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Is there effective behavioural treatment for children with chronic fatigue syndrome/myalgic encephalomyelitis?
  1. Simon N Smith1,
  2. Esther Crawley2
  1. 1 Medical Student, School of Medicine, Swansea University, Swansea, UK
  2. 2 School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Simon N Smith, College of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK; 630443{at}

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A 15-year-old girl comes to your outpatient clinic with a 6-month history of fatigue, headaches, nausea and muscle pain. Clinical examination and investigations are normal and you make a diagnosis of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). She is going to sit her General Certificate of Secondary Education (GCSE) examinations in 6 months, but is currently unable to attend school full time. She and her mother ask you which behavioural treatment (they don't want medication) is the most likely to get her back to school.

Structured clinical question

Do teenagers with CFS/ME (P) benefit from behavioural treatments (I) compared with usual care (C) in improving school attendance and fatigue (O).


A comprehensive list of synonyms was compiled for the subjects (adolescents) and the condition (CFS). These were then combined and applied to the following databases so that all possible combinations of synonyms in article titles would be returned: Cochrane Library, PubMed, Ovid, Medline and EMBASE. This review updates the previous systematic review1 used to inform NICE guidance. We reviewed randomised controlled trials (RCTs) comparing any behavioural intervention with normal care published since 2005. The results are discussed in the context of published case–control and cohort studies.

Abstracts were reviewed for 77 papers, and 20 papers were retrieved. Seven papers were excluded because they were case studies, two were cohort studies, four evaluated non-behavioural treatments and four did not use normal usual care as a control group leaving three RCTs.

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  • Contributors SS and EC had idea for the article. SS completed the literature search and wrote the first draft. SS and EC critically reviewed, redrafted the article and approved the final version. EC is guarantor.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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