Skip to main content
SpringerLink
Log in

Severe Versus Moderate Criteria for the New Pediatric Case Definition for ME/CFS

  • Original Article
  • Published:
Child Psychiatry and Human Development Aims and scope Submit manuscript

Abstract

The new diagnostic criteria for pediatric ME/CFS are structurally based on the Canadian Clinical Adult case definition, and have more required specific symptoms than the (Fukuda et al. Ann Intern Med 121:953–959, 1994) adult case definition. Physicians specializing in pediatric ME/CFS referred thirty-three pediatric patients with ME/CFS and 21 youth without the illness. Those who met ME/CFS criteria were separated into Severe and Moderate categories. Significant differences were found for symptoms within each of the six major categories: fatigue, post-exertional malaise, sleep, pain, neurocognitive difficulties, and autonomic/neuroendocrine/immune manifestations. In general, the results showed participants who met the Severe ME/CFS criteria reported the highest scores, the Moderate ME/CFS group show scores that were a little lower, and the control group evidenced the lowest scores. Findings indicate that the Pediatric Case Definition for ME/CFS can distinguish between those with this illness and controls, and between those with Severe versus Moderate manifestations of the illness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. The Pediatric Case Definition for ME/CFS also diagnoses children and adolescents with subtype variations for ME/CFS for those who experience idiopathic chronic fatigue. Two of the children who had been referred as having ME/CFS were classified within this group. For example, one subtype variation is Atypical ME/CFS, which is defined as 3 or more months of fatigue, but having at least two classic ME/CFS symptoms. Accordingly, 2 children met the criteria for Atypical ME/CFS illness. Further, a child could be classified as having ME/CFS in remission, if the child met full symptom criteria at one time but was not experiencing full symptomology at the time of the study. To qualify for inclusion to this group, children must not currently meet either the Severe, Moderate, or Atypical criteria, and must have 0 or 1 classic ME/CFS symptoms, and their symptoms need to be reported as improving over time. One of the participants were categorized as experiencing ME/CFS in remission, as this participant was not currently meeting full criteria and reported that the long standing condition had improved dramatically at the time of evaluation.

  2. Because of small sample sizes, we did not include ME/CFS-like, atypical ME/CFS, those In Remission, and ME/CFS-like.

  3. In addition, as one part of the ME/CFS Severe criteria, a child needed to respond yes to the question: “Need to limit activity”. As another part of the original Fatigue criteria, to meet Severe ME/CFS criteria, a child would need to indicate that with rest, all of their fatigue would not go away. A child could receive a Moderate ME/CFS diagnosis, and indicate that with rest, some or all of their fatigue went away. We did not find these items differentiating the Severe or Moderate ME/CFS groups, and the original Fatigue question was sufficient to differentiate the Severe or Moderate ME/CFS groups from the Controls. We no longer require these two additional questions in meeting criteria for ME/CFS.

  4. An additional requirement for post-exertional malaise, in order to meet the original pediatric case definition of ME/CFS, involved the question: “how does being physically active make you feel for the rest of the day?” A response of “much more tired than usual” or “more tired than usual” was required, but this question was not needed to differentiate the Moderate from Severe ME/CFS diagnosis, and the original post-exertional malaise item was sufficient to differentiate the Moderate and Severe ME/CFS groups from the Controls. We therefore only required the original post-exertional malaise question to met the ME/CFS requirement.

References

  1. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 121:953–959

    PubMed  Google Scholar 

  2. Torres-Harding SR, Jordan K, Jason LA, Arias R (2006) Psychosocial and physical impact of chronic fatigue in a community-based simple of children and adolescents. J Chronic Fatigue Syndr 13:55–74. doi:10.1300/J092v13n02_03

    Article  Google Scholar 

  3. Dowsett EG, Colby J (1997) Chronic fatigue syndrome in children. Journal was wrong to criticize study in school children. BMJ 315(7113):949

    PubMed  Google Scholar 

  4. Smith MS, Mitchell J, Corey L, Gold D, McCauley EA, Glover D, Tenover FC (1991) Chronic fatigue in adolescents. Pediatrics 8:195–202

    Google Scholar 

  5. Carter BD, Edwards JF, Kronenberger WG, Michalczyk L, Marshall GS (1995) Case control study of chronic fatigue in pediatric patients. Pediatrics 95:179–186

    PubMed  Google Scholar 

  6. Carruthers BM, Jain AK, DeMeirleir KL, Peterson DL, Dlimas NG, Lerner AM, Bested AC, Flor-Henry P, Josh P, Powles ACP, Sherkey JA, van de Sande MI (2003) Myalgic encephalomyelitis/chronic fatigue syndrome: clinical working case definition, diagnostic and treatments protocols. J Chronic Fatigue Syndr 11:7–115. doi:10.1300/J092v11n01_02

    Article  Google Scholar 

  7. Jason LA, Torres-Harding SR, Jurgens A, Helgerson J (2004) Comparing the Fukuda et al. criteria and the Canadian case definition for chronic fatigue syndrome. J Chronic Fatigue Syndrome 12:37–52. doi:10.1300/J092v12n01_03

    Article  Google Scholar 

  8. Jordan K, Kolak A, Jason LA (1997) Research with children and adolescents with chronic fatigue syndrome: methodologies, designs, and special considerations. J Chronic Fatigue Syndr 3:3–13. doi:10.1300/J092v03n02_02

    Article  Google Scholar 

  9. Harris F, Taitz LS (1989) Damaging diagnosis of myalgic encephalomyelitis in children. BMJ 299:790. doi:10.1136/bmj.299.6702.790

    Article  PubMed  Google Scholar 

  10. Lask B, Dillon MJ (1990) Postviral fatigue syndrome. Arch Dis Child 65:1198. doi:10.1136/adc.65.11.1198

    Article  PubMed  Google Scholar 

  11. Jason LA, Bell DS, Rowe K, Van Hoof ELS, Jordan K, Lapp C, Gurwitt A, Miike T, Torres-Harding S, De Meirleir K, FS IAC (2006) A pediatric case definition for ME/CFS. J Chronic Fatigue Syndr 13:1–44. doi:10.1300/J092v13n02_01

    Article  Google Scholar 

  12. Kulig JW (1991) Chronic fatigue syndrome and fibromyalgia in adolescence. Adolesc Med State Arts Rev 2:473–484

    Google Scholar 

  13. Vereker MI (1992) Chronic fatigue syndrome: a joint pediatric-psychiatric approach. Arch Dis Child 67:550–555. doi:10.1136/adc.67.4.550

    Article  PubMed  Google Scholar 

  14. Fowler T, Duthie P, Thapar A, Farmer A (2005) The definition of disabling fatigue in children and adolescents. BMC Family Practice 6:33 (available from http://www.biomedcentral.com/1471-2296/6/33)

  15. Jason LA, Porter N, Shelleby E, Till L, Bell DS, Lapp CW, Rowe K, DeMeirleir K (2009) Examining criteria to diagnose ME/CFS in pediatric samples (manuscript submitted for publication)

Download references

Acknowledgments

The authors appreciate the financial assistance provided by the National Institute of Allergy and Infectious Diseases (grant numbers AI36295 and AI49720).

Author information

Authors and Affiliations

  1. Center for Community Research, DePaul University, 990 West Fullerton Avenue #3100, Chicago, IL, 60614, USA

    Leonard Jason, Nicole Porter, Elizabeth Shelleby & Lindsay Till

  2. Medina Hospital, Lyndonville, NY, USA

    David S. Bell

  3. Hunter-Hopkins Center, Charlotte, NC, USA

    Charles W. Lapp

  4. Royal Children’s Hospital, Herston, QLD, Australia

    Kathy Rowe

  5. Vrije Universiteit Brussel, Brussel, Belgium

    Kenny De Meirleir

Authors
  1. Leonard Jason
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicole Porter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Shelleby
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lindsay Till
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David S. Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Charles W. Lapp
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kathy Rowe
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kenny De Meirleir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leonard Jason.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jason, L., Porter, N., Shelleby, E. et al. Severe Versus Moderate Criteria for the New Pediatric Case Definition for ME/CFS. Child Psychiatry Hum Dev 40, 609–620 (2009). https://doi.org/10.1007/s10578-009-0147-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-009-0147-8

Keywords

Search

Navigation