Section 1 Primary Care

**3**

**Chapter 1**

**Abstract**

it has evolved over time.

outcomes

**1. Introduction**

isolation [8, 10].

Self-Management of Chronic

*Katherine Rowe, Amanda Apple and Fiona McDonald*

Fatigue Syndrome in Adolescents

Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis/chronic fatigue

syndrome (ME/CFS) is a condition of unknown aetiology that commonly follows an infection. There are no known predictors for recovery or established treatments. At the Royal Children's Hospital (RCH) in Melbourne, Australia, the majority of young people with CFS are provided with symptom management and lifestyle guidance in an outpatient setting. However, for some, educational or social issues preclude progress and for those who request this assistance, since 2012, the Victorian Paediatric Rehabilitation Service has offered an Intensive Self-Management Program. For this program, participants engage in both group and individual sessions, attending 3 days per week for 4 weeks in small groups of 3–4. Interdisciplinary input is from Occupational Therapy, Physiotherapy, Education and Psychology to assist with goal setting and strategies. Outcome measures are obtained at initial assessment, 6 weeks and 6 months post-program. Support is offered for 12 months post-program. For both the outpatient program and the intensive program the outcomes and feedback from patient and family has influenced the approach and focus. This chapter outlines the current approach and how

**Keywords:** adolescent, chronic fatigue syndrome, management, rehabilitation,

Chronic fatigue syndrome is a condition of unknown aetiology that commonly follows an infective process in young people. There is a new onset of fatigue for at least 3–6 months that is not relieved by rest and not explained by other medical conditions. Post-exertional malaise, cognitive difficulties and unrefreshing sleep are present. In addition, a variety of somatic symptoms are commonly present such as headache, abdominal or muscle pain, as well as flu-like symptoms without fever, and symptoms associated with orthostatic intolerance [1–5]. The key features and symptom patterns in young people have remained consistent [6–9]. Anxiety and depression may also be present but when compared with population levels, were only mildly increased in prevalence, and generally did not precede the illness. They were understandably associated with diagnosis delay, not being believed or social

There is currently no defined treatment, as the underlying pathology is not well understood [11]. Similarly, there are no known predictors for recovery [10]. When this illness occurs during childhood and adolescence, it is at a period of significant

## **Chapter 1**
