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Arch Dis Child 96:211-214 doi:10.1136/adc.2009.173161
  • Leading article

Depression and anxiety in children with CFS/ME: cause or effect?

  1. Esther Crawley1
  1. 1Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
  2. 2Department of Academic Psychiatry, University of Bristol, Bristol, UK
  1. Correspondence to Professor Alan Emond, Centre for Child and Adolescent Health, University of Bristol, Hampton House, Cotham Hill, Bristol BS6 6JS, UK; alan.emond{at}bristol.ac.uk
  • Accepted 2 June 2010
  • Published Online First 26 July 2010

Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a common (0.19–2%)1,,4 and disabling condition in children and young people, with over 50% of affected children and young people bed bound at some stage and a mean time off school of 1 academic year.5 The importance of CFS/ME has been highlighted by both the Chief Medical Officer's report6 and the National Institute for Health and Clinical Excellence (NICE) guidelines.7

A variety of case definitions for CFS/ME exist (box 1), and studies, including those reviewed here, often use different definitions, particularly around the duration of symptoms. It is not clear whether the different case definitions have different implications for aetiology or prognosis. Paediatric CFS/ME is defined in the Royal College of Paediatrics and Child Health guidelines as “generalised fatigue persisting after routine tests and investigations have failed to identify an obvious underlying cause”.8 The NICE recommended that the fatigue should have lasted 3 months before a diagnosis is made and highlighted the fact that the fatigue must be disabling and was likely to occur in the presence of one other symptom7 (box 1). There is a philosophical discussion to be had on how diagnoses are made, particularly with diagnoses where no underlying pathogen has been identified, but it can be argued that “delineation of a syndrome is the first step towards elucidation of the chain of causation and redefinition of the whole group or subgroups within it”.9

Box 1

Definitions for chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) in children and young people

Royal College of Paediatrics and Child Health definition of chronic fatigue syndrome or myalgic encephalomyelitis

  • ”Generalised fatigue persisting after routine tests and investigations have failed to identify an obvious underlying cause”

National Institute for Health and Clinical Excellence 2007 guidelines7

  • Fatigue with all of the following features:

    • New or had a specific onset …

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