Who should we ask about mental health symptoms in adolescents with CFS/ME? Parent-child agreement on the revised children's anxiety and depression scale

Clin Child Psychol Psychiatry. 2021 Apr;26(2):367-380. doi: 10.1177/1359104521994880. Epub 2021 Feb 15.


Background: One in three adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) have mental health problems. Multi-informant perspectives are key to psychological assessment. Understanding parent-child agreement is crucial to accurate diagnosis, particularly where severe fatigue limits self-report.

Methods: Agreement on the revised children's anxiety and depression scale (RCADs) was assessed between parents and children with CFS/ME (n = 93) using Bland-Altman plots, cross tabulations and regression analyses.

Results: Diagnostic thresholds were met more frequently based on child-report. Parent- and child-report had similar sensitivity and specificity on RCADS compared to gold-standard diagnostic interviews. Regression analysis found similar accuracy between both reports. For anxiety diagnoses, odds ratio (OR) for child-report was 1.10 (CI = 1.06-1.14), and 1.10 (CI = 1.05-1.14) for parent-report. For depression, OR for child report was 1.26 (CI = 1.11-1.43), while for parent-report is was 1.25 (CI = 1.10-1.41). For total score, OR for child-report was 1.10 (CI = 1.05-1.13) while OR for parent-report was 1.09 (CI = 1.05-1.13).

Conclusions: Reasonable agreement was observed between parent- and child-report of mental health symptoms in paediatric CFS/ME. While parent-report can facilitate psychological evaluation in CFS/ME, this is not a substitute for a child's own report.

Keywords: Chronic fatigue syndrome; anxiety; depression; myalgic encephalomyelitis; paediatric chronic fatigue syndrome; parent child agreement.

MeSH terms

  • Adolescent
  • Anxiety / diagnosis
  • Child
  • Depression / diagnosis
  • Fatigue Syndrome, Chronic* / diagnosis
  • Humans
  • Mental Health
  • Parent-Child Relations