title: The definition of disabling fatigue in children and adolescents.
abstract: BACKGROUND
  Disabling fatigue is the main illness related reason for prolonged absence from school. Although there are accepted criteria for diagnosing chronic fatigue in adults, it remains uncertain as to how best to define disabling fatigue and Chronic Fatigue Syndrome (CFS) in children and adolescents. In this population-based study, the aim was to identify children who had experienced an episode of disabling fatigue and examine the clinical and demographic differences between those individuals who fulfilled a narrow definition of disabling fatigue and those who fulfilled broader definitions of disabling fatigue.
  
  
  METHODS
  Participants (aged 8-17 years) were identified from a population-based twin register. Parent report was used to identify children who had ever experienced a period of disabling fatigue. Standardised telephone interviews were then conducted with the parents of these affected children. Data on clinical and demographic characteristics, including age of onset, gender, days per week affected, hours per day spent resting, absence from school, comorbidity with depression and a global measure of impairment due to the fatigue, were examined. A narrow definition was defined as a minimum of 6 months disabling fatigue plus at least 4 associated symptoms, which is comparable to the operational criteria for CFS in adults. Broader definitions included those with at least 3 months of disabling fatigue and 4 or more of the associated symptoms and those with simply a minimum of 3 months of disabling fatigue. Groups were mutually exclusive.
  
  
  RESULTS
  Questionnaires were returned by 1468 families (65% response rate) and telephone interviews were completed on 99 of the 129 participants (77%) who had experienced fatigue. There were no significant differences in demographic and clinical characteristics or levels of impairment between those who fulfilled the narrower definition and those who fulfilled the broader definitions. The only exception was the reported number of days per week that the child was affected by the fatigue. All groups demonstrated evidence of substantial impairment associated with the fatigue.
  
  
  CONCLUSIONS
  Children and adolescents who do not fulfil the current narrow definition of CFS but do suffer from disabling fatigue show comparable and substantial impairment. In primary care settings, a broader definition of disabling fatigue would improve the identification of impaired children and adolescents who require support.
authors.affiliation: Department of Psychological Medicine, Wales College of Medicine, Cardiff University, UK. fowlerta@cardiff.ac.uk
authors.forename: Tom
authors.initials: T
authors.lastname: Fowler
authors.forename: Pamela
authors.initials: P
authors.lastname: Duthie
authors.forename: Anita
authors.initials: A
authors.lastname: Thapar
authors.forename: Anne
authors.initials: A
authors.lastname: Farmer
mesh_terms: D000293:Adolescent; D002648:Child; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology; D004739:England; D017050:Episode of Care; D015673:Fatigue Syndrome, Chronic / Q000145:classification* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D013997:Time Factors; D014852:Wales