Since development of this illness often occurs in grade 8, children changing school systems are out of view of the teachers who know them well. Unless there is parental intervention, they are sometimes moved to slow learners' classes. If the parent objects, they are often classified inappropriately as suffering from school phobia or having an interfering parent. The younger the age, the more difficult it is for the children to verbalize the changes in their physical and mental state. Uninformed physicians frequently misdiagnose these children as simply depressed.
Suicide is frequent.
This occurred in all but the mildest cases and frequently persisted. Serial seven test was poorly performed, often with errors, often starting the test well and then getting bogged down. Inversion of sleep rhythm was common with nightmares in children, often with hallucinations on waking. In older children unsociability, lack of attention and effort on return to school was frequent. If behaviour was checked, children tended to weep.