Chronic fatigue syndrome may be reason behind many school absenteeism: Study

By Dr. Ananya Mandal, MDDec 14 2011

According to a new study one in 100 secondary school pupils could be missing classes because of chronic fatigue syndrome, also known as Myalgic Encephalomyelitis (ME). A study following 2,855 pupils at three schools, published in the online journal BMJ Open, found 28 missed school with chronic fatigue syndrome.

Dr Ester Crawley, researcher at the University of Bristol, told the BBC, “The impact of missing school is potentially devastating.” A charity said the true figure was likely to be even higher. The cause of chronic fatigue syndrome is unknown and there is no known cure. It is a medical condition rather than just schoolchildren staying up too late. It results in extreme tiredness as well as problems with memory and concentration. The disease is thought to affect some 250,000 people in the UK. Symptoms include extreme tiredness, problems with memory and concentration, sleep disturbances and mood swings. Children are thought to be more likely to recover than adults.

The researchers looked at every pupil between the age of 11 and 16 at three secondary schools in Bath. The 461 pupils who were absent for at least a day a week in a six-week term were investigated further. Five had already been diagnosed with chronic fatigue and a further 23 cases were identified.

Of the newly diagnosed pupils, 19 chose to have treatment. They were given either cognitive behavioral therapy, which alters the way people think and cope with their symptoms, or graded exercise therapy, a gradual and supervised increase in activity levels. Twelve of them were back to school full time after six months, six of them had made a full recovery. Another pupil who had been housebound returned to school part-time.

Crawley says the study looked at the pupils who were missing the most school, “Missing one day a week is severe. The total level [of chronic fatigue syndrome] is going to be higher.” The chief executive of the Association of Young People with ME, Mary-Jane Willows, said the impact of the illness was “horrendous” and that “1% is a phenomenal number. It proves the problem we're up against.” But she added, “I would say that it is on the lean side, it is at least 1%, there is a hidden population out there.”

Prof Matthew Hotopf, from the Institute of Psychiatry at King's College London, said, “Chronic fatigue syndrome is not uncommon as a cause of recurrent school absence, and therefore something to actively look for.” He added, “There is everything to play for in terms of outcome for chronic fatigue syndrome in kids. This study demonstrates that about two-thirds had recovered by six months, and that's a really important message for families and GPs.”

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. Pediatricians 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,” he said.

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 behavioral Psychotherapy, at King's College London and Director CFS Research and Treatment Unit, at South London and Maudsley NHS Trust, also 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 [this is] very good news for children with CFS/ME and their families.”