title: Understanding fatigue in paediatric multiple sclerosis: a systematic review of clinical and psychosocial factors.
abstract: OBJECTIVE
  Fatigue in children and adolescents with multiple sclerosis (caMS) is currently poorly understood. This review aimed to provide greater insight into this area and direction for future research by evaluating evidence of associations between fatigue and clinical, psychological, and social factors in caMS.
  
  
  METHODS
  Studies were identified by searching online databases, hand-searching reference lists, and requesting unpublished literature from key authors. Studies that examined fatigue in relation to at least one clinical, psychological, or social factor in caMS were included. Data on design, sample characteristics, measures of fatigue, clinical, psychological, and social variables, and key findings were extracted. Twelve studies were narratively synthesized.
  
  
  RESULTS
  Clinical factors appeared largely unrelated to fatigue, whereas associations between fatigue and tests of neurocognitive functioning, and fatigue and diagnosable psychiatric disorders, were mixed. However, fatigue and depressed mood consistently correlated. A small number of studies indicated associations between fatigue and reduced quality of life and school performance.
  
  
  CONCLUSIONS
  A sufficient explanatory model of fatigue in caMS is lacking as studies in this area are few and diverse. Future research should endeavour to identify potentially modifiable clinical and psychosocial factors that are associated with fatigue in caMS so that interventions targeting such factors may be developed.
authors.affiliation: Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Carroll
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Trudie
authors.initials: T
authors.lastname: Chalder
authors.affiliation: Department of Neurology, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Hemingway
authors.affiliation: Department of Psychological Medicine, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Isobel
authors.initials: I
authors.lastname: Heyman
authors.affiliation: Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Rona
authors.initials: R
authors.lastname: Moss-Morris
mesh_terms: D000293:Adolescent; D002648:Child; D005221:Fatigue / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications / Q000503:physiopathology / Q000523:psychology