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Conditions That May Coexist With Pediatric ME/CFS (co-morbid conditions)
The child or adolescent may have concomitant disorders "that do not explain fatigue, and are, therefore, not necessarily exclusionary: (a) psychiatric diagnoses such as school phobia, separation anxiety, anxiety disorders, somatoform disorders, depressive disorders."
Also, a child with pediatric ME/CFS may also concurrently have fibromyalgia and/or multiple food and chemical sensitivity. See the full pediatric definition for further concomitant illnesses.
Differential Diagnoses with Pediatric ME/CFS
Often pediatric ME/CFS is misdiagnosed as a psychiatric or behavioral disorder. These disorders include depression, anxiety, and school phobia—among others. However, a child or adolescent may actually have these disorders rather than pediatric ME/CFS.
It is critical for the diagnosing physician to determine if the child or adolescent actually has pediatric ME/CFS (even if these psychiatric or behavioral disorders coexist with the illness), or if the child does not have pediatric ME/CFS but is suffering exclusively with a psychiatric and/or behavioral disorder.
Psychiatric and Behavioral Diagnoses and ME/CFS
First, it should be noted that "somatization disorder that meets the DSM-IV criteria is rare in this age group", i.e., children and adolescents.
Depression: The pediatric criteria makes clear that depression of any diagnostic category may be a symptom of, or even co-exist, with childhood or adolescent ME/CFS. Depression is less common in childhood as opposed to adolescence, and symptoms may be different in the two age groups. Since symptoms of depression may co-exist with ME/CFS, the diagnosing physician must conduct a careful evaluation of the "differing developmental presentations...Inquiring about hobbies and leisure activities is important in distinguishing depression" and pediatric ME/CFS. Those with the physical illness will likely have abandoned their hobbies and leisure activities. Much of the concomitant depression in ME/CFS comes from "underlying frustration as a result of losing control rather than a negative self-image."
Falling behind in school with no recognition of their illness and with no extra help or support—and thereby having to struggle to catch-up—will often lead to depression and anxiety. Moreover, the isolation and loss of friendships and peer activity can lead to depression.
One primary way to differentiate between ME/CFS with depression, as opposed to a separate depressive illness, is to look carefully at symptoms. Depression itself is unlikely to cause multiple symptoms such as sore throats, swollen lymph nodes, fevers, etc. If a diagnosis of depression better explains the child's fatigue and symptom patterns, then depression may be the appropriate diagnosis as opposed to ME/CFS.
School phobia and separation anxiety: When these conditions predate the fatigue and other symptoms, it is possible that the child does not have ME/CFS and the symptoms are better explained by either of these diagnoses. "Children with school phobia may be differentiated from children with ME/CFS in that the former typically feel ill in the morning but recover once allowed to remain at home from school...In contrast, children and adolescents with ME/CFS would experience symptoms not only at school, but in other settings." Those with school phobia only would not usually have symptoms on weekends or school holidays.
The definition also contains a short discussion as to whether the child might be exhibiting symptoms due to family dysfunction as opposed to ME/CFS. A child with symptoms clearly aimed at holding a family together would not be diagnosed with ME/CFS—however a child truly ill with ME/CFS might be living in an unhealthy family system.