evans RN. Objective:

An overview of the unique aspects of Chronic Fatigue Syndrome in children and adolescents (CACFS) is herein provided for healthcare professionals who may be called upon to diagnose and/or treat this illness. Young age of onset, puberty, and interactions with peers and the educational system provide greater diagnostic and treatment challenges than found with adult onset CFS. Method:

A review of diagnostic procedures and treatment protocols found in the contemporary literature is coupled with the professional experiences of the authors in treating CACFS to delineate the roles and responsibilities of family, healthcare providers and educators in diagnosing, treating and supporting the CACFS patient. Results:

Areas discussed include: pathogenesis, patient evaluation, clinical evaluation, laboratory evaluation, treatment options, psychological issues, role of schools, and the roles of primary and tertiary care providers. Conclusion:

CACFS can be diagnosed and treated with varying levels of success if all the professionals involved in the treatment program have a clear understanding of their roles and responsibilities. Primary care physicians, pediatricians, other subspecialists, family members, social workers and educators, may all be called upon to participate in the treatment program of CACFS. While it is best to have one, compassionate physician in charge of care, the CACFS may benefit from the inclusion of specialized treatment options available from or through a tertiary care provider. To the extent possible, socialization, education and psychological support of the CACFS should be provided.