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CHRONIC FATIGUE SYNDROME – A NEW EXCEPTIONALITY?

by Brenda Bowlby (of Hicks Morley L.L.P.)
August 22, 2005
I received a phone call the other day from Margaret Parlour, who is Coordinator
for Youth and Education Issues with the Myalgic Encephalomyelitis Association
of Ontario. She had been reading An Educator’s Guide to Special Education
Law, which I co-authored, and she wondered what exceptionality students living
with Chronic Fatigue Syndrome (“CFS”) could fit into in order to access special
education programs and services.
While I was vaguely aware of CFS, I wanted more information and so I “googled”
Chronic Fatigue Syndrome [“CFS. I found a number of helpful websites on the
topic, one of which is www.cdc.gov/ncidod/diseases/cfs/ ( the U. S. Department of
Health and Human Sciences Centres for Disease Control and Prevention’s
website) which provides the following information:
“Chronic fatigue syndrome, or CFS, is a debilitating and complex disorder characterized
by profound fatigue that is not improved by bed rest and that may be worsened by
physical or mental activity. Persons with CFS most often function at a substantially lower
level of activity than they were capable of before the onset of illness. In addition to these
key defining characteristics, patients report various nonspecific symptoms, including
weakness, muscle pain, impaired memory and/or mental concentration, insomnia, and
post-exertional fatigue lasting more than 24 hours. In some cases, CFS can persist for
years. The cause or causes of CFS have not been identified and no specific diagnostic
tests are available. Moreover, since many illnesses have incapacitating fatigue as a
symptom, care must be taken to exclude other known and often treatable conditions
before a diagnosis of CFS is made.
...In essence, in order to receive a diagnosis of chronic fatigue syndrome, a patient must
satisfy two criteria:
1) Have severe chronic fatigue of six months or longer duration with other known medical
conditions excluded by clinical diagnosis; and 2) concurrently have four or more of the
following symptoms: substantial impairment in short-term memory or concentration; sore
throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness;
headaches of a new type, pattern or severity; unrefreshing sleep; and post-exertional
malaise lasting more than 24 hours. The symptoms must have persisted or recurred
during six or more consecutive months of illness and must not have predated the fatigue.

It is critical to note that CFS can involve cognitive impairment which impacts on
short term memory and ability to attend, as well as limiting energy and physical
movement.
Although there is no particular treatment of CFS which has proven to be
universally effective, about one third of persons with CFS can hope to recover in
time, according to the CDC website.

Margaret Palour advised me that there are several thousand children who have
been diagnosed with CFS in Canada and that the number is on the rise.
So, can a student with CFS be identified as an exceptional pupil?
The answer is “yes” for some and “no” for others. Whether a student with CFS
can or should be identified as exceptional will depend upon whether the
particular symptoms of the student – and it should be noted that symptoms will
vary from person to person -- are of the severity and nature that they interfere
with the student’s ability to benefit from education from the Ontario curriculum in
the regular classroom.
The Education Act1 defines “exceptional pupil” as “a pupil whose behavioural,
communicational, intellectual, physical or multiple exceptionalities are such that he or she is
considered to need placement in a special education program by [an IPRC] ”.

If the nature and severity of symptoms of a particular student’s symptoms does
impact on his/her ability to benefit from education, a student with CFS may fall
into one of the following categories :
Physical Disability: A condition of such severe physical limitation or deficiency as to
require special assistance in learning situations to provide the opportunity for educational
achievement equivalent to that of pupils without exceptionalities who are of the same age
or development level.
Learning Disability: A learning disorder evident in both academic and social situations
that involves one or more of the processes necessary for the proper use of spoken
language or the symbols of communication, and that is characterized by a condition that:
a) is not primarily the result of impairment of vision; impairment of hearing;
physical disability; primary emotional disturbance; cultural difference; and
b) results in a significant discrepancy between academic achievement and
assessed intellectual ability, with deficits in one or more of he following: receptive
language; language processing; expressive language; mathematical
computations;
Multiple: A combination of learning and other disorders, impairments or physical
disabilities that is of such nature as to require, for educational achievement, the services
of one or more teachers holding qualifications in special education and the provision of
support services appropriate fro such disorders, impairment, or disabilities. 2

In the United States, CFS has been recognized as a condition which will entitle a
student to the benefits under the Individuals with Disabilities Act (IDEA).
Meanwhile, in Ontario, Margaret Parlour advises, she is aware of only one
student with CFS who has been identified to date.

1

R.S.O. 1990 c.E.2., s. 1.

2

Standards for School Boards’ Special Education Plans (2000).

While it may be obvious in some cases that a student who has always performed
well is suddenly incapable, identifying of students with CFS as exceptional will
not always be easy; as a result it is reasonable for school boards to request that
parents who claim that their students are suffering from CFS provide any medical
reports which would assist the School Board in identifying the student. Further, it
should be noted that a student who is identified as exceptional because of the
impact of having CFS may not always remain exceptional. Since recovery is
possible, this is one of the few situations where a child may be ‘de-identified’
should he/she recover to the point of his/her post CFS level of ability (assuming
that the student was not otherwise eligible to be identified prior to contracting
CFS.) Accordingly, the status of the student will have to be monitored and
parents should provide ongoing medical information as time goes on.
CFS is a condition which is affecting more and more children. In order to ensure
unnecessary IPRC appeals or human rights complaints, special educators will
want to be in a position to deal with the inquiries of parents of students with CFS.
A helpful website is www.mefmaction.net.