Page 4 of 7
This case definition includes a number of further qualifications and quantifying criteria.
The diagnostic criteria stipulates that "each of the symptoms be either moderate or severe." The following rating scale is to be used by the diagnosing physician: "1= not present, 3= moderate, 7 = severe. Symptoms need to be rated at moderate or severe...to meet criteria."
Also, the definition includes a method for assessing "illness severity and remission states": "(A) minimal (just enough symptoms to meet the diagnosis, particularly occurring with exertion, usually able to attend school); (B) mild (few symptoms in excess of those of the diagnosis, occurring even at rest—may be able to attend school part of the time); (C) moderate (many symptoms in excess of those in the diagnosis, moderate symptoms at rest that become severe with effort—unable to attend school); (D) severe (often housebound or bed bound); (E) in partial remission (full criteria...were previously met, but currently only a few symptoms remain with effort—able to attend school regularly); (F) in full remission (no longer any symptoms, even with effort—able to attend school)."
The diagnostic criteria also note separate diagnoses that would exclude a finding of pediatric ME/CFS (unless they had been separately and successfully treated).
a) These include: "untreated hypothyroidism, sleep apnea, narcolepsy, malignancies, leukemia, unresolved hepatitis, multiple sclerosis, juvenile rheumatoid arthritis, lupus erythematosus, HIV/AIDS, severe obesity... Lyme disease, celiac disease."
b) "Some active psychiatric conditions that may explain the presence of chronic fatigue such as: childhood schizophrenia or psychotic disorders; bipolar disorder; active alcohol abuse unless it has been successfully treated and resolved; active anorexia nervosa or bulimia nervosa, unless it has been treated and resolved."
c) "depressive disorders" -Special note: These are depressive disorders not related to, or secondary to the pediatric ME/CFS. These exclusionary depressive disorders must also adequately explain the physical symptoms. Please see differential diagnosis section below.