Crawley, E, Sterne, J A C · Archives of disease in childhood · 2009 · DOI
This study looked at how often children with ME/CFS attended school and how their physical abilities changed over time. Researchers found that 62% of children attended school 40% of the time or less, and those with better physical function were more likely to go to school. The study suggests that improving school attendance should focus on treatments that reduce fatigue and pain, not treatments for anxiety.
This study challenges the assumption that anxiety drives school avoidance in paediatric ME/CFS, instead identifying physical dysfunction as the primary barrier. These findings support a paradigm shift toward interventions targeting fatigue and pain reduction rather than anxiety-focused treatments, potentially improving clinical management strategies and school reintegration outcomes.
This cross-sectional study cannot prove that improving physical function causes increased school attendance—the relationship may be bidirectional or both may be driven by a third factor. The study does not establish whether interventions targeting fatigue and pain will actually improve school attendance, only that these variables are associated. The absence of evidence for anxiety as a driver does not prove anxiety plays no role; it only shows no significant statistical association in this cohort.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Crawley, E & Sterne, J A C (2009). Association between school absence and physical function in paediatric chronic fatigue syndrome/myalgic encephalopathy.. Archives of disease in childhood. https://doi.org/10.1136/adc.2008.143537
BibTeX
@article{mecfsatlas-crawley-2009-association-between,
author = {Crawley, E and Sterne, J A C},
title = {Association between school absence and physical function in paediatric chronic fatigue syndrome/myalgic encephalopathy.},
journal = {Archives of disease in childhood},
year = {2009},
doi = {10.1136/adc.2008.143537},
note = {PubMed: 19001477},
url = {https://www.mecfsatlas.com/evidence/crawley-2009-association-between},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/crawley-2009-association-between
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