To determine nationwide general practitioner (GP)-diagnosed prevalence and pediatrician–diagnosed incidence rates of adolescent chronic fatigue syndrome (CFS), and to assess CFS morbidity.
We collected data from a cross-sectional national sample among GPs and prospective registration of new patients with CFS in all pediatric hospital departments in the Netherlands.
Study participants were adolescents aged 10 to 18 years. A representative sample of GPs completed questionnaires on the prevalence of CFS in their adolescent patients. Pediatric hospital departments prospectively reported new cases of CFS in adolescent patients. For every new reported case, a questionnaire was sent to the reporting pediatrician and the reported patient to assess CFS morbidity. Prevalence was estimated through the data from GP questionnaires and incidence was estimated on the basis of cases newly reported by pediatricians from January to December 2008.
Prevalence was calculated as 111 per 100 000 adolescents and incidence as 12 per 100 000 adolescents per year. Of newly reported patients with CFS, 91% scored at or above cutoff points for severe fatigue and 93% at or above the cutoff points for physical impairment. Forty-five percent of patients with CFS reported >50% school absence during the previous 6 months.
Clinically diagnosed incidence and prevalence rates show that adolescent CFS is uncommon compared with chronic fatigue. The primary adverse impact of CFS is extreme disability associated with considerable school absence.
The authors quite correctly note that there are multiple definitions for CFS which has resulted in an umbrella term that may even encompass people who do not have the neuroimmune disease of CFS but rather affective disorders only.
Although the original 1994 Fukuda definition for adults is most commonly used in research, it may not represent the pediatric experience.
A pediatric CFS definition was created in 2008 and has been endorsed by the IACFS/ME professional organization which represents the largest group of CFS researchers, clinicians and educators in the world.
The use of the adult criteria may have affected prevalence rates.
As well, although the CIS-20 is satisfactory in many dimensions it may well characterize clinical depression as well as CFS. It is unknown if the CIS can differentiate the two disorders. It would be tragic to misdiagnose one for the other.
The age range studied could also be a factor because some experts have hypothesized that hormonal changes at puberty may shift prevalence.
Also, Huang et al found that adolescents with chronic fatigue syndrome appear to be pushing themselves in an attempt to maintain similar activity levels as their peers, but paying for it in terms of fatigue severity and an increased need for sleep, particularly during the day. This may affect school absence. Cognitive abnormalities often found in CFS may effect school performance as well.
Jason LA, Porter N, Shelleby E, Bell DS, Lapp CW, Rowe K, DeMeirleir KA Case Definition for Children with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Clinical Medicine: Pediatrics 2008:1 53-57
Huang Y, Katz BZ, Mears C, Kielhofner GW, Taylor R. Postinfectious fatigue in adolescents and physical activity. Arch Pediatr Adolesc Med. 2010 Sep;164(9):803-9.
Conflict of Interest:
None declared