Kathy Rowe

Synthetic food colourings and 'hyperactivity': a double-blind crossover study.

Of 220 children referred for suspected ‘hyperactivity’, 55 were subjected to a 6 week trial of the Feingold diet. Forty (72.7%) demonstrated improved behaviour and 26 (47.3%) remained improved following liberalization of the diet over a period of 3–6 months. The parents of 14 children claimed that a particular cluster of behaviours was associated with the ingestion of foods containing synthetic colourings. A double‐blind crossover study, employing a single‐subject repeated measures design was conducted, using eight of these children. Subjects were maintained on a diet free from synthetic additives and were challenged daily for 18 weeks with either placebo (during lead‐in and washout periods) or 50 mg of either tartrazine or carmoisine, each for 2 separate weeks. Two significant reactors were identified whose behavioural pattern featured extreme irritability, restlessness and sleep disturbance. One of the reactors did not have inattention as a feature. The findings raise the issue of whether the strict criteria for inclusion in studies concerned with ‘hyperactivity’ based on ‘attention deficit disorder’ may miss children who indicate behavioural changes associated with the ingestion of food colourings. Moreover, for further studies, the need to construct a behavioural rating instrument specifically validated for dye challenge is suggested.

Paediatric chronic fatigue syndrome: complex presentations and protracted time to diagnosis.

The diagnosis and management of paediatric chronic fatigue syndrome (CFS) remain ongoing challenges for paediatric clinicians, particularly given its unknown aetiology and the little research on effective treatments for this condition. The aim of this study was to describe the presenting features of new patients attending a specialist chronic fatigue clinic at a tertiary‐level Australian childrens hospital.

Severe versus Moderate Criteria for the New Pediatric Case Definition for ME/CFS.

The new diagnostic criteria for pediatric ME/CFS are structurally based on the Canadian Clinical Adult case definition, and have more required specific symptoms than the (Fukuda et al. Ann Intern Med 121:953–959, 1994) adult case definition. Physicians specializing in pediatric ME/CFS referred thirty-three pediatric patients with ME/CFS and 21 youth without the illness. Those who met ME/CFS criteria were separated into Severe and Moderate categories. Significant differences were found for symptoms within each of the six major categories: fatigue, post-exertional malaise, sleep, pain, neurocognitive difficulties, and autonomic/neuroendocrine/immune manifestations. In general, the results showed participants who met the Severe ME/CFS criteria reported the highest scores, the Moderate ME/CFS group show scores that were a little lower, and the control group evidenced the lowest scores. Findings indicate that the Pediatric Case Definition for ME/CFS can distinguish between those with this illness and controls, and between those with Severe versus Moderate manifestations of the illness.

How is paediatric chronic fatigue syndrome/myalgic encephalomyelitis diagnosed and managed by paediatricians? An Australian Paediatric Research Network Study

The diagnosis and management of paediatric chronic fatigue syndrome/myalgic encepnalomyelitis (CFS/ME) represent ongoing challenges for paediatricians. A better understanding of current approaches at a national level is important in informing where research and education could improve treatment outcomes. We aimed to examine current diagnosis and management practices for CFS/ME by Australian paediatricians.

Measuring quality of life and fatigue in adolescents with chronic fatigue syndrome: estimates of feasibility, internal consistency and parent–adolescent agreement of the PedsQLTM

The aim of this study was to investigate the psychometric properties of the Paediatric Quality of Life Inventory (PedsQLTM) in measuring health-related quality of life (HRQOL) and fatigue in adolescents with chronic fatigue syndrome (CFS), using both adolescent-reported and caregiver proxy ratings. Eighty-four participants (42 adolescents and 42 parent proxies) recruited consecutively through CFS specialist clinics at a tertiary paediatric hospital completed the PedsQLTM Core Generic Module (CGM) and Multidimensional Fatigue Scale (MFS). Overall, feasibility, floor/ceiling effects and internal consistency were found to be acceptable for the PedsQLTM CGM and the MFS according to predetermined criteria. For parent–adolescent agreement, intra-class correlations between adolescent and parent report on the PedsQLTM CGM and MFS were statistically significant and rated as ‘fair’ (range 0.45–0.68). At a group level, statistically significant discrepancies between mean adolescent and parent scores for the PedsQLTM CGM were noted on all scales (except school functioning). On the MFS, there were no significant differences between parent and adolescent mean scores. Bland–Altman plots revealed significant variability in the discrepancies between parent and adolescent reports on the PedsQLTM CGM and MFS. Based on the psychometric properties assessment, findings of this study suggest that the parent and adolescent PedsQLTM CGM and MFS are promising scales for use in adolescents with CFS. Parent and adolescent reports offer unique perspectives on HRQOL and fatigue in adolescents with CFS and ideally, reports should be sought from both parties.