Karen Jordan

Karen M. Jordan, PhD, Licensed Psychologist, is the founder and chief psychologist at Jordan Psychological Assessment Center, Overland Park, Kansas, a center that provides psychological and psychoeducational assessments for children, adolescents and adults.

Pediatric Case Definition

• 2006, "A Pediatric Case Definition for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome"

  "Summary: For a diagnosis of chronic fatigue syndrome (CFS), most researchers use criteria that were developed by Fukuda et al. (1994), with modifications suggested by Reeves et al. (2003). However, this case definition was established for adults rather than children. A Canadian Case Definition (ME/CFS; Myalgic Encephalomyelitis/CFS) has recently been developed, with more specific inclusion criteria (Carruthers et al., 2003). Again, the primary aim of this case definition is to diagnose adult CFS. A significant problem in the literature is the lack of both a pediatric definition of ME/CFS and a reliable instrument to assess it. These deficiencies can lead to criterion variance problems resulting in studies labeling children with a wide variety of symptoms as having ME/CFS. Subsequently, comparisons between articles become more difficult, decreasing the possibility of conducting a meta-analysis. This article presents recommendations developed by the International Association of Chronic Fatigue Syndrome Pediatric Case Definition Working group for a ME/CFS pediatric case definition. It is hoped that this pediatric case definition will lead to more appropriate identification of children and adolescents with ME/CFS."

Notable studies

• 2006, Prevalence of Pediatric Chronic Fatigue Syndrome in a Community-Based Sample

  "Abstract - Background: This study evaluated the prevalence of chronic fatigue syndrome (CFS) among children and adolescents (ages 5 to 17) in an ethnically and socioeconomically diverse community population. Objectives: This investigation attempted to address limitations of previous studies by using a community-based sample and thoroughly evaluating each participant (i.e., using medical and psychological evaluations) to determine a proper diagnosis of CFS. Methods: A community-based sample of children and adolescents aged 5 to 17 were screened for symptoms of chronic fatigue syndrome by telephone. Those reported to suffer from CFS-like symptoms were given medical and psychological evaluations to allow a determination of the CFS diagnosis. Results: The overall prevalence rate for the sample was 60 per 100,000 or .06%. The prevalence for the adolescents (aged 13 to 17) was 181 per 100,000 or .181%. Conclusions: The current prevalence estimate for CFS in adolescents is higher than previous estimates. CFS was more common in adolescents than pre-pubescent children.

• 2006, Psychosocial and Physical Impact of Chronic Fatigue in a Community-Based Sample of Children and Adolescents

  "Abstract - Background: Few studies have examined the problem of chronic fatigue in children and adolescents and its potential impact on functioning. Chronic fatigue may have a negative impact on school functioning, family activities, psychological well-being, physical functioning, and severity of medical symptomatology. Objectives: This study compared psychosocial, family, and physical functioning between a randomly selected community based sample of 36 children and adolescents with chronic fatigue and a group of 21 children and adolescents without fatigue. Methods: Children and parents completed a comprehensive medical history questionnaire and questionnaires assessing psychological functioning, family functioning, and school attendance. Results: Results indicated that children with chronic fatigue tended to have more difficulties in overall physical and psychological functioning, as measured by the Child Health Questionnaire and the Child Behavior Checklist. In addition, children in the chronic fatigue group experienced disruptions in a range of activities and reported more severe physical symptomatology when compared to children without fatigue. Conclusions: Findings suggest that children and adolescents with chronic fatigue may have a range of associated difficulties, including limitations in physical and psychosocial functioning and a negative impact on the ability to engage in normative activities."

• 2001, Thirteen-Year Follow-Up of Children and Adolescents With Chronic Fatigue Syndrome

  Abstract - Objective: To describe the educational, social, and symptomatic outcome of children and adolescents with chronic fatigue syndrome 13 years after illness onset. Methods: Between January 1984 and December 1987, 46 children and adolescents developed an illness suggestive of chronic fatigue syndrome. Follow-up questionnaires were obtained from 35 participants an average of 13 years after illness onset. Data were obtained concerning subsequent medical diagnoses, amount of school missed, presence and severity of current symptoms, and subjective assessment of degree of illness resolution. Results: Of the 35 participants, 24 were female (68.6%) and 11 were male (31.4%). Average age at illness onset was 12.1 years. Eight participants (22.9%) had an acute onset of symptoms, 27 (77.1%) had a gradual onset. No participant received an alternative medical diagnosis that could have explained the symptom complex between illness onset and follow-up. Thirteen participants (37.1%) considered themselves resolved of illness at follow-up; 15 participants (42.9%) considered themselves well but not resolved; 4 (11.4%) considered themselves chronically ill; and 3 (8.6%) considered themselves more ill than during the early years of illness. Correlation with the Medical Outcomes Study Short Form Health Survey was good for current level of symptoms and degree of recovery. Eight participants (22.9%) missed >2 years of school, and 5 of these were still ill at follow-up. Amount of school missed correlated with both illness severity at follow-up and perceived social impact of the illness. Conclusions: These data demonstrate the presence of an illness consistent with the current definition of chronic fatigue syndrome. Eighty percent of children and adolescents affected had a satisfactory outcome from their fatiguing illness, although the majority of these participants had mild to moderate persisting symptoms. Twenty percent of participants remain ill with significant symptoms and activity limitation 13 years after illness onset. Chronic fatigue syndrome in children and adolescents may result in persistent somatic symptoms and disability in a minority of those affected.

• 2000, Prevalence of Fatigue and Chronic Fatigue Syndrome-Like Illness in Children and Adolescents

  Abstract - "A community-based screening of over 12,000 households was conducted in order to determine the prevalence of fatigue and CFS-like illness in a sample of 5- to 17-year olds. Results indicate that over 4% of the sample was fatigued and that 2.05% were diagnosed with CFS-like illness. Adolescents had a slightly higher rate of CFS-like illness (2.91%) than did pre-pubescent children (1.96%). Those with CFS-like illness were almost evenly divided between male (47.5%) and female (52.5%). Youngsters of Latino origin had the highest representation in the CFS-like group. Symptom data, family patterns, and other data are presented for both the CFS-like group and the entire sample."

• 1997, Research with Children and Adolescents with Chronic Fatigue Syndrome: Methodologies, Designs, and Special Considerations

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

subjective outcome An outcome of a clinical trial that depends on the judgement or opinion of the assessor or patient, e.g. asking if fatigue has increased or decreased "a little" or "a lot", patient questionnaires like the Chalder Fatigue Scale, and other patient-reported outcome measures (PROMs).

somatic symptoms Physical or bodily symptoms. May be used to mean bodily symptoms that are not the result of a known physical or biological illness.

somatic symptoms Physical or bodily symptoms. May be used to mean bodily symptoms that are not the result of a known physical or biological illness.

somatic An adjective relating to the physical body or physical symptoms. It is often contrasted with the adjective "psychological", which refers to the human mind or mental symptoms. In biology, "somatic cells" refer to all the cells of the body, except those which form an egg or sperm.