Esther Crawley

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Esther Crawley is Professor in Child Health at the University of Bristol in the United Kingdom. She is a proponent of Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) as treatments for paediatric and adult Chronic Fatigue Syndrome.

She is vice-chair of the UK CFS/ME Research Collaborative (CMRC) and leads the paediatric centre for children and young people with ME/CFS at the Royal United Hospital in Bath. (Previously at the Royal National Hospital for Rheumatic Diseases in Bath). Her work has been funded by the National Institute for Health Research (NIHR) and Action for ME.[1].

She was on the guideline development group for the NICE guidelines published in August 2007 and the Medical Research Council CFS/ME expert working group (2009-2010).

She has published studies in the Journal of Psychosomatic Research [2] and collaborates with Peter White of Queen Mary University of London.

Since 2006, Prof Crawley has been awarded £2.3 million in grants by various bodies to study ME/CFS.[3]


BA(Hons), BMBCh(Oxon) Bachelor of Medicine, PhD(UCLond)

Notable studies[edit]

MEGA Ester Crawley is leading

S.M.I.L.E. Lightning Process trial

SMILE was a pilot trial on children with ME/CFS and involved comparing the effects of standard medical treatment (SMC) against that of the Lightning Process & SMC.[4] The initial budget was £164,000 funded by the Linbury Trust and the Ashden Trust.[5]

Children aged 12 to 18 were drawn from the Bristol & Bath areas, with those too unwell to attend hospital appointments excluded. The charity Association of Young People with ME (AYME) was a participant in the trial[6] and gave evidence in support during the trial ethics procedure.

A Freedom of Information request asking for the cost of the trial and payments to Phil Parker were turned down as they university states the "information is held by the University but is exempt from disclosure under section 22(1) of the Freedom of Information Act as it is information intended for future publication."[7]


Prof Crawley is studying GET in children.[8]. The protocol[9] and peer review history[10] have been published.

The trial started in September 2015 and studies 100 paediatric patients aged 8-17 in centres in Bath, Newcastle and Cambridge who randomly receive graded exercise therapy or activity management. It aimed to be completed in August 2016.

FITNET online CBT study

This is a major study led by Dr Crawley funded by the NIHR which began in May 2016 and is due to be completed by May 2022.[11] The projected cost is £994,430 and participants include UMC Utrecht and Radboud University Medical Centre in the Netherlands. The charity AYME and the Science Media Centre are also involved to "help us inform patients".

The study aim is to test FITNET-NHS (specialist CBT for paediatric CFS/ME delivered on-line) compared with Activity Management in terms of cost-effectiveness and clinical success.

David Tuller who exposed the PACE trial scandal in his Trial by Error series of investigations wrote about FITNET in November 2016. On 21 Nov, 21016 he wrote Trial By Error, Continued: The New FITNET Trial for Kids and on 28 November 2016 he wrote Trial By Error, Continued: A Follow-Up Post on FITNET-NHS.

There was severe criticism by patients including on the Bristol university student newspaper Backlash for ‘landmark’ University research trials.

Ester Crawley was one of the authors in a paper on Pervasive Refusal Syndrome (PRS) presenting with Chronic Fatigue Syndrome: avoiding the pitfall of a wrong diagnosis in which Patients with PRS were similar to those with CFS/ME in terms of age, gender, presence of anxiety or depressive symptoms, time to assessment and pain. They were more disabled than CFS patients and had higher levels of fatigue. It is not clear how PRS is distinguished from severe ME/CFS as the description of PRS matches that of severe/profound ME/CFS. The study suggests that clinicians should think about PRS in patients with refusal symptoms affecting, eating, social interaction, self-care, mobility and treatment. Patients have extremely high levels of fatigue and/or disability. Post-exertional fatigue and disrupted sleep occur but patients are less likely to have characteristic symptoms of CFS/ME such as unrefreshing sleep. Of major concern is that the treatment for PRS is admittance to a psychiatric ward and coercion to do more activity i.e. the exact opposite of the needs of a child with profound ME/CFS. A clinical case that describes a child with pervasive refusal disorder (3) is consistent with a description of profound ME/CFS, and the description of what works to help the child is also consistent with what helps a child with profound ME/CFS, "Treatment must involve tender loving care. The carers must be very patient and sensitive. It takes a long time for the patients to recover, and pressuring them makes their condition worse. It typically takes a few months of treatment before it becomes possible to implement a very gradual rehabilitation programme. Therapeutic enthusiasm in the early stages is almost always counterproductive [11]." Ironically the authors did not appear to collect any physiological data such as the child's temperature (despite her complaints of being cold, or her heart rate, and blood pressure.[12]

Article in Archives of Disease in Childhood 99(Suppl 1):A70-A70 · April 2014 with 246 Reads DOI: 10.1136/archdischild-2014-306237.168

(2) Eur Child Adolesc Psychiatry. 2009 Nov; 18(11): 645–651. Published online 2009 May 21. doi: 10.1007/s00787-009-0027-6 PMCID: PMC2762526 Pervasive refusal syndrome as part of the refusal–withdrawal–regression spectrum: critical review of the literature illustrated by a case report Tine Jaspers,corresponding author1,2 G. M. J. Hanssen,3 Judith A. van der Valk,3 Johann H. Hanekom,4 Gijs Th. J. van Well,5 and Jan N. M. Schieveld1

(3) Pervasive refusal syndrome as part of the refusal–withdrawal–regression spectrum: critical review of the literature illustrated by a case report Tine Jaspers,corresponding author1,2 G. M. J. Hanssen,3 Judith A. van der Valk,3 Johann H. Hanekom,4 Gijs Th. J. van Well,5 and Jan N. M. Schieveld1

Media coverage & interviews[edit]

Controversies and Criticism[edit]


In a joint statement in August 2010, the ME Association and the Young ME Sufferers Trust called the SMILE study "unethical". They quoted the Medical Research Council guidelines on research in children - "Research involving children should only be carried out if it cannot feasibly be carried out on adults. The ME Association and The Young ME Sufferers Trust do not believe that it is ethically right to use children in trialling an unproven and controversial process such as the Lightning Process."[13] Invest in ME in a letter to the National Research Ethics Committee (NRES) described the process as "rather like CBT but with bullying and risks of harm".[14]

James Coyne has criticised Crawley's work with regard to public availability of data & the involvement of Phil Parker in the SMILE study.[15]

Daniel Clark has noted that the primary outcome measure was changed from school attendance to scores on a self-report questionnaire. He stated, "Given that LP involves making claims to patients about their own ability to control symptoms in exactly the sort of way likely to lead to response bias, it seems very likely that this trial will now find LP to be 'effective'." [16]

The study only received final ethical approval after prolonged protests from patient groups in January 2011. [17]

SRCTN81456207 DOI 10.1186/ISRCTN81456207 Specialist Medical Intervention & Lightning Evaluation: Comparing specialist medical care with specialist medical care plus the Lightning Process for Chronic Fatigue Syndrome or Myalgic Encephalopathy (CFS/ME)


James Coyne has urged patents not to enroll their children in the trial. He has highlighted the lack of information given to patients about potential harm, the consent procedure and the lack of published data on previous studies.[18]

Complaints and Death Threats

Dr Crawley has been the subject of complaints to the General Medical Council (GMC)[19] and claimed to have received death threats[20]

Canadian Consensus Criteria

In an reply to an Editorial in the British Medical Journal by Fiona Goodle, Crawley (with Peter White and Alastair Miller) rejected using the Canadian Consensus Criteria to diagnose patients, labeling it as "not practical", although conceding post-exertional malaise (which is part of the criteria) "may need incorporating in future definitions to help differentiate CFS from more general fatigue."[21][22]

Prevalence at Age 16

In a study[23] published in 2016 using data from almost 6000 children in the Children of the 90s Project[24], Crawley and her team concluded that the prevalence of CFS at age 16 was 1.8%. However, the children were included as having CFS on the basis of questionnaires, no doctors were involved in the diagnosis, and there was no attempt to exclude other fatigue-related conditions except depression. If children reporting depressive thoughts were excluded, the prevalence was reduced to 0.6%, but the 1.8% figure was highlighted in the media. BBC Radio 4 coverage[25] described the condition studied as ‘ME also known as chronic fatigue syndrome’. Dr Charles Shepherd of the ME Association wrote to express concerns about the methodology used but the journal did not publish his letter[26]

NICE Guidelines

Esther Crawley was on the guideline development group for the NICE guidelines CG53 NICE guidelines

Science Media Centre Expert on PACE trial

Crawley was on of the experts chosen by the Science Media Centre to comment on the PACE trial publications in February 2011 and January 2013. She said “All children with chronic fatigue syndrome and their parents are desperate for new research to understand how to treat this condition. The next step is to do a study like this for children to find out if these treatments work.”[27][28]

She also stated in a BBC interview that the PACE trial was “a great, great study.” [29]

Smearing critics as "anti-science" and unauthorised use of personal photos

Esther Crawley presented at a conference in which she accused all critics of her work being "anti-science'. She smeared patient groups, scientists and Dr David Tuller. She inferred about patients being drug users, criminals, with financial and relationship problems. She also defamed a US college student whose picture she took without any permission and used in her presentation [30] [31] .

Freedom of information requests[edit]

A number of Freedom of Information requests have been made to Dr Crawley about her work. One request revealed records were not kept of patients subsequently re-diagnosed with another illness at Dr Crawley's paediatric clinic.[32]

Other publications[edit]

  • 2016: Taylor, A, Loades, M, Brigden, A, Collin, S & Crawley, E, 2016, ‘“It’s personal to me”: A qualitative study of depression in young people with CFS/ME’. Clinical Child Psychology and Psychiatry.
  • 2016: Brigden, A, Beasant, L, Hollingworth, W, Metcalfe, C, Gaunt, D, Mills, N, Jago, R & Crawley, E, 2016, ‘Managed Activity Graded Exercise iN Teenagers and pre-Adolescents (MAGENTA) feasibility randomised controlled trial: study protocol’. BMJ Open, vol 6.
  • 2016: Norris, T, Hawton, K, Hamilton-Shield, J & Crawley, E, 2016, ‘Obesity in adolescents with chronic fatigue syndrome: an observational study’. Archives of disease in childhood.
  • 2016: Parslow, R, Harris, S, Broughton, J, Alattas, A, Crawley, E, Hayward, K & Shaw, ARG, 2016, ‘Children’s experiences of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME): A systematic review and meta-ethnography of qualitative studies’. BMJ Open.
  • 2016: Norris, T, Collin, S, Tilling, K, Nuevo, R, Stansfeld, S, Sterne, J, Heron, J & Crawley, E, 2016, ‘Natural course of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis in adolescents’. Archives of Disease in Childhood.
  • 2016: Loades, M, Sheils, E & Crawley, E, 2016, ‘Treatment for paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) and comorbid depression: a systematic review’. BMJ Open. Harris, S, Gilbert, M, Beasant, L, Broughton, J & Crawley, E, 2016, ‘A qualitative investigation of eating difficulties in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis’.
  • 2016: Stoll, S, Loades, M & Crawley, E, 2016, ‘Anxiety in paediatric Chronic Fatigue Syndrome (CFS/ME): A Systematic Review’.
  • 2016: Crawley, E, 2016, ‘Trials and tribulations’. New Scientist, vol 232., pp. 20-21
  • 2015: Collin, SM, Tilling, K, Joinson, C, Rimes, KA, Pearson, RM, Hughes, RA, Sterne, JAC & Crawley, E, 2015, ‘Maternal and childhood psychological factors predict chronic disabling fatigue at age 13 years’. Journal of Adolescent Health, vol 56., pp. 181-187

Online presence[edit]

Directorships and Shareholdings[edit]

Esther Madeleine Crawley has 1 total appointment.

See also[edit]


  1. Action for ME announces grant for Esther Crawley on incidence Severe Paediatric ME
  2. Chronic Fatigue Syndrome (CFS) symptom-based phenotypes in two clinical cohorts of adult patients in the UK and The Netherlands
  3. ME/CFS Research Funding - CMRC (Sept 2016)
  4. Crawley, Esther; Mills, Nicola; Beasant, Lucy; Johnson, Debbie; Collin, Simon M; Deans, Zuzana; White, Kate; Montgomery, Alan (2013), "The feasibility and acceptability of conducting a trial of specialist medical care and the Lightning Process in children with chronic fatigue syndrome: feasibility randomized controlled trial (SMILE study)", Trials, 14 (415), doi:10.1186/1745-6215-14-415 
  5. £164,000 grant for study into the Lightning Process and children with ME - ME Association (March 2010)
  6. SMILE Protocol documents: Bristol University December 2013
  7. Refusal of Information request by Bristol Uiversity - James Coyne (Oct 2016)
  8. The MAGENTA trial: can we investigate the effectiveness and cost effectiveness of managed activity compared to graded exercise in teenagers and pre-adolescents
  9. Managed Activity Graded Exercise iN Teenagers and pre-Adolescents (MAGENTA) feasibility randomised controlled trial: study protocol
  10. Peer Review History for MAGENTA trial
  11. FITNET to treat Paediatric CFS/ME (NIHR)
  12. The treatment for pervasive refusal syndrome as described here for PRS, is exactly the same as the protocols used by patients worldwide, experienced clinicians, Dr. Nigel Speight.G160(P) Case series of Pervasive Refusal Syndrome presenting with Chronic Fatigue Syndrome: avoiding the pitfall of a wrong diagnosis
  13. Statement of ME Association and Young Sufferers Trust on SMILE (August 2010)
  14. Letter to National Research Ethics Committee - Invest in ME
  15. James Coyne's criticisms of the work of Esther Crawley
  16. Daniel Craig's criticism on Skepdic website
  17. Ethics Committee finally approves SMILE (January 2011)
  18. Before you enroll your child in the MAGENTA chronic fatigue syndrome study: Issues to be considered -PLOS Blogs
  19. GMC complaint - Dr Esther Crawley
  20. Transcription BBC Radio 4 interview with Esther Crawley and Charles Shepherd
  21. Ending the stalemate over CFS/ME: British Medical Journal
  22. Use of the Canadian criteria to diagnose CFS: ME Association
  23. Chronic Fatigue Syndrome At Age 16 Years: Pediatrics (Jan 2016)
  24. Children Of The 90s Project: Avon Longitudinal Study Of Parents And Children
  25. BBC Radio Four Womans Hour Interview with Esther Crawley: Jan 2016
  26. Phoenix Rising copy of unpublished letter from Charles Shepherd to Pediatrics: Feb 2016
  27. expert reaction to Lancet study looking at treatments for Chronic Fatigue Syndrome/ME - Science Media Centre Feb. 17, 2011
  28. expert reaction to new research into therapies for Chronic Fatigue Syndrome/ME - Science Media Centre Jan. 31, 2013
  32. Number of children re-diagnosed with a psychological or psychiatric illness, by Dr Esther Crawley or any team led by Dr Crawley, or any team where Dr Crawley has worked/advised/trained

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From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history