To investigate the feasibility of conducting clinics for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in schools.
School-based clinical project.
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.
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.
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.
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.
Hypothesis: many children with CFS/ME remain undiagnosed and untreated, despite evidence that treatment is effective in children.
Research question: are school-based clinics a feasible way to identify children with CFS/ME and offer treatment?
1.0% of enrolled children missed ≥20% of school because of CFS/ME.
Fewer than one in five children with CFS/ME had received a diagnosis and been offered treatment.
Children with CFS/ME who were detected through school-based clinics were less severely affected than children referred via health services and appeared to do well once treated.
Strengths and limitations of this study
Children were offered assessment regardless of how their absence had been classified.
All children given a diagnosis of CFS/ME were screened for other medical and emotional causes of fatigue and were prospectively characterised and followed up.
School clinics were conducted in three schools in the south west, which has a well-established specialist CFS/ME service. Results may not be generalisable to regions without a CFS/ME service or to regions with different socioeconomic factors that impact on school attendance.