Pinquart, Martin, Shen, Yuhui · Journal of pediatric psychology · 2011 · DOI
This large review of 569 studies found that children and teenagers with chronic physical illnesses—including ME/CFS—experience higher rates of emotional and behavioral problems compared to healthy peers. Children with ME/CFS showed particularly high levels of emotional problems like anxiety and depression. The review emphasizes that doctors should routinely screen young patients with chronic illnesses for psychological distress and refer them to mental health services when needed.
This meta-analysis provides robust evidence that ME/CFS in young people is associated with significant psychological and emotional burden beyond physical symptoms. For ME/CFS patients and families, it validates that emotional and behavioral difficulties are common and warrant professional mental health support as part of comprehensive care. For researchers, it highlights the need to standardize psychological assessment in pediatric ME/CFS studies and investigate mechanisms linking illness severity to mental health outcomes.
This meta-analysis does not establish whether behavioral problems are caused by chronic illness, are pre-existing vulnerabilities, or result from social/educational disruption due to illness. The reliance on different behavioral rating scales across studies may conflate true psychological distress with reporting bias or differences in informant perception. The study does not differentiate between age-appropriate stress reactions and clinical psychiatric disorders requiring intervention.
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
Pinquart, Martin & Shen, Yuhui (2011). Behavior problems in children and adolescents with chronic physical illness: a meta-analysis.. Journal of pediatric psychology. https://doi.org/10.1093/jpepsy/jsr042
BibTeX
@article{mecfsatlas-pinquart-2011-behavior-problems,
author = {Pinquart, Martin and Shen, Yuhui},
title = {Behavior problems in children and adolescents with chronic physical illness: a meta-analysis.},
journal = {Journal of pediatric psychology},
year = {2011},
doi = {10.1093/jpepsy/jsr042},
note = {PubMed: 21810623},
url = {https://www.mecfsatlas.com/evidence/pinquart-2011-behavior-problems},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/pinquart-2011-behavior-problems
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