Article Text

Unidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME) is a major cause of school absence: surveillance outcomes from school-based clinics
  1. Esther M Crawley1,
  2. Alan M Emond1,
  3. Jonathan A C Sterne2
  1. 1Centre for Child and Adolescent Health, School of Social and Community Medicine, Bristol, UK
  2. 2Department of Medical Statistics and Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Esther M Crawley; esther.crawley{at}


Objective To investigate the feasibility of conducting clinics for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in schools.

Design School-based clinical project.

Participants Children aged 11–16 years were enrolled in three state secondary schools in England.

Main outcome measures Number of children newly diagnosed as having CFS/ME.

Methods Attendance officers identified children missing ≥20% of school in a 6-week term without a known cause, excluding those with a single episode off school, a known medical illness explaining the absence or known to be truanting. Children with fatigue were referred to a specialist CFS/ME service for further assessment. The authors compared children with CFS/ME identified through school-based clinics with those referred via health services. Outcomes of CFS/ME were evaluated at 6 weeks and 6 months.

Results 461 of the 2855 enrolled children had missed ≥20% school over a 6-week period. In 315, of whom three had CFS/ME, the reason for absence was known. 112 of the 146 children with unexplained absence attended clinical review at school; two had been previously diagnosed as having CFS/ME and 42 were referred on to a specialist clinic, where 23 were newly diagnosed as having CFS/ME. Therefore, 28 of the 2855 (1.0%) children had CFS/ME. Children with CFS/ME identified through surveillance had been ill for an amount of time comparable to those referred via health services but had less fatigue (mean difference 4.4, 95% CI 2.2 to 6.6), less disability (mean difference −5.7, 95% CI −7.9 to −3.5) and fewer symptoms (mean difference 1.86, 95% CI 0.8 to 2.93). Of 19 children followed up, six had fully recovered at 6 weeks and a further six at 6 months.

Conclusions Chronic fatigue is an important cause of unexplained absence from school. Children diagnosed through school-based clinics are less severely affected than those referred to specialist services and appear to make rapid progress when they access treatment.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Crawley EM, Emond AM, Sterne JAC. Unidentified Chronic Fatigue Syndrome (CFS/ME) is a major cause of school absence: surveillance outcomes from school-based clinics. BMJ Open 2011;1:e000252. doi:10.1136/bmjopen-2011-000252

  • Funding This work was supported by the Linbury Trust Grant number LIN 1750. The funders did not take part in the collection, analysis or interpretation of the data and have not been involved in writing this article for publication. The researchers are independent from the funders.

  • Competing interests The authors declare that (1) EMC, AME and JACS did not receive any financial support from companies for the submitted work; (2) EMC, AME and JACS have no relationships with any companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners or children have no financial relationships that may be relevant to the submitted work and (4) AME and JACS have no non-financial interest that may be relevant to the submitted work. EMC is a medical advisor for the Association for Young people with ME (AYME).

  • Ethics approval The clinical service in this study was provided as an outreach from the Bath specialist CFS/ME service. The North Somerset & South Bristol Research Ethics Committee decided that the collection and analysis of data from children and young people seen by the CFS/ME specialist service were part of service evaluation and as such did not require ethical review by the NHS Research Ethics Committee or approval from the NHS R&D office (REC reference number 07/Q2006/48).

  • Contributors EMC conceived the idea for this study, conducted the school clinics, analysed the data with support from JACS and wrote the first draft of the paper. AME contributed to writing and the interpretation of the data helping to critically revise the paper. JACS helped with the analyses and contributed to writing the paper. All authors read and approved the final manuscript. All authors had full access to all the data in the study. EMC will act as guarantor for this paper.

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

  • Data sharing statement No additional data available.

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