Emotional and behavior problems in children and adolescents with chronic physical health conditions: an updated meta-analysis.
Pinquart, Martin · Journal of pediatric psychology · 2026 · DOI
Quick Summary
This study looked at 1,337 research papers to understand how children with long-term health conditions—including chronic fatigue syndrome (ME/CFS)—experience emotional and behavioral challenges. Children with these conditions had higher rates of anxiety, depression, and behavior problems compared to healthy peers. The study found that parents reported more problems than teenagers themselves did, and that ME/CFS was particularly linked to emotional difficulties.
Why It Matters
For ME/CFS patients and families, this study provides robust evidence that emotional and behavioral challenges are common and measurable in children with ME/CFS—not simply a secondary response to illness. These findings support the need for integrated mental health screening and care in pediatric ME/CFS services, acknowledging that psychological distress warrants clinical attention alongside physical symptom management.
Observed Findings
Children with ME/CFS showed the largest elevations in internalizing problems (anxiety, depression) compared to other chronic conditions studied.
Parent-reported behavioral problems were consistently larger in effect size than adolescent self-reports.
Total behavioral problem elevations in this updated meta-analysis were larger than reported in previous meta-analyses.
Effect sizes varied significantly by country, condition duration, and baseline equivalence of comparison groups.
Children with thalassemia showed the largest elevations in total and externalizing (behavior/conduct) problems.
Inferred Conclusions
Emotional and behavioral screening should be routine in pediatric care for all children with chronic physical health conditions, particularly ME/CFS.
Informant differences (parent vs. child reports) are clinically meaningful and suggest both actual behavioral differences and possible underrecognition by affected adolescents.
The psychological burden in childhood CPHC is substantial enough to warrant integrated psychological services alongside medical care.
Remaining Questions
Does the psychological distress in ME/CFS precede illness onset, develop as a reaction to disability, or reflect shared neurobiological mechanisms (e.g., neuroimmune dysfunction)?
What This Study Does Not Prove
This meta-analysis does not establish whether psychological problems are caused by the physical illness itself, result from living with chronic disability, or reflect shared underlying biological mechanisms. It also does not specify which children are at highest risk or define optimal screening and intervention approaches. The analysis is cross-sectional and does not track whether psychological problems emerge before, during, or after condition onset.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →