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Arch Dis Child. 2017 Jun;102(6):522-528. doi: 10.1136/archdischild-2016-311198. Epub 2017 Jan 19.

Natural course of chronic fatigue syndrome/myalgic encephalomyelitis in adolescents.

Author information

Centre for Child and Adolescent Health, University of Bristol, Bristol, UK.
School of Social & Community Medicine, University of Bristol, Bristol, UK.
CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK.



Little is known about persistence of or recovery from chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in adolescents. Previous studies have small sample sizes, short follow-up or have focused on fatigue rather than CFS/ME or, equivalently, chronic fatigue, which is disabling. This work aimed to describe the epidemiology and natural course of CFS/ME in adolescents aged 13-18 years.


Longitudinal follow-up of adolescents enrolled in the Avon Longitudinal Study of Parents and Children.


Avon, UK.


We identified adolescents who had disabling fatigue of >6 months duration without a known cause at ages 13, 16 and 18 years. We use the term 'chronic disabling fatigue' (CDF) because CFS/ME was not verified by clinical diagnosis. We used multiple imputation to obtain unbiased estimates of prevalence and persistence.


The estimated prevalence of CDF was 1.47% (95% CI 1.05% to 1.89%) at age 13, 2.22% (1.67% to 2.78%) at age 16 and 2.99% (2.24% to 3.75%) at age 18. Among adolescents with CDF of 6 months duration at 13 years 75.3% (64.0% to 86.6%) were not classified as such at age 16. Similar change was observed between 16 and 18 years (75.0% (62.8% to 87.2%)). Of those with CDF at age 13, 8.02% (0.61% to 15.4%) presented with CDF throughout the duration of adolescence.


The prevalence of CDF lasting 6 months or longer (a proxy for clinically diagnosed CFS/ME) increases from 13 to 18 years. However, persistent CDF is rare in adolescents, with approximately 75% recovering after 2-3 years.


ALSPAC; Adolescent Health; CFS/ME; Chronic Fatigue Syndrome; Longitudinal

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: TN is funded by an MRC research grant (MR/K020269/1); SC is funded by an NIHR Postdoctoral Fellowship (PDF-2013-06-011); EC is funded by an NIHR Senior Research Fellowship (SRF-2013-06-013); JH is funded by a number of grants, mainly the MRC and Kate Tilling is HEFCE-funded. JS is funded by National Institute for Health Research Senior Investigator award NF-SI-0611-10168. This study was supported by an MRC research grant (MR/K020269/1). EC is a medical advisor for the Association of Young People with ME (AYME) and the Sussex & Kent ME/CFS Society.

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