Abstract
The characteristics of the clinical symptoms of 28 children and adolescents who visited the clinic with the chief complaints of generalized physical symptoms and school attendance problems were investigated. Persistent chronic generalized skeletal muscle pain, arthralgia, and various types of headache were observed in all patients. They suffered from sleep disturbances and difficulty waking up in the morning, fatigue and easy fatigability, stomach pain after eating, recurrent diarrhea and constipation, and hypersensitivity to light, sound, and smell at normal indoor environmental levels, with associated nausea and headache. Children and adolescents whose physical condition worsened on the way to school often complained of dizziness, palpitations, breathlessness, headache, and abdominal pain. On physical examination, all patients had muscle stiffness and tenderness, and all 18 tender points of fibromyalgia were positive. These physical symptoms and findings are similar to those of juvenile fibromyalgia, and it is possible that children and adolescents with school attendance problems include undiagnosed cases of juvenile fibromyalgia. The pathological picture of hypothalamic stress intolerant and exhaustive syndrome, with autonomic symptoms and pain/sensory hypersensitivity at its core, was clear, with disruption of circadian rhythm control, dysfunction of the energy metabolism system, and abnormal response of stress response to internal and external environmental stress. In adults with fibromyalgia, positron emission tomography (PET) showed the presence of microglia-derived inflammatory lesions in and around the thalamus, suggesting that the thalamus-hypothalamus-limbic system is also responsible for the lesions in children and adolescents with school attendance disorders. A level of indoor environment that would not be a problem at all for normal children and adolescents can cause significant stress intolerance and fatigue in those with school attendance disorders, leading to no school registration.
