Walford, G A, Nelson, W M, McCluskey, D R · Archives of disease in childhood · 1993 · DOI
This study looked at 12 children with ME/CFS and compared them to children with cystic fibrosis and healthy children. Children with ME/CFS reported much higher levels of tiredness affecting both body and mind, and many showed signs of depression. Their schooling and social lives were seriously disrupted by the illness.
This study is important because it establishes that ME/CFS in children causes severe, measurable fatigue affecting both physical and cognitive function, and that depression commonly co-occurs—findings that support the need for comprehensive evaluation and treatment addressing both fatigue and mental health in pediatric ME/CFS patients.
This study does not establish whether depression is a cause or consequence of ME/CFS, nor does it explain the mechanisms underlying fatigue or depression. The small sample size (12 patients) limits generalizability, and the cross-sectional design cannot establish causal relationships or track changes over time.
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
Walford, G A, Nelson, W M, & McCluskey, D R (1993). Fatigue, depression, and social adjustment in chronic fatigue syndrome.. Archives of disease in childhood. https://doi.org/10.1136/adc.68.3.384
BibTeX
@article{mecfsatlas-walford-1993-fatigue-depression,
author = {Walford, G A and Nelson, W M and McCluskey, D R},
title = {Fatigue, depression, and social adjustment in chronic fatigue syndrome.},
journal = {Archives of disease in childhood},
year = {1993},
doi = {10.1136/adc.68.3.384},
note = {PubMed: 8096688},
url = {https://www.mecfsatlas.com/evidence/walford-1993-fatigue-depression},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/walford-1993-fatigue-depression
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