Monday, 9 January 2012

1% of UK school children with chronic fatigue?

I am ashamed to admit that 'wagging school' is something I did on more than one occasion as a teenager. It wasn't that I didn't like school or anything like that but some days I just couldn't face double maths or that sprightly cross country run over fields and mountains in the pouring rain that was PE. Don't get me wrong, I was no Ferris Bueller when it came to excuses and there was most certainly no 'Save Paul' campaign when I was absent from school. I might add that as a [supposedly] responsible adult, I don't condone such behaviour - "kids, stay in school" (he says in his best Mr T voice).

Nowadays I wonder if it would be so easy for me to miss school if I was still a child. With the advent of mobile phones and even mobile emailing, parents of school-absent children can be contacted much more easily and informed about any unscheduled absences. Indeed here in the UK, and no doubt other parts of the world, schools are getting tough on student absenteeism.

With this in mind, a paper published late last year by Crawley and colleagues* has been on mind for a few weeks now. The paper suggested that previously unidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME) might be an important reason why some children are absent from school. CFS/ME in adults has appeared before on this blog with regards to issues with identification and other more contentious areas which came to a head recently. The T-Rex identification post(?) on CFS reported a prevalence of 0.2% for all areas of the UK. The Crawley study suggested that in children, the prevalence of CFS/ME was 1%.

The paper is open-access as per the journal title, but in case you'd like a summary:

  • A new service set up in Bath, UK designed to reduce the numbers of student absences formed the basis of the study. Three schools in the locality with a student body totalling 2855 children aged 11-16 years old were screened for non-attenders who had missed 20% or more of a 6-week term.
  • When known medical reasons, a single stint of absence due to illness and truanting were excluded, 112 identified children attended a school clinic to discuss why school had been missed.
  • Forty-eight of these 112 children (42.9%) described significant fatigue as a reason for their absence, which when assessed, turned out to fulfil criteria for CFS/ME in 23 cases. Combined with the known cases of CFS/ME in the participant group, 28 cases of CFS/ME were recorded, which in the total study population (2855) equates to a prevalence just shy of 1%. The authors suggest that this is likely to be an underestimate given the children who did not attend the school absenteeism clinic.

As with every study finding, there are caveats to this study which have been covered very succinctly by the NHS Choices website (here).

I don't know what it is about the 1 in 100 figure when applied to heterogeneous conditions with very little universal knowledge on why they occur and how to diagnose them outside of just looking at behaviour. I am sure that someone somewhere probably has a good explanation of this (outside of just being a chance finding) and possible clues on where we should be looking in terms of genetics and environment.

To end, a song which came back into my music collection very recently after a few years absence, being one of the all-time best karaoke classics... livin' on a prayer.

* Crawley EM. et al. Unidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME) is a major cause of school absence: surveillance outcomes from school-based clinics. BMJ Open. December 2011.