conduct a case study on a problematic child and prepare a report on it

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Description of Assignment

During your time at Manor, you will need to conduct a child case study. To do well, you will need to plan ahead and keep a schedule for observing the child. A case study at Manor typically includes the following components: 

• Three observations of the child: one qualitative, one quantitative, and one of your choice. 
• Three artifact collections and review: one qualitative, one quantitative, and one of your choice. 
• A Narrative

Within this tab, we will discuss how to complete all portions of the case study.  A copy of the rubric for the assignment is attached. 

• Case Study Rubric (Online)
• Case Study Rubric (Hybrid/F2F)

Qualitative and Quantitative Observation Tips

Remember your observation notes should provide the following detailed information about the child:

• child’s age,
• physical appearance,
• the setting, and
• any other important background information.

You should observe the child a minimum of 5 hours. Make sure you DO NOT use the child's real name in your observations. Always use a pseudo name for course assignments. 

You will use your observations to help write your narrative. When submitting your observations for the course please make sure they are typed so that they are legible for your instructor. This will help them provide feedback to you. 

Qualitative Observations

A qualitative observation is one in which you simply write down what you see using the anecdotal note format listed below. 

Quantitative Observations

A quantitative observation is one in which you will use some type of checklist to assess a child's skills. This can be a checklist that you create and/or one that you find on the web. A great choice of a checklist would be an Ounce Assessment and/or work sampling assessment depending on the age of the child. Below you will find some resources on finding checklists for this portion of the case study. If you are interested in using Ounce or Work Sampling, please see your program director for a copy. 

Remaining Objective 

For both qualitative and quantitative observations, you will only write down what your see and hear. Do not interpret your observation notes. Remain objective versus being subjective.

An example of an objective statement would be the following: "Johnny stacked three blocks vertically on top of a classroom table." or "When prompted by his teacher Johnny wrote his name but omitted the two N's in his name." 

An example of a subjective statement would be the following: "Johnny is happy because he was able to play with the block." or "Johnny omitted the two N's in his name on purpose." 

• Anecdotal Notes Form Form to use to record your observations.
• Guidelines for Writing Your Observations
• Tips for Writing Objective Observations
• Objective vs. Subjective

Qualitative and Quantitative Artifact Collection and Review Tips

For this section, you will collect artifacts from and/or on the child during the time you observe the child. Here is a list of the different types of artifacts you might collect: 

Potential Qualitative Artifacts 

• Photos of a child completing a task, during free play, and/or outdoors. 
• Samples of Artwork 
• Samples of writing 
• Products of child-led activities 

Potential Quantitative Artifacts 

• Checklist 
• Rating Scales
• Product Teacher-led activities 

Examples of Components of the Case Study

Here you will find a number of examples of components of the Case Study. Please use them as a guide as best practice for completing your Case Study assignment. 

• Qualitatitive Example 1
• Qualitatitive Example 2
• Quantitative Photo 1
• Qualitatitive Photo 1
• Quantitative Observation Example 1
• Artifact Photo 1
• Artifact Photo 2
• Artifact Photo 3
• Artifact Photo 4
• Artifact Sample Write-Up
• Case Study Narrative Example Although we do not expect you to have this many pages for your case study, pay close attention to how this case study is organized and written. The is an example of best practice.

Narrative Tips

The Narrative portion of your case study assignment should be written in APA style, double-spaced, and follow the format below:

• Introduction : Background information about the child (if any is known), setting, age, physical appearance, and other relevant details. There should be an overall feel for what this child and his/her family is like. Remember that the child’s neighborhood, school, community, etc all play a role in development, so make sure you accurately and fully describe this setting! --- 1 page
• Observations of Development :   The main body of your observations coupled with course material supporting whether or not the observed behavior was typical of the child’s age or not. Report behaviors and statements from both the child observation and from the parent/guardian interview— 1.5  pages
• Comment on Development: This is the portion of the paper where your professional analysis of your observations are shared. Based on your evidence, what can you generally state regarding the cognitive, social and emotional, and physical development of this child? Include both information from your observations and from your interview— 1.5 pages
• Conclusion: What are the relative strengths and weaknesses of the family, the child? What could this child benefit from? Make any final remarks regarding the child’s overall development in this section.— 1page
• Your Case Study Narrative should be a minimum of 5 pages.

Make sure to NOT to use the child’s real name in the Narrative Report. You should make reference to course material, information from your textbook, and class supplemental materials throughout the paper . 

Same rules apply in terms of writing in objective language and only using subjective minimally. REMEMBER to CHECK your grammar, spelling, and APA formatting before submitting to your instructor. It is imperative that you review the rubric of this assignment as well before completing it. 

Biggest Mistakes Students Make on this Assignment

Here is a list of the biggest mistakes that students make on this assignment: 

• Failing to start early . The case study assignment is one that you will submit in parts throughout the semester. It is important that you begin your observations on the case study before the first assignment is due. Waiting to the last minute will lead to a poor grade on this assignment, which historically has been the case for students who have completed this assignment. 
• Failing to utilize the rubrics. The rubrics provide students with guidelines on what components are necessary for the assignment. Often students will lose points because they simply read the descriptions of the assignment but did not pay attention to rubric portions of the assignment. 
• Failing to use APA formatting and proper grammar and spelling. It is imperative that you use spell check and/or other grammar checking software to ensure that your narrative is written well. Remember it must be in APA formatting so make sure that you review the tutorials available for you on our Lib Guide that will assess you in this area. 
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• Case report
• Open access
• Published: 11 September 2017

A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy

• Magdalena Romanowicz   ORCID: orcid.org/0000-0002-4916-0625 1 ,
• Alastair J. McKean 1 &
• Jennifer Vande Voort 1  

BMC Psychiatry volume  17 , Article number:  330 ( 2017 ) Cite this article

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Long-term effects of neglect in early life are still widely unknown. Diversity of outcomes can be explained by differences in genetic risk, epigenetics, prenatal factors, exposure to stress and/or substances, and parent-child interactions. Very common sub-threshold presentations of children with history of early trauma are challenging not only to diagnose but also in treatment.

Case presentation

A Caucasian 4-year-old, adopted at 8 months, male patient with early history of neglect presented to pediatrician with symptoms of behavioral dyscontrol, emotional dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment issues. He was subsequently seen by two different child psychiatrists. Pharmacotherapy treatment attempted included guanfacine, fluoxetine and amphetamine salts as well as quetiapine, aripiprazole and thioridazine without much improvement. Risperidone initiated by primary care seemed to help with his symptoms of dyscontrol initially but later the dose had to be escalated to 6 mg total for the same result. After an episode of significant aggression, the patient was admitted to inpatient child psychiatric unit for stabilization and taper of the medicine.

Conclusions

The case illustrates difficulties in management of children with early history of neglect. A particular danger in this patient population is polypharmacy, which is often used to manage transdiagnostic symptoms that significantly impacts functioning with long term consequences.

Peer Review reports

There is a paucity of studies that address long-term effects of deprivation, trauma and neglect in early life, with what little data is available coming from institutionalized children [ 1 ]. Rutter [ 2 ], who studied formerly-institutionalized Romanian children adopted into UK families, found that this group exhibited prominent attachment disturbances, attention-deficit/hyperactivity disorder (ADHD), quasi-autistic features and cognitive delays. Interestingly, no other increases in psychopathology were noted [ 2 ].

Even more challenging to properly diagnose and treat are so called sub-threshold presentations of children with histories of early trauma [ 3 ]. Pincus, McQueen, & Elinson [ 4 ] described a group of children who presented with a combination of co-morbid symptoms of various diagnoses such as conduct disorder, ADHD, post-traumatic stress disorder (PTSD), depression and anxiety. As per Shankman et al. [ 5 ], these patients may escalate to fulfill the criteria for these disorders. The lack of proper diagnosis imposes significant challenges in terms of management [ 3 ].

J is a 4-year-old adopted Caucasian male who at the age of 2 years and 4 months was brought by his adoptive mother to primary care with symptoms of behavioral dyscontrol, emotional dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment issues. J was given diagnoses of reactive attachment disorder (RAD) and ADHD. No medications were recommended at that time and a referral was made for behavioral therapy.

She subsequently took him to two different child psychiatrists who diagnosed disruptive mood dysregulation disorder (DMDD), PTSD, anxiety and a mood disorder. To help with mood and inattention symptoms, guanfacine, fluoxetine, methylphenidate and amphetamine salts were all prescribed without significant improvement. Later quetiapine, aripiprazole and thioridazine were tried consecutively without behavioral improvement (please see Table  1 for details).

No significant drug/substance interactions were noted (Table 1 ). There were no concerns regarding adherence and serum drug concentrations were not ordered. On review of patient’s history of medication trials guanfacine and methylphenidate seemed to have no effect on J’s hyperactive and impulsive behavior as well as his lack of focus. Amphetamine salts that were initiated during hospitalization were stopped by the patient’s mother due to significant increase in aggressive behaviors and irritability. Aripiprazole was tried for a brief period of time and seemed to have no effect. Quetiapine was initially helpful at 150 mg (50 mg three times a day), unfortunately its effects wore off quickly and increase in dose to 300 mg (100 mg three times a day) did not seem to make a difference. Fluoxetine that was tried for anxiety did not seem to improve the behaviors and was stopped after less than a month on mother’s request.

J’s condition continued to deteriorate and his primary care provider started risperidone. While initially helpful, escalating doses were required until he was on 6 mg daily. In spite of this treatment, J attempted to stab a girl at preschool with scissors necessitating emergent evaluation, whereupon he was admitted to inpatient care for safety and observation. Risperidone was discontinued and J was referred to outpatient psychiatry for continuing medical monitoring and therapy.

Little is known about J’s early history. There is suspicion that his mother was neglectful with feeding and frequently left him crying, unattended or with strangers. He was taken away from his mother’s care at 7 months due to neglect and placed with his aunt. After 1 month, his aunt declined to collect him from daycare, deciding she was unable to manage him. The owner of the daycare called Child Services and offered to care for J, eventually becoming his present adoptive parent.

J was a very needy baby who would wake screaming and was hard to console. More recently he wakes in the mornings anxious and agitated. He is often indiscriminate and inappropriate interpersonally, unable to play with other children. When in significant distress he regresses, and behaves as a cat, meowing and scratching the floor. Though J bonded with his adoptive mother well and was able to express affection towards her, his affection is frequently indiscriminate and he rarely shows any signs of separation anxiety.

At the age of 2 years and 8 months there was a suspicion for speech delay and J was evaluated by a speech pathologist who concluded that J was exhibiting speech and language skills that were solidly in the average range for age, with developmental speech errors that should be monitored over time. They did not think that issues with communication contributed significantly to his behavioral difficulties. Assessment of intellectual functioning was performed at the age of 2 years and 5 months by a special education teacher. Based on Bailey Infant and Toddler Development Scale, fine and gross motor, cognitive and social communication were all within normal range.

J’s adoptive mother and in-home therapist expressed significant concerns in regards to his appetite. She reports that J’s biological father would come and visit him infrequently, but always with food and sweets. J often eats to the point of throwing up and there have been occasions where he has eaten his own vomit and dog feces. Mother noticed there is an association between his mood and eating behaviors. J’s episodes of insatiable and indiscriminate hunger frequently co-occur with increased energy, diminished need for sleep, and increased speech. This typically lasts a few days to a week and is followed by a period of reduced appetite, low energy, hypersomnia, tearfulness, sadness, rocking behavior and slurred speech. Those episodes last for one to 3 days. Additionally, there are times when his symptomatology seems to be more manageable with fewer outbursts and less difficulty regarding food behaviors.

J’s family history is poorly understood, with his biological mother having a personality disorder and ADHD, and a biological father with substance abuse. Both maternally and paternally there is concern for bipolar disorder.

J has a clear history of disrupted attachment. He is somewhat indiscriminate in his relationship to strangers and struggles with impulsivity, aggression, sleep and feeding issues. In addition to early life neglect and possible trauma, J has a strong family history of psychiatric illness. His mood, anxiety and sleep issues might suggest underlying PTSD. His prominent hyperactivity could be due to trauma or related to ADHD. With his history of neglect, indiscrimination towards strangers, mood liability, attention difficulties, and heightened emotional state, the possibility of Disinhibited Social Engagement Disorder (DSED) is likely. J’s prominent mood lability, irritability and family history of bipolar disorder, are concerning for what future mood diagnosis this portends.

As evidenced above, J presents as a diagnostic conundrum suffering from a combination of transdiagnostic symptoms that broadly impact his functioning. Unfortunately, although various diagnoses such as ADHD, PTSD, Depression, DMDD or DSED may be entertained, the patient does not fall neatly into any of the categories.

This is a case report that describes a diagnostic conundrum in a young boy with prominent early life deprivation who presented with multidimensional symptoms managed with polypharmacy.

A sub-threshold presentation in this patient partially explains difficulties with diagnosis. There is no doubt that negative effects of early childhood deprivation had significant impact on developmental outcomes in this patient, but the mechanisms that could explain the associations are still widely unknown. Significant family history of mental illness also predisposes him to early challenges. The clinical picture is further complicated by the potential dynamic factors that could explain some of the patient’s behaviors. Careful examination of J’s early life history would suggest such a pattern of being able to engage with his biological caregivers, being given food, being tended to; followed by periods of neglect where he would withdraw, regress and engage in rocking as a self-soothing behavior. His adoptive mother observed that visitations with his biological father were accompanied by being given a lot of food. It is also possible that when he was under the care of his biological mother, he was either attended to with access to food or neglected, left hungry and screaming for hours.

The current healthcare model, being centered on obtaining accurate diagnosis, poses difficulties for treatment in these patients. Given the complicated transdiagnostic symptomatology, clear guidelines surrounding treatment are unavailable. To date, there have been no psychopharmacological intervention trials for attachment issues. In patients with disordered attachment, pharmacologic treatment is typically focused on co-morbid disorders, even with sub-threshold presentations, with the goal of symptom reduction [ 6 ]. A study by dosReis [ 7 ] found that psychotropic usage in community foster care patients ranged from 14% to 30%, going to 67% in therapeutic foster care and as high as 77% in group homes. Another study by Breland-Noble [ 8 ] showed that many children receive more than one psychotropic medication, with 22% using two medications from the same class.

It is important to note that our patient received four different neuroleptic medications (quetiapine, aripiprazole, risperidone and thioridazine) for disruptive behaviors and impulsivity at a very young age. Olfson et al. [ 9 ] noted that between 1999 and 2007 there has been a significant increase in the use of neuroleptics for very young children who present with difficult behaviors. A preliminary study by Ercan et al. [ 10 ] showed promising results with the use of risperidone in preschool children with behavioral dyscontrol. Review by Memarzia et al. [ 11 ] suggested that risperidone decreased behavioral problems and improved cognitive-motor functions in preschoolers. The study also raised concerns in regards to side effects from neuroleptic medications in such a vulnerable patient population. Younger children seemed to be much more susceptible to side effects in comparison to older children and adults with weight gain being the most common. Weight gain associated with risperidone was most pronounced in pre-adolescents (Safer) [ 12 ]. Quetiapine and aripiprazole were also associated with higher rates of weight gain (Correll et al.) [ 13 ].

Pharmacokinetics of medications is difficult to assess in very young children with ongoing development of the liver and the kidneys. It has been observed that psychotropic medications in children have shorter half-lives (Kearns et al.) [ 14 ], which would require use of higher doses for body weight in comparison to adults for same plasma level. Unfortunately, that in turn significantly increases the likelihood and severity of potential side effects.

There is also a question on effects of early exposure to antipsychotics on neurodevelopment. In particular in the first 3 years of life there are many changes in developing brains, such as increase in synaptic density, pruning and increase in neuronal myelination to list just a few [ 11 ]. Unfortunately at this point in time there is a significant paucity of data that would allow drawing any conclusions.

Our case report presents a preschool patient with history of adoption, early life abuse and neglect who exhibited significant behavioral challenges and was treated with various psychotropic medications with limited results. It is important to emphasize that subthreshold presentation and poor diagnostic clarity leads to dangerous and excessive medication regimens that, as evidenced above is fairly common in this patient population.

Neglect and/or abuse experienced early in life is a risk factor for mental health problems even after adoption. Differences in genetic risk, epigenetics, prenatal factors (e.g., malnutrition or poor nutrition), exposure to stress and/or substances, and parent-child interactions may explain the diversity of outcomes among these individuals, both in terms of mood and behavioral patterns [ 15 , 16 , 17 ]. Considering that these children often present with significant functional impairment and a wide variety of symptoms, further studies are needed regarding diagnosis and treatment.

Abbreviations

Attention-Deficit/Hyperactivity Disorder

Disruptive Mood Dysregulation Disorder

Disinhibited Social Engagement Disorder

Post-Traumatic Stress Disorder

Reactive Attachment disorder

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Acknowledgements

We are also grateful to patient’s legal guardian for their support in writing this manuscript.

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Magdalena Romanowicz, Alastair J. McKean & Jennifer Vande Voort

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MR, AJM, JVV conceptualized and followed up the patient. MR, AJM, JVV did literature survey and wrote the report and took part in the scientific discussion and in finalizing the manuscript. All the authors read and approved the final document.

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Correspondence to Magdalena Romanowicz .

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Romanowicz, M., McKean, A.J. & Vande Voort, J. A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy. BMC Psychiatry 17 , 330 (2017). https://doi.org/10.1186/s12888-017-1492-y

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Module 13: Disorders of Childhood and Adolescence

Case studies: disorders of childhood and adolescence, learning objectives.

• Identify disorders of childhood and adolescence in case studies

Case Study: Jake

Jake was born at full term and was described as a quiet baby. In the first three months of his life, his mother became worried as he was unresponsive to cuddles and hugs. He also never cried. He has no friends and, on occasions, he has been victimized by bullying at school and in the community. His father is 44 years old and describes having had a difficult childhood; he is characterized by the family as indifferent to the children’s problems and verbally violent towards his wife and son, but less so to his daughters. The mother is 41 years old, and describes herself as having a close relationship with her children and mentioned that she usually covers up for Jake’s difficulties and makes excuses for his violent outbursts. [1]

During his stay (for two and a half months) in the inpatient unit, Jake underwent psychiatric and pediatric assessments plus occupational therapy. He took part in the unit’s psycho-educational activities and was started on risperidone, two mg daily. Risperidone was preferred over an anti-ADHD agent because his behavioral problems prevailed and thus were the main target of treatment. In addition, his behavioral problems had undoubtedly influenced his functionality and mainly his relations with parents, siblings, peers, teachers, and others. Risperidone was also preferred over other atypical antipsychotics for its safe profile and fewer side effects. Family meetings were held regularly, and parental and family support along with psycho-education were the main goals. Jake was aided in recognizing his own emotions and conveying them to others as well as in learning how to recognize the emotions of others and to become aware of the consequences of his actions. Improvement was made in rule setting and boundary adherence. Since his discharge, he received regular psychiatric follow-up and continues with the medication and the occupational therapy. Supportive and advisory work is done with the parents. Marked improvement has been noticed regarding his social behavior and behavior during activity as described by all concerned. Occasional anger outbursts of smaller intensity and frequency have been reported, but seem more manageable by the child with the support of his mother and teachers.

In the case presented here, the history of abuse by the parents, the disrupted family relations, the bullying by his peers, the educational difficulties, and the poor SES could be identified as additional risk factors relating to a bad prognosis. Good prognostic factors would include the ending of the abuse after intervention, the child’s encouragement and support from parents and teachers, and the improvement of parental relations as a result of parent training and family support by mental health professionals. Taken together, it appears that also in the case of psychiatric patients presenting with complex genetic aberrations and additional psychosocial problems, traditional psychiatric and psychological approaches can lead to a decrease of symptoms and improved functioning.

Case Study: Kelli

Kelli may benefit from a course of comprehensive behavioral intervention for her tics in addition to psychotherapy to treat any comorbid depression she experiences from isolation and bullying at school. Psychoeducation and approaches to reduce stigma will also likely be very helpful for both her and her family, as well as bringing awareness to her school and those involved in her education.

• Kolaitis, G., Bouwkamp, C.G., Papakonstantinou, A. et al. A boy with conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), borderline intellectual disability, and 47,XXY syndrome in combination with a 7q11.23 duplication, 11p15.5 deletion, and 20q13.33 deletion. Child Adolesc Psychiatry Ment Health 10, 33 (2016). https://doi.org/10.1186/s13034-016-0121-8 ↵
• Case Study: Childhood and Adolescence. Authored by : Chrissy Hicks for Lumen Learning. Provided by : Lumen Learning. License : CC BY: Attribution
• A boy with conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), borderline intellectual disability.... Authored by : Gerasimos Kolaitis, Christian G. Bouwkamp, Alexia Papakonstantinou, Ioanna Otheiti, Maria Belivanaki, Styliani Haritaki, Terpsihori Korpa, Zinovia Albani, Elena Terzioglou, Polyxeni Apostola, Aggeliki Skamnaki, Athena Xaidara, Konstantina Kosma, Sophia Kitsiou-Tzeli, Maria Tzetis . Provided by : Child and Adolescent Psychiatry and Mental Health. Located at : https://capmh.biomedcentral.com/articles/10.1186/s13034-016-0121-8 . License : CC BY: Attribution
• Angry boy. Located at : https://www.pxfuel.com/en/free-photo-jojfk . License : Public Domain: No Known Copyright
• Frustrated girl. Located at : https://www.pickpik.com/book-bored-college-education-female-girl-1717 . License : Public Domain: No Known Copyright

• Children's mental health case studies
• Parenting and caregiving
• Mental health

Explore the experiences of children and families with these interdisciplinary case studies. Designed to help professionals and students explore the strengths and needs of children and their families, each case presents a detailed situation, related research, problem-solving questions and feedback for the user. Use these cases on your own or in classes and training events

Each case study:

• Explores the experiences of a child and family over time.
• Introduces theories, research and practice ideas about children's mental health.
• Shows the needs of a child at specific stages of development.
• Invites users to “try on the hat” of different specific professionals.

By completing a case study participants will:

• Examine the needs of children from an interdisciplinary perspective.
• Recognize the importance of prevention/early intervention in children’s mental health.
• Apply ecological and developmental perspectives to children’s mental health.
• Predict probable outcomes for children based on services they receive.

Case studies prompt users to practice making decisions that are:

• Research-based.
• Practice-based.
• Best to meet a child and family's needs in that moment.

Children’s mental health service delivery systems often face significant challenges.

• Services can be disconnected and hard to access.
• Stigma can prevent people from seeking help.
• Parents, teachers and other direct providers can become overwhelmed with piecing together a system of care that meets the needs of an individual child.
• Professionals can be unaware of the theories and perspectives under which others serving the same family work
• Professionals may face challenges doing interdisciplinary work.
• Limited funding promotes competition between organizations trying to serve families.

These case studies help explore life-like mental health situations and decision-making. Case studies introduce characters with history, relationships and real-life problems. They offer users the opportunity to:

• Examine all these details, as well as pertinent research.
• Make informed decisions about intervention based on the available information.

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• Brianna and Tanya: A case study about infant and early childhood mental health
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• v.26(2); 2019

Evidence-based psychosocial treatments of conduct problems in children and adolescents: an overview

Uberto gatti.

a Department of Health Sciences, Section of Criminology, University of Genoa, Genoa, Italy;

Ignazio Grattagliano

b Section of Forensic Psychiatry, University of Bari, Bari, Italy

Gabriele Rocca

The aims of the present study were to identify empirically supported psychosocial intervention programs for young people with conduct problems and to evaluate the underpinnings, techniques and outcomes of these treatments. We analyzed reviews and meta-analyses published between 1982 and 2016 concerning psychosocial intervention programs for children aged 3 to 12 years with conduct problems. Parent training should be considered the first-line approach to dealing with young children, whereas cognitive-behavioral approaches have a greater effect on older youths. Family interventions have shown greater efficacy in older youths, whereas multi-component and multimodal treatment approaches have yielded moderate effects in both childhood and adolescence.

Some limitations were found, especially regarding the evaluation of effects. To date, no single program has emerged as the best. However, it emerges that the choice of intervention should be age-specific and should take into account developmental differences in cognitive, behavioral, affective and communicative abilities.

Introduction

Behavioral problems in young people are common and costly, being the most frequent cause of referral of children and adolescents to mental health services (Rutter et al., 2008 ). This is not surprising, as antisocial behaviors in childhood and adolescence elicit significant social reactions and are closely associated with delinquency and mental health problems in adulthood (Loeber & Farrington, 2001 ; Moffitt, 1993 ; Reef, van Meurs, Verhulst, & van der Ende, 2010 ).

In Western countries, it has been reported that the prevalence of conduct problems in subjects between 5 and 15 years of age is 5–10% (Loeber & Farrington, 2001 ) and is steadily increasing, though it is not clear whether this rise is due to a real increase in the phenomenon or to better detection. The economic consequences are considerable: it is estimated that the costs incurred for youths with conduct problems are at least 10 times higher than in non-antisocial individuals by the time they reach 28 years of age (Scott, Knapp, Henderson, & Maughan, 2001 ).

Conduct problems cover a broad spectrum of behaviors and typically include troublesome, disruptive and aggressive behavior; an unwillingness or inability to perform school work; few positive interactions with adults; poor social skills; low self-esteem; non-compliance with instructions and emotional volatility (Furlong et al., 2012 ).

Extensive research in the fields of psychiatry, developmental psychopathology and criminology has furthered our understanding of the many factors that may be involved in the development of juveniles’ conduct problems. Each of these disciplines has its own tradition of assessment, which yields different outcomes (Loeber, Burke & Pardini, 2009 ).

Psychiatry adopts a mainly medical approach, classifying children with disruptive behaviors in clinical categories according to symptom-based criteria. Clearly, children with these diagnoses constitute only a subset of those with conduct problems, since different forms of aggressive and antisocial behavior become clinically relevant only when aggregated.

Developmental psychopathology does not focus on classification, but on the developmental mechanisms that can lead to conduct problems. It therefore analyzes individual differences in the qualitative and quantitative aspects of antisocial behaviors. Such analyses reveal, for instance, that the incidence of stealing and truancy increases with age, whereas the frequency of physical fighting tends to decrease (Barker et al., 2007 ).

By contrast, criminology does not adopt a medical approach, preferring to refer to the more specific notion of ‘behaviors that violate criminal laws’ and focusing mainly on sociological explanations of antisocial behaviors.

Research from each of these disciplines provides a unique perspective for understanding the course, causes and possible treatment of antisocial behaviors in young people, and the results obtained have had a significant impact on assessment and the design of more effective and specific interventions to prevent and treat this phenomenon.

In this manuscript, we focus on the psychosocial treatment of conduct problems in youth. Despite the widespread publication of lists of evidence-based interventions (Eyberg, Nelson, & Boggs, 2008 ), a large gap remains between the knowledge gained through empirical research and clinical practice (Garland, Hawley, Brookman-Frazee, & Hurlburt, 2008 ). Several programs have been proposed and evaluated (Substance Abuse and Mental Health Services Administration, 2011 ), but much remains to be learned about their implementation and about how to support their effective ongoing delivery in community-based settings.

In the first part of the manuscript, we focus on psychosocial interventions, reviewing the scientific literature on evidence-based treatments (EBTs) and evaluating the underpinnings, techniques and outcomes of these treatments. Some examples of the most widespread programs are also provided. We then conclude by discussing the critical issues raised and proposing some recommendations for future work to overcome these problems.

Conduct problems in youth: a brief overview

Before discussing treatment, it is important to delineate the clinical extent of the phenomenon.

Indeed, conduct problems cover a broad spectrum of acting-out behaviors, ranging from relatively minor oppositional behaviors, such as yelling and temper tantrums, to more serious forms of antisocial behavior, such as physical destructiveness, stealing and physical violence. Moreover, it should be remembered that aggressive and defiant behavior is an important part of normal child and adolescent development, which ensures physical and social survival.

As noted by Scott ( 2007 ), empirical studies do not suggest a level at which behaviors become qualitatively different, nor is there a single cut-off point at which they become impairing for the child or a clear problem for others.

One relevant question that is often raised in clinical and research practice is whether or not patterns of antisocial behavior should or should not be considered a psychopathological condition (Wakefield, Pottick, & Kirk, 2002 ). The answer is largely dependent on how one defines ‘mental disorder’ (First, Wakefield, et al., 2010 ). Indeed, picking a particular level of antisocial behavior that is classifiable as a ‘disorder’ is therefore necessarily arbitrary (Moffitt et al., 2007 ).

Although disruptive behaviors are seen to varying degrees during the development of most young people, they become clinically relevant when they are frequent, severe, persistent, not just isolated acts, and lead to distress and functional impairment (American Academy of Child & Adolescent Psychiatry, 1997 ).

The term ‘disruptive behavior disorders’ (DBDs) is an overarching expression used in psychiatric nosology to describe these conditions, in which conduct problems (e.g. breaking rules, disrupting the lives of caregivers, defying authority, etc.) are clinically significant and clearly beyond the realm of ‘normal’ functioning.

According to the psychiatric nosography (American Psychiatric Association, 2013 ), children with these patterns of disruptive behaviors may be diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD), when behavior involves significant violations of the rights of others and/or major societal norms.

Indeed it is important to bear in mind the different conception of the term ‘juvenile delinquency’, a socio-legal category that refers to children and adolescents who have been convicted of an offence that would be deemed a crime if committed by an adult. Most, but not all, recurrent juvenile offenders can be regarded as suffering from conduct disorder (Woolfenden, Williams, & Peat, 2001 ).

A comprehensive review of the literature (Boylan, Vaillancourt, Boyle, & Szatmari, 2007 ) found that the prevalence of ODD reported in community samples ranged from 2.6% to 15.6%, and in clinical samples from 28% to 65%. Moreover, although boys show higher prevalence rates than girls prior to adolescence, during adolescence boys and girls display equal rates of ODD.

There is evidence that ODD can be clearly distinguished from common problem behaviors among preschool children in both clinical (Keenan & Wakschlag, 2004 ) and community (Lavigne et al., 2001 ) samples. Although most empirical evidence supports a distinction between ODD and CD within a DBD spectrum, other evidence appears to support a distinction between ODD and aggressive CD and non-aggressive CD behaviors (Loeber, Burke, Lahey, Winters, & Zera, 2000 ).

The diagnosis of ODD is relatively stable over time, in that diagnostic criteria are reported to be met in two successive years in 36% of cases (Burke, Pardini, & Loeber, 2008 ). Moreover, ODD is a significant risk factor for CD, children with earlier-onset ODD displaying a three-fold higher incidence of CD (Burke, Loeber, Lahey, & Rathouz, 2005 ). In addition, youths with ODD appear to have significantly higher rates of co-morbid psychiatric disorders, such as ADHD, anxiety disorders, depressive disorders and substance use disorders, and ODD is associated with subsequent impairments in school and social functioning, even when other forms of psychopathology are taken into account (Greene et al., 2002 ).

CD is divided into childhood-onset and adolescent-onset subtypes, according to whether the first CD symptom emerges before or after the age of 10 years. Evidence suggests that childhood-onset CD is particularly associated with a more persistent and severe course than adolescent-onset CD, and is associated with a greater risk of antisocial behavior, violence and criminality in adulthood (Odgers et al., 2008 ). In addition, CD tends to progress from less to more severe problem behaviors, with a more rapid increase in this progression being observed in childhood-onset CD (Frick & Viding, 2009 ). Furthermore, there are developmental differences in the manifestation of CD symptoms; for example, the incidence of stealing and truancy increases with age, as does the total number of CD symptoms, whereas the initiation of physical fights tends to decrease (Barker et al., 2007 ).

Prevalence rates of CD in community samples have been found to range from 1.8% to 16.0% for boys, and 0.8% to 9.2% for girls (Loeber et al., 2000 ). In contrast to ODD, gender differences appear to remain consistent throughout development.

The stability of CD diagnoses is moderate to high, ranging from 44% to 88% (Loeber, Burke & Pardini, 2009), the course being strongly influenced by the age of onset. Indeed, in about half of those with early-onset CD, serious problems persist into adulthood, while the great majority (over 85%) of those with adolescent-onset CD discontinue their antisocial behavior by their early twenties (Moffitt & Scott, 2008 ). Moreover, childhood-onset CD is a strong predictor of antisocial personality disorder (APD), especially among subjects from families of low socio-economic status. On the other hand, the majority of children with CD will not progress to APD (Kim-Cohen et al., 2005 ). Other negative outcomes include substance-related disorders, internalizing psychopathology and all personality disorders (Morcillo et al., 2012 ).

Recent research has suggested that a minority of youths with CD display traits similar to those of adult psychopathy (Kahn, Frick, Youngstrom, Findling, & Youngstrom, 2012 ). For this reason in the DSM-5 it has been suggested a subtype “With a Callous-Unemotional Presentation” (American Psychiatric Association, 2013 ). To meet this specification, the young person must fulfill the criteria for CD and display two or more callous-unemotional (CU) characteristics. These include: lack of remorse or feelings of guilt, lack of empathy, unconcern over performance in important activities, and/or shallow affection, persistently for at least 12 months across multiple settings and relationships (Scheepers, Buitelaar, & Matthys, 2011 ). Youths with CU traits show more severe and stable conduct problems (Frick & Dickens, 2006 ), are more difficult to treat and often do not respond to typical treatments in mental health or juvenile justice settings (Stellwagen & Kerig, 2010 ).

While no single cause of ODD and CD has been identified, a number of risk factors have been found. These include biological (e.g. genes and neurotransmitters), perinatal (e.g. minor physical anomalies and low birth weight), cognitive (e.g. deficits in executive functioning), emotional (e.g. poor emotional regulation), personality (e.g. impulsivity), familial (e.g. ineffective discipline), peer (e.g. association with deviant peers) and neighborhood (e.g. high levels of exposure to violence) risk factors (for a review, see Murray & Farrington, 2010 ).

The bulk of the research has made it clear that causal models cannot focus on single risk factors or single domains of risk factors, since DBDs are the result of a complex interaction of multiple causal factors (Lahey & Waldman, 2012 ). From a diagnostic point of view, it should be highlighted that the diagnosis of DBDs is – and remains – mainly clinical, despite the availability of a wide range of instruments for measuring the symptoms of ODD and CD and for assisting the assessment process ( for a review, see Frick & Nigg, 2012 and Barry, Golmaryami, Rivera-Hudson, & Frick et al., 2013 ).

Identification of evidence-based treatments

To identify empirically supported psychosocial intervention programs for the young with conduct problems, we searched for and analyzed reviews and meta-analyses published between 1982 and 2016 concerning treatments for children and adolescents with disruptive behaviors.

Disruptive behaviors were broadly defined on the basis of the symptoms described in the psychiatric classification systems (DSM and ICD). Treatment was defined as any psychosocial intervention aimed at reducing aggressive, oppositional and disruptive behaviors or enhancing prosocial behavior.

Preventive interventions were included only if they involved children with early signs of disruptive behaviors (indicated prevention). Interventions designed with the primary goal of preventing conduct problems (universal and selected) were not included.

We considered as evidence-based the interventions that were recognized in most of the reviews and meta-analyses as well-established or probably efficacious according to the American Psychological Association’s criteria (Chambless & Hollon, 1998 ; Task Force APA, 1995 ) and/or which were identified as superior to the comparison on at least 50% of the disruptive behavior measures.

Two methods were used to identify the database: an internet-based search and a manual search. First, four internet-based databases (Cochrane Reviews, MEDLINE, PsycINFO and Scopus) were searched for articles published between January 1982 and December 2011. All the necessary terms referring to the treatment (psychosocial interventions; individual, family, multi-systemic, parent, school programs; etc.) and the participant groups (age 3–18 years, conduct disorder, oppositional defiant disorder, maladaptive aggression, disruptive behavior, juvenile delinquency) were used. Search terms were modified to meet the requirements of each database. Second, further articles were identified by means of a manual search of reference lists from the papers retrieved.

The reviews and meta-analyses examined are included in the reference section; Table 1 summarizes a few characteristics of the most relevant interventions. It is important to bear in mind that the inventory of studies analyzed is a ‘working list’; indeed, although we attempted to make an exhaustive review of the literature on the outcome of psychosocial treatment, our search may have missed some important treatments.

Evidence-based psychosocial treatments of conduct problems in children and adolescents: selected study characteristics.

Empirically supported intervention programs for youths with conduct problems

Psychosocial interventions for youths with conduct problems have been developed across a wide spectrum (from the individual level to the family and community levels) and over a range of theoretical frameworks (e.g. social learning theory, cognitive-behavioral therapy, systemic and psychodynamic approaches). On the whole, the range of treatments for child conduct problems that have been evaluated empirically may be broadly classified according to the key focus of delivery, in terms of whether they are child-focused, parent-focused, family-focused, multi-modal or multi-component.

With regard to interventions for the individual child, the most carefully evaluated methods are based on cognitive-behavioral principles (Furlong et al., 2012 ). More traditional forms of psychotherapy, such as psychodynamic therapy, have also been used, but some studies have stressed that these approaches have not been evaluated rigorously and are less supported by the existing evidence (Weiss, Catron, Harris, & Phung, 1999 ).

Child-focused programs

Broadly speaking, the child-focused cognitive-behavioral approach emphasizes helping the child to identify stimuli linked to aggressive and antisocial behaviors, to face cognitive distortions, to develop problem-solving skills and to cope with anger and frustration. Thus, the proposed mechanisms of therapeutic change are modifications of the child’s abilities in each of these skill areas (Nock, 2003 ).

Two of the best evaluated treatment models are Problem-Solving Skills Training (PSST) and the Anger Coping Program.

The PSST program was originally drawn up by Alan Kazdin for children aged 5–12 years who were referred for oppositional, aggressive and antisocial behaviors and who were hospitalized in the Child Psychiatric Intensive Care Service facility of the University of Pittsburg (Kazdin, Esveldt-Dawson, French, & Unis, 1987 ). In its most recent version, which was created at the Yale Parenting Center and Child Conduct Clinic, the age of the patients was raised to 14 years, though in exceptional cases older subjects are accepted (Kazdin & Weisz, 2003 ). In reality, the first approach adopted by Kazdin focused on the parents, not on the child. However, as it proved extremely difficult to involve the parents, owing to such obstacles as drug addiction, imprisonment, mental retardation or simple refusal, Kazdin was prompted to work out a program that could be implemented directly with the child.

The core program of Problem-Solving Skills Training consists of 12 weekly sessions of 30–50 min and utilizes cognitive and behavioral methods aimed at teaching the children new problem-solving techniques and improving their social skills. The advocates of this method claim that children suffering from disruptive disorder have cognitive deficits that lead them to interpret their surrounding social setting erroneously, to perceive the behavior of others as hostile and therefore to react aggressively. The program, which can be applied either in the clinic or at home, involves working individually with the child, with the therapist encouraging the child to adopt a progressively more positive approach to interpersonal relationships. This goal is achieved through various strategies, such as role-playing, reinforcement schedules, feedback, etc. The child is then helped to apply problem-solving skills in everyday life, in a variety of situations and contexts.

In the last 30 years, PSST has been implemented on thousands of children and has been amply evaluated (Weisz & Kazdin, 2010 ). The evidence indicates that it reduces the child’s aggressiveness both at home and at school, reduces the number of deviant behaviors and increases pro-social behaviors (Kazdin, Bass, Siegel, & Thomas, 1989 ). Moreover, research has demonstrated that the addition of a real-life practice (Kazdin et al., 1989 ) and/or of a parent training component (Kazdin, Siegel, & Bass, 1992 ) may have a greater impact on outcomes.

The Anger Coping Program is a structured 18-session cognitive-behavioral group intervention that has been refined over a period of 20 years from an earlier 12-session Anger Control Program by Larson and Lochman, ( 2002 ). This program has been used in school settings for children in Grades 4–6 with disruptive behavior disorders. Group sessions typically last 45–60 min and are moderately structured, with specific objectives and exercises for each session. The goals are to help children to cope with anger after provocation or frustration and to learn possible strategies for solving the problem or conflict they are experiencing (Lochman & Lenhart, 1993 ). Outcome research indicates that program participants display less disruptive-aggressive behavior, more time on-task in the classroom, lower levels of parent-rated aggression, higher self-esteem or perceived social competence, and a trend toward a reduction in teacher-rated aggression (Lochman, Curry, Dane, & Ellis, 2001 ).

A further evolution of the Anger Coping Program is the Coping Power Program, in which Lochman and Wells added a parent component designed to be integrated with the child component (Lochman & Wells, 2002 ). This program is intended for boys and girls, approximately 9–11 years of age (4th to 6th grade) who have been screened for disruptive and aggressive behavior and comprises 33 group sessions each lasting 60–90 min, with periodic individual meetings. Sessions include imagined scenarios, therapist modeling, role-play with corrective feedback, and assignments to practice outside sessions. Outcome analyses in randomized controlled intervention studies indicate that the Coping Power Program significantly reduces risks of self-reported delinquency, parent-reported aggression and teacher-reported behavioral problems at 1-year follow-up (Lochman et al., 2009 ).

Parents-focused programs

In the light of the research suggesting that child conduct problems develop as a result of maladaptive parent–child interactions, parenting interventions have been the most thoroughly studied treatment approaches for children who enact disruptive behaviors. The main goals of these interventions are to improve parents’ behavior management skills and the quality of the parent–child relationship. There are two main types of program: behavioral, focused on helping parents learn skills needed to address the causes of problem behaviors, and relationship, aimed at helping parents understand both their own and their child's emotions and behavior and at improving their communication with the child. However, most parenting programs combine elements of both (Gould & Richardson, 2006 ).

A well-known clinical intervention model designed to enhance effective parenting is the Parent Management Training–Oregon model (PMT–O) program. Developed at the end of the 1960s by the Oregon Social Learning Group, it is based on the ‘Living with children’ theory of Patterson and Guillion ( 1968 ). According to the authors (Patterson, Reid, Jones, & Conger, 1975 ), the aggressiveness and behavioral problems of children are inadvertently sustained by inadequate behaviors on the part of parents; by this token, inconsistent discipline, harsh and inappropriate punishments, and oppressive and inefficacious demands end up exacerbating, rather than reducing, the antisocial behavior of children.

The objective of the program, which is carried out in about 20 sessions, is to teach parents to avoid coercive practices and to improve their parenting skills. Thus, parents are taught to adopt more consistent behaviors, to utilize a rational system of rewards and minor punishments, to draw up clear codes of behavior that their children must respect, to devote more attention to their children and to help them to solve the problems of everyday life. The therapist works directly with the parents, generally at home, and only marginally interacts with the child. The parents are prompted to identify and define their child's behavior in a new way, to analyze in detail the problems raised by the child, and to learn how to react constructively so as to reinforce desirable behavior and progressively reduce undesirable behavior, the final goal being to get the child to learn specific educational skills.

PMT has been widely implemented for decades in many parts of the world and is utilized both as a single instrument of intervention and in combination with other components (child, school, etc.) in a multimodal setting. The program has been evaluated in various randomized controlled trials involving children aged 4–12 years and has proved superior to alternative treatments in reducing disruptive behaviors (Forgatch, Patterson, DeGarmo, & Beldavs, 2009 ; Hagen, Ogden, & Bjornebekk, 2011 ; Hautmann et al., 2009 ; Patterson, Chamberlain, & Reid, 1982 ). Several meta-analyses have confirmed this evidence and have demonstrated that this intervention is generally cost-effective (Dretzke et al., 2005 ; McCart, Priester, Davies, & Azen, 2006 ). Moreover, research shows that treatment effects may be generalized across settings, may be maintained for up to 2 years post-treatment, may benefit other children in the same family and also may extend to other deviant behaviors beyond those emphasized in treatment (Kjøbli, Hukkelberg, & Ogden et al., 2013 ).

The Helping the Non-Compliant Child Program (NCCP) and Parent–Child Interaction Therapy (PCIT) are two further examples of well-validated individual parent-training interventions for child conduct problems. The NCCP, developed by Forehand and McMahon (Forehand & McMahon, 1981 ), is a parent-training program for preschool and early school-age children (ages 3–8) with noncompliant behavior, and is aimed at creating a controlled environment in which parents can learn new ‘adaptive’ ways to interact with their children. Parents and children participate in 60–90-min sessions once or twice a week, with an average total of 8–10 sessions; sessions are typically conducted with individual families rather than in groups. Parents are instructed in skills aimed at interrupting the coercive cycle of parent–child interaction and at establishing positive, prosocial interaction patterns. They also learn a planned ignoring procedure for reducing undesirable behaviors on the part of the child (McMahon & Forehand, 2003 ).

The NCCP has been extensively researched and has proved superior to systemic family therapy in reducing child noncompliance in the clinic and at home (Wells & Egan, 1988 ). Moreover, it has shown many positive outcomes in both children and parents, with a maintenance effect ranging from 6 months to more than 14 years after treatment termination (McMahon & Forehand, 2003 ).

PCIT is a dyadic (parent–child) treatment program for children from 2 to 7 years of age with severe behavioral disorders. Originally developed by Sheila Eyberg, it targets change in parent–child interaction patterns through the use of play therapy (Eyberg & Calzada, 1998 ). This program is typically implemented in a community outpatient clinic and uses a two-stage approach aimed at relationship enhancement and child behavior management. Families meet for an average of 12 to 16 weekly 1-hour sessions, during which parents learn to build a supportive parent–child bond through play, to set realistic expectations, to improve consistency and to reduce the reinforcement of negative behavior (Eyberg, Boggs, & Algina, 1995 ).

PCIT has proved superior to waitlist control conditions in reducing disruptive behavior in young children (Nixon, Sweeney, Erickson, & Touyz, 2003 ; Schuhmann, Foote, Eyberg, Boggs, & Algina, 1998 ) and has demonstrated long-term maintenance of treatment gains of up to 6 years post-treatment (Hood & Eyberg, 2003 ). In a recent meta-analysis, the ability of PCIT to produce significant changes in negative child behavior was confirmed (Thomas & Zimmer-Gembeck, 2007 ).

The Triple P Positive Parenting Program is a multilevel parenting program designed to prevent and treat severe behavioral, emotional and developmental problems in children aged 0 to 16 years through enhancing the knowledge, skills and confidence of parents. Triple P incorporates five levels of interventions in a tiered continuum of increasing intensity. The rationale for this stepped-care strategy is that there are different levels of dysfunction and behavioral disturbance in children, and that parents may have different needs and desires regarding the type, intensity and mode of assistance they require (Sanders, Markie-Dadds, & Turner, 1999 ). Level 1 is a media-based information strategy designed to increase community awareness of parenting resources, encourage parents to participate in programs, and communicate solutions to common behavioral and developmental concerns. Level 2 provides specific advice on how to solve common child development issues and minor child behavior problems. It includes parenting ‘tip sheets’ and videotapes demonstrating specific parenting strategies. Level 3 involves active skills training that combines advice with rehearsal and self-evaluation in order to teach parents how to manage these behaviors. Level 4 is designed to teach positive parenting skills and their application to a range of target behaviors, settings and children. Level 4 is delivered in 10 individual or 8 group sessions, totaling about 10 hours. Level 5 is an enhanced behavioral strategy for families in which parenting difficulties are complicated by other sources of family distress. Variations of some Triple P levels are available for parents of young children with developmental disabilities (Stepping Stones Triple P) and for parents who have abused (Pathways Triple P) (Sanders, 2012 ).

Triple P has been used in many diverse cultural contexts, and the multilevel nature of the program enables various combinations of the levels and modalities within levels, tailored on local priorities, staffing and budget constraints. The program has a strong research base, which has revealed the effectiveness of various levels of Triple P for children with conduct problems from infancy to 16 years of age. In particular, a recent comprehensive meta-analysis confirmed the efficacy of Triple-P in improving parenting skills, child problem behavior and parental well-being. Moreover, the fact that Triple P comprises a diverse set of options for families from different social and cultural backgrounds, as well as for varying degrees of problems, seems to be evidence of the program’s ability to impact positively on parent–child interactions (Nowak & Heinrichs, 2008 ).

Family-focused programs

For what concerns intervention on the family, family therapy researchers have conceptualized child conduct problems not as the result of inept parenting practices or cognitive deficits in the child but, rather, as the result of maladaptive interactions and dynamics in the family as a whole (Nock, 2003 ).

Various approaches to family therapy have been developed and, among these, the Functional Family Therapy (FFT) program should be mentioned. Based on a systemic approach, this program was worked out more than 30 years ago by James Alexander and Bruce Parsons (Alexander & Parsons, 1973 ) and is widely used for the treatment of minors aged 11–18 years who display aggressive behavior or have problems of substance abuse. The idea underlying the program is that children's behavior problems are not due to cognitive deficits or to parental incapacity; rather, they are the expression of a malfunction of the whole family system, within which the child’s behavioral disorder exerts a function (e.g. reducing conflict between the parents). Only by improving the structures of communication and interaction among all members of the family, therefore, will it be possible to modify the child’s behavior.

The program generally consists of 8–12 one-hour sessions over a period of about three months. There are different phases to treatment: initially, there is a period of engagement and motivation, during which the therapist applies cognitive techniques in order to replace negative attitudes (lack of motivation, mistrust, etc) with positive ones and tries to gain acceptance, to acquire credibility and to initiate a therapeutic alliance with all of the family members. In the second phase (behavioral change), interactions among the various family members are assessed and oriented towards a better functioning of the family system. The therapist tries to make all members of the family understand what each expects from the others and to clarify the relationships among the various members. Changes in family interactions are induced by facilitating the identification of problems and improving communication (learning to listen, to use direct and clear messages, etc.) and developing the ability to solve problems. In general, the therapist tries to restructure family relationships through various techniques (such as cognitive reframing and skills training, for example) in order to modify behaviors. Subsequently, in the phase of generalization, this modification is reinforced and projected outside the immediate family circle (e.g. in the school or judicial spheres), and the family is prompted to become independent of the therapist (Alexander, Pugh, Parsons, & Sexton, 2000 ).

The effectiveness of functional family therapy has been researched for a long time, and evidence gleaned over follow-up periods of 1, 2, 3, and 5 years seems to support its superiority over control conditions and alternative treatment conditions in dealing with both status offenders and more serious juvenile offenders (Henggeler & Sheidow, 2012 ).

An emerging model for treating children with conduct problems is brief strategic family therapy (BSFT), a short-term family-treatment model developed over nearly 40 years of research at the University of Miami’s Center for Family Studies for children and adolescents aged 6 to 18 years. Briefly, BSFT is based on structural and strategic family theories, and uses family therapy techniques to modify the interactions within the family system that are maintaining the youth’s problem behavior. BSFT is delivered through weekly sessions in a clinic or the family home. Treatment, which typically lasts 4 months and comprises 8–24 sessions according to the family’s needs, focuses on three central constructs (system, structure/patterns of interaction, and strategy) involving three components: joining, diagnosis and restructuring (Szapocznik, Hervis, & Schwartz, 2003 ). The treatment developers have conducted several studies, which have demonstrated significant positive effects of BSFT in reducing anger and bullying behaviors among youths (Coatsworth, Santisteban, McBride, & Szapocznik, 2001 ).

Multimodal and multi-component programs

The combination of various treatment modalities involving different levels of intervention at the same time (individual, family, school, etc) led to the creation of multi-component or multimodal treatment approaches, which some regard as the most efficacious types of intervention (Burke, Loeber, & Birmaher, 2002 ). These approaches, which are more intensive and more complex than those that focus exclusively on the child or on the family, are not always limited to combining two or more types of treatment or to adding a standard component to enhance an existing treatment package; indeed, they often bring together those features of the various programs that are most suited to each individual case, either by addressing multiple risk factors in a comprehensive program or by focusing on the surrounding environment, in order to change the child’s behavior.

Some examples of this kind of intervention are: the Incredible Years (IY) Parents’, Teachers’ and Children’s Training Series program, which was initially developed by Carolyn Webster-Stratton for children 3–8 years of age with early-onset conduct problems (Webster-Stratton, 1992 ); the Montreal Longitudinal Experimental Study (MLES), drawn up by Richard Tremblay and designed to treat aggressive children (McCord, 1992 ); the Multi-systemic Therapy (MST) program, proposed by Henggeler for antisocial preadolescents and adolescents (Henggeler, Rodick, Borduin, Hanson, Watson & Urey, 1986 ), and the multidimensional treatment foster care (MTFC) program, developed by Chamberlain for youths who display chronic disruptive behavior (Chamberlain, 2003 ).

The IY series is broken down into three areas: a child-based program, a parent-based program and a teacher-based program. The general aim of the intervention is to reduce children’s aggressiveness by teaching parents and teachers how best to deal with disruptive behavior and to facilitate pro-social behavior.

Parents’ and children's sessions are held weekly in small groups. Parents watch videotapes that depict models of parents interacting with their children in various situations. They then discuss the contents with two group leaders and try out new techniques of intervention with their children through role play. In the children's group sessions (2 hours per week for about 6 months), the therapist also discusses a few videotapes, with a view to developing better social skills, fostering the ability to control impulses and emotions and improving the children's problem-solving skills. This program works on empathy, anger control, friendly relationships, communication, and relationships with the school and teachers. The teachers’ program consists of a four-day workshop, which focuses on learning the most effective classroom management strategies for coping with disruptive behavior and promoting positive relationships among pupils.

The basic program may be supplemented by further treatment modules, such as the ADVANCE program, which focuses on interpersonal issues such as communication and problem-solving (Webster-Stratton, 1994 ), and the School Readiness Series, which tackles school issues (Webster-Stratton, Reid, & Stoolmiller, 2008 ). Different combinations of the IY components are utilized, depending on the child population targeted (Webster-Stratton, 2008 ). The Incredible Years program, which has been implemented in the United States, Canada, Norway, Denmark, Great Britain and New Zealand, is one of the most widely used and amply tested intervention programs for children with disruptive behaviors (Webster-Stratton, Rinaldi, & Reid, 2010 ).

Three components were also used in the Montreal Longitudinal Experimental Study (Tremblay, Vitaro, Bertrand, et al., 1992 ). The first consisted of social skills training and aimed at promoting changes in behavior towards peers by fostering greater social acceptance of antisocial peers. Training was offered at school in small groups of 4–7 children, with a ratio of three pro-social children from the school to one disruptive child in each group. The second focus was that of training parents in effective child-rearing, based on the Oregon Social Learning Center Model (Patterson et al., 1975 ). The third domain, which served as a complement to parent training, was the provision of information and support for teachers involved with at-risk pupils.

The parent management skills training component was intended to improve parents’ disciplinary practices and to reduce their supervision deficits, whereas the social and social-cognitive skills training component, in which the children interacted with pro-social peers in small groups, was intended to reduce children’s aggressive and hyperactive behaviors by teaching them self-control strategies and alternative behaviors to aggression. The intervention program lasted 2 school years; children were 7 years old when the intervention started and 9 years old when it finished.

The long-term efficacy of the program was assessed when the subjects were 24 years old; it emerged that significantly more individuals in the intervention group had completed high school and graduated, and generally fewer had a criminal record in comparison with those allocated to the control group (Boisjoli, Vitaro, Lacourse, Barker, & Tremblay, 2007 ).

Multi-systemic therapy (MST), which was designed by Henggeler at the end of the 1970s, is one of the most intensive intervention programs and has chiefly been used to treat antisocial adolescents and pre-adolescents, even as an alternative to the traditional judicial pathway (Henggeler, Melton, & Smith, 1992 ). This program was based on the conviction that antisocial behavior is underpinned by multiple risk factors at the individual, family, school and community levels, and that only by acting simultaneously and intensively on all of these factors is it possible to achieve results.

This family-focused and community-based treatment program is implemented by a team of 3–4 therapists, who have a small caseload (5 families for each therapist). Therapists are available 24 hours a day, 7 days a week, and provide a service for 2–15 hours a week; moreover, they receive intensive training and continuous supervision. The program lasts 4–6 months and is carried out at the youths’ homes and in other places frequented by them. The therapists’ aims are to improve the child-rearing capacity of parents and to act on teachers, educators, community leaders and influential persons in general, with a view to transforming the social ecology of the minor in such a way as to create an environment that is more favorable to positive adaptation and less conducive to antisocial behavior.

The intervention targets young people, family relationships, peer relationships, the school and other social systems. According to Henggeler, MST must follow a series of principles: precise identification of the most appropriate treatment process for each specific case; appreciation of the youth’s positive features; creation of a sense of responsibility on the part of family members; a focus on the present, in order to solve current problems rather than dwelling on the past; point-by-point consideration of the appropriateness of the interventions in relation to the youth’s age and developmental stage; timely, continuous effort to bring about change, accompanied by frequent checks and responses; and a constant commitment to evaluating the functioning of the program, including consideration of the effects that will ensue once the intervention has been concluded (Henggeler, Melton, Brondino, Scherer, & Hanley, 1997 ).

More than 450 MST programs are currently utilized in 11 countries; each year, more than 15,000 youths with antisocial behavior are treated (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009 ; Ogden & Halliday-Boykins, 2004 ; Sundell et al., 2008 ). Many published studies have asserted the efficacy of the MST programs in reducing antisocial behavior and the probability of being arrested, even in the long term (Henggeler et al., 1999 ; Timmons-Mitchell, Bender, Kishna, & Mitchell, 2006 ).

Nevertheless, these results have been called into question. Indeed, according to a Cochrane review in 2005 (Littell, Popa, & Forsythe et al., 2006 ), there are no significant differences, in terms of restrictive out-of-home placements and arrests or convictions, between MST and usual services. Pooled results that include studies with data of varying quality tend to favor MST, but these relative effects are not significantly different from zero. The study sample size is small, and effects are not consistent across studies; hence, it is not clear whether MST has clinically significant advantages over other services.

Finally, we should mention a type of program that is applied in particular circumstances, when parents categorically refuse any involvement or indulge in abusive behaviors. In these situations, the child may be removed from the home environment, temporarily if possible. At one time, antisocial youths with parents of this kind (and also from other types of problem families) were placed in institutions or reformatories. Several studies have shown, however, that putting problem youths together, even in therapeutic or educational facilities, actually worsens the situation, in that the influence of deviant peers outweighs that of educators and therapists (Dishion, McCord, & Poulin, 1999 ).

For youths with conduct disorders who cannot be treated in their own family setting, programs that make use of foster families have therefore been designed. An example of these is Multidimensional Treatment Foster Care (MTFC). Developed at the beginning of the 1980s by Patricia Chamberlain and coll. at the Oregon Social Learning Center, this program targeted violent delinquent youths who needed treatment outside their family environment (Chamberlain, 1994 ). Thereafter, a program was drawn up for aggressive children of preschool age (3–6 years) as an alternative to residential therapy (Chamberlain & Reid, 1998 ). The cases dealt with are often the result of referral by child welfare services or the juvenile justice system.

As with MST and FFT, many of the techniques used in MTFC are derived from behavioral and cognitive-behavioral approaches, implemented within a framework that highlights the critical role of foster parent supervision. In particular, therapists provide intensive support for the individual, the biological family (to which the minor will return if possible) and the foster family through daily contact, in order to monitor the evolution of the situation and to solve any problems that arise; they also act in the school and community settings. Founded on Social Learning Theory, the MTFC program helps parents, teachers and educators to acquire the skills needed in order to cope with the youth’s problems and behaviors by teaching them to set clear limits and rules and to support and encourage the youth’s progress by establishing close supervision. Therapists also strive to promote contact with pro-social peers and to discourage relationships with deviant youths.

The program is preceded by careful selection and training of the foster parents, who are the most important component of the therapeutic plan. Only one child or youth is placed with a foster family at a time. Throughout the program, the foster parents maintain a close relationship with the therapists through daily telephone calls, home visits and weekly meetings. During the daily telephone calls, the foster parents provide information on about 40 behaviors through the Parent Daily Report; this enables the supervisor to evaluate the progress of the treatment and to make any necessary adjustments.

The staff members who run the program have specific roles: the Program Supervisor, who is responsible for organizing all aspects of the treatment; the Foster Parents; the Consultant/Recruiter/Trainer, who constitutes the most direct means of support for foster parents; Skills Trainers/Playgroup Staff Members, who teach pro-social behavior and problem-solving skills to the child through intensive one-on-one interaction and skill practice in the community; the Family Therapist, who teaches the birth parents and foster parents how to effectively supervise, discipline and encourage the child; the PDR Caller, who contacts foster families each day by telephone for the Parent Daily Report (PDR); and the Consulting Psychiatrist, if psychiatric consultation is required.

From all of the above, it is clear that MTFC is a highly intensive program that requires very complex organization and a multiplicity of therapeutic and organizational skills. The final objective is to modify the behavior of these children or adolescents and to facilitate their return to the family of origin or, in the exceptional cases in which this is not possible, their placement with adoptive families.

Some studies seem to have demonstrated the efficacy of these programs in improving the behavior of the subjects treated and in reducing their aggressiveness (Chamberlain, Leve, & DeGarmo, 2007 ; Eddy, Whaley, & Chamberlain, 2004 ; Westermark, Hansson, & Olsson, 2011 ). This seems to be mainly due to an improvement in the family’s ability to manage the behavior of these subjects and to the fact that they are kept away from deviant peers (Eddy & Chamberlain, 2000 ).

Critical considerations and best-practice recommendations

This analysis reveals that the diagnostic category ‘conduct disorder’ is almost never used specifically by the operators who have designed and implemented psychosocial interventions aimed at treating children and adolescents who display antisocial, defiant or aggressive behaviors. Indeed, while conduct disorders are cited in almost all of the programs examined, in reality the inclusion criteria cover a range of behavioral problems that do not fully match the diagnostic categories used in medical nosography. Moreover, evaluation of the effects of such interventions considers different types of result, such as increased prosocial behavior and reduced antisocial behavior on the part of the minor, without specifically taking into account the diagnosis of conduct disorder.

In addition, it should be pointed out that the conceptual category ‘conduct disorder’ includes symptoms of behaviors that differ markedly from one another and that may require specific interventions. In this regard, it should be borne in mind, for example, that aggressive behaviors and theft constitute very different problems, which evolve differently over time and are underpinned by different risk factors. Specifically, the developmental trajectories of physical violence and theft during adolescence and early adulthood are different and differently related to neurocognitive functioning. Indeed, an important longitudinal study has demonstrated that the majority of subjects show an increased frequency of theft from adolescence to adulthood, whereas only a minority evince an increasing frequency of physical violence. In addition, the neurocognitive mechanisms seem to be different, in that executive function and verbal IQ performance have been negatively related to a high frequency of physical violence but positively related to a high frequency of theft (Barker et al., 2007 ).

Despite these conceptual limits, our literature analysis indicates that psychosocial interventions for minors with conduct problems are widely studied and can be considered a useful part of treatment planning for youths who display problems of adaptation.

By contrast, not least in the light of the difficulties of defining conduct disorders conceptually, the role of medical treatments is debated. Although the literature supporting the psychopharmacological management of aggressive and disruptive behavior in youth is growing, it still seems to be insufficient to determine the comparative risks and benefits of using drugs in pediatric populations, especially in the long term. A specific in-depth analysis of this treatment modality has been provided by the American Academy of Child and Adolescent Psychiatry and other groups, which have published practice parameters on the medical treatment of conduct disorders in youth (Gleason et al., 2007 ). However, the imbalance between the relatively strong evidence for psychotherapeutic interventions and the weak evidence for medication use justifies the view that psychotherapy is the first-line treatment for maladaptive aggression and conduct problems (Scotto Rosato et al., 2012 ).

A further cornerstone in the treatment of youths with conduct problems is the concept that it is important to intervene early in the developmental trajectory in order to prevent subsequent serious antisocial behaviors and other mental health problems in adulthood (McNeil, Capage, Bahl, & Blanc, 1999 ).

Despite extensive research into treatment, no single program has yet emerged as the best. However, on the basis of the bulk of evidence available, it emerges that the choice of intervention should be age-specific and should take into account developmental differences in cognitive, behavioral, affective and communicative abilities.

On the whole, according to the studies considered, clinical evidence suggests that, in dealing with younger children (<11 years old) with conduct problems (or with symptoms suggestive of high risk), parent-focused interventions seem to be more effective. By contrast, for older children (>11 years old), child-focused interventions appear to be more effective. For children in foster care, there is some evidence that foster carer-focused interventions are also effective. Interventions conducted separately on both the parents and the child are not clearly more effective than parent-focused interventions alone. Moreover, interventions delivered in school settings seems to be more effective than those delivered in the clinical setting.

According to the literature reviewed, parent training should be considered the first-line approach to dealing with young children, whereas cognitive-behavioral approaches have a greater effect on older youths, who probably have a greater capacity to benefit from this kind of treatment. In addition, family interventions addressing parent–child relationships and communication have shown greater efficacy in older youths, whereas multi-component and multimodal treatment approaches have shown moderate effects in both childhood and adolescence. For children with CU traits, treatments that intervene early in the parent–child relationship to teach parents ways of fostering empathic concern in their young child, or those that help the child develop cognitive perspective-taking skills, have shown evidence of effectiveness (Hawes & Dadds, 2005 ; Kolko & Pardini, 2010 ).

Finally, family engagement in treatment significantly influences outcomes. More positive child–therapist and parent–therapist alliances also predict greater improvement, fewer perceived barriers to participation in treatment and greater treatment acceptability (Scotto Rosato et al., 2012 ).

One limitation that emerges from the scientific literature is the lack of long-term assessments. Consequently, we do not know whether the positive effects recorded at the end of the treatment, or after a relatively short period, last throughout adolescence and into adulthood, nor whether any undesired effects arise. In this regard, we should remember the results obtained from one of the most interesting and prolonged studies carried out in criminology. This study analyzed the long-term efficacy of a delinquency-prevention psychosocial program carried out in Cambridge-Somerville. As reported by McCord ( 1978 ), some decades after intervention, the results were surprisingly negative; in spite of all the efforts made, all the support for the children and their families, and the intervention of counselors, the subjects treated suffered a higher percentage of mental illness, early death (before the age of 35 years), alcoholism, recidivism, failure at work, etc., during the course of their lives than did control subjects. While it would be fairly easy to explain the lack of success of preventive intervention if the results showed no difference between the treatment group and the control group, it is much more difficult to explain the worse outcome of the treated subjects. The lack of success might easily be attributed to the inefficacy of the program, insufficient support for minors and their families, or too little contact between operators and subjects. Such explanations, however, cannot justify the worse results obtained by treated subjects; moreover, they are at variance with McCord’s ( 1992 ) finding that the worst results were seen in those very cases in which the relationships between counselors and minors were most intense and long-standing.

An interpretation of these negative results was proposed by Dishion et al. ( 1999 ). Within the framework of the Cambridge–Somerville program, 125 youths were sent to summer camps once or more often. Examination of the long-term results revealed that those who had attended summer camps more than once were ten times more likely to have had a negative outcome (early death, mental illness or involvement in crime) than did control subjects. The authors ascertained that there was no significant initial difference between those who attended the camps and those who did not; they concluded therefore that failure could not have been due to a selection bias. In the light of these data, Dishion et al. ( 1999 ) reached the conclusion that placing at-risk minors in a group of deviant peers can produce highly negative effects on youths with behavior problems, and that this was why summer camp attendance had a deleterious effect. The Cambridge–Somerville findings were in agreement with other results, which demonstrated that placing problem youths in a group treatment program had produced long-term negative effects. Indeed, in terms of delinquency, these youths had a worse outcome than did control subjects who had not undergone any treatment. This was attributed to the fact that the negative influence of deviant peers outweighed the positive influence of the therapists. These results highlight the need to carry out long-term assessments in order to ascertain whether the results of intervention are stable and whether any side-effects emerge over the years.

A second problem is that, despite the rapid growth of empirically supported psychosocial interventions for children and adolescents, the variables that predict, influence or account for good or poor responses to treatments of conduct problems are still poorly understood. Much more research is needed in order to understand the circumstances under which treatments work and the ways in which treatments produce outcomes. Moreover, further efforts aimed at studying treatment replications in new populations or by community-based providers are needed.

Finally, an observation regarding the conceptual context in which the most common psychosocial programs set the behavioral problems of children and adolescents. Through the concept of conduct disorders, a process is often unleashed whereby problems that have a major environmental component become ‘medicalized’. Consequently, in many cases treatment focuses mainly on the child or, at best, on the family and school context, without specifically taking into account the social environment as a whole. This approach not only produces intervention that has a scant or temporary effect; it also limits social policy to acting on the effects of problem situations, rather than trying to eliminate their causes. In conclusion, further studies are necessary to evaluate in depth the effectiveness of psychosocial treatments for juvenile conduct problems.

Ethical standards

Declaration of conflicts of interest.

Gabriele Rocca has declared no conflicts of interest.

Ignazio Grattagliano has declared no conflicts of interest.

Uberto Gatti has declared no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Part of this article is published in a chapter of a French book “Psychiatrie de l’enfant et de l’adolescent Une approche basée sur les preuves” (by Holzer, L.; De Boeck-Solal: 2014).”

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Behavior Management in Young Children Exposed to Trauma: A Case Study of Three Evidence-Based Treatments

• Published: 21 September 2023
• Volume 16 , pages 839–852, ( 2023 )

Cite this article

• Allison B. Smith   ORCID: orcid.org/0000-0003-4335-6237 1 ,
• Daryl T. Cooley   ORCID: orcid.org/0000-0002-8689-4759 1 ,
• Glenn R. Mesman   ORCID: orcid.org/0000-0002-0120-2486 1 ,
• Sufna G. John   ORCID: orcid.org/0000-0002-7555-6340 1 ,
• Elissa H. Wilburn   ORCID: orcid.org/0000-0002-8087-6410 1 ,
• Karin L. Vanderzee   ORCID: orcid.org/0000-0001-9664-5652 1 &
• Joy R. Pemberton   ORCID: orcid.org/0000-0002-4424-7326 1  

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Young children are particularly vulnerable to traumatic events and the development of posttraumatic stress symptoms, including comorbid disruptive behaviors. Fortunately, several evidence-based interventions have been shown to be effective at decreasing both posttraumatic stress symptoms and disruptive behaviors in young children. This paper provides an overview of three such interventions—Child-Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). An illustrative case study is used to compare how each intervention addresses disruptive behaviors, with a focus on theoretical underpinnings, model similarities, and model differences. The models each have empirical evidence for the treatment of disruptive behavior in young children, and therefore, may be appropriate for treating children with a history of trauma exposure and comorbid disruptive behaviors. Child, caregiver, and environmental factors are essential to consider when identifying an evidence-based intervention for this population.

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Smith, A.B., Cooley, D.T., Mesman, G.R. et al. Behavior Management in Young Children Exposed to Trauma: A Case Study of Three Evidence-Based Treatments. Journ Child Adol Trauma 16 , 839–852 (2023). https://doi.org/10.1007/s40653-023-00573-7

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Trauma-informed practices in schools, teacher well-being, cultivating diversity, equity, & inclusion, integrating technology in the classroom, social-emotional development, covid-19 resources, invest in resilience: summer toolkit, civics & resilience, all toolkits, degree programs, trauma-informed professional development, teacher licensure & certification, how to become - career information, classroom management, instructional design, lifestyle & self-care, online higher ed teaching, current events, how to write a case study: the basics.

The purpose of a case study is to walk the reader through a situation where a problem is presented, background information provided and a description of the solution given, along with how it was derived. A case study can be written to encourage the reader to come up with his or her own solution or to review the solution that was already implemented. The goal of the writer is to give the reader experiences similar to those the writer had as he or she researched the situation presented.

Several steps must be taken before actually writing anything:

• Choose the situation on which to write
• Gather as much information as possible about the situation
• Analyze all of the elements surrounding the situation
• Determine the final solution implemented
• Gather information about why the solution worked or did not work

From these steps you will create the content of your case study.

Describe the situation/problem

The reader needs to have a clear understanding of the situation for which a solution is sought. You can explicitly state the problem posed in the study. You can begin by sharing quotes from someone intimate with the situation. Or you can present a question:

• ABC Hospital has a higher post-surgical infection rate than other health care facilities in the area.
• The Director of Nursing at ABC Hospital stated that “In spite of following rigid standards, we continue to experience high post-surgical infection rates”
• Why is it that the post-surgical infection rate at ABC Hospital  higher than any other health center in the area?

This sets the tone for the reader to think of the problem while he or she read the rest of the case study. This also sets the expectation that you will be presenting information the reader can use to further understand the situation.

Give background

Background is the information you discovered that describes why there is a problem. This will consist of facts and figures from authoritative sources. Graphs, charts, tables, photos, videos, audio files, and anything that points to the problem is useful here. Quotes from interviews are also good. You might include anecdotal information as well:

“According to previous employees of this facility, this has been a problem for several years”

What is not included in this section is the author’s opinion:

“I don’t think the infection review procedures are followed very closely”

In this section you give the reader information that they can use to come to their own conclusion. Like writing a mystery, you are giving clues from which the reader can decide how to solve the puzzle. From all of this evidence, how did the problem become a problem? How can the trend be reversed so the problem goes away?

A good case study doesn’t tell the readers what to think. It guides the reader through the thought process used to create the final conclusion. The readers may come to their own conclusion or find fault in the logic being presented. That’s okay because there may be more than one solution to the problem. The readers will have their own perspective and background as they read the case study.

Describe the solution

This section discusses the solution and the thought processes that lead up to it. It guides the reader through the information to the solution that was implemented. This section may contain the author’s opinions and speculations.

Facts will be involved in the decision, but there can be subjective thinking as well:

“Taking into account A, B and C, the committee suggested solution X. In lieu of the current budget situation, the committee felt this was the most prudent approach”

Briefly present the key elements used to derive the solution. Be clear about the goal of the solution. Was it to slow down, reduce or eliminate the problem?

Evaluate the response to the solution

If the case study is for a recent situation, there may not have been enough time to determine the overall effect of the solution:

“New infection standards were adopted in the first quarter and the center hopes to have enough information by the year’s end to judge their effectiveness”

If the solution has been in place for some time, then an opportunity to gather and review facts and impressions exists. A summary of how well the solution is working would be included here.

Tell the whole story

Case study-writing is about telling the story of a problem that has been fixed. The focus is on the evidence for the problem and the approach used to create a solution. The writing style guides the readers through the problem analysis as if they were part of the project. The result is a case study that can be both entertaining and educational.

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What Is a Case Study?

Weighing the pros and cons of this method of research

Verywell / Colleen Tighe

• Pros and Cons

What Types of Case Studies Are Out There?

Where do you find data for a case study, how do i write a psychology case study.

A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in many different fields, including psychology, medicine, education, anthropology, political science, and social work.

The point of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, we got you—here are some rules of APA format to reference.  

At a Glance

A case study, or an in-depth study of a person, group, or event, can be a useful research tool when used wisely. In many cases, case studies are best used in situations where it would be difficult or impossible for you to conduct an experiment. They are helpful for looking at unique situations and allow researchers to gather a lot of˜ information about a specific individual or group of people. However, it's important to be cautious of any bias we draw from them as they are highly subjective.

What Are the Benefits and Limitations of Case Studies?

A case study can have its strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult or impossible to replicate in a lab. Some other benefits of a case study:

• Allows researchers to capture information on the 'how,' 'what,' and 'why,' of something that's implemented
• Gives researchers the chance to collect information on why one strategy might be chosen over another
• Permits researchers to develop hypotheses that can be explored in experimental research

On the other hand, a case study can have some drawbacks:

• It cannot necessarily be generalized to the larger population
• Cannot demonstrate cause and effect
• It may not be scientifically rigorous
• It can lead to bias

Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.

It's important to remember that the insights from case studies cannot be used to determine cause-and-effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.

Case Study Examples

There have been a number of notable case studies in the history of psychology. Much of  Freud's work and theories were developed through individual case studies. Some great examples of case studies in psychology include:

• Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
• Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
• Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language learning was possible, even after missing critical periods for language development. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse denied her the opportunity to learn a language at critical points in her development.

This is clearly not something researchers could ethically replicate, but conducting a case study on Genie allowed researchers to study phenomena that are otherwise impossible to reproduce.

There are a few different types of case studies that psychologists and other researchers might use:

• Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those who live there.
• Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
• Explanatory case studies : These   are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
• Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
• Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
• Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic case study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.

The type of case study that psychology researchers use depends on the unique characteristics of the situation and the case itself.

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

• Archival records : Census records, survey records, and name lists are examples of archival records.
• Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
• Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
• Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
• Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
• Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.

Here is a general outline of what should be included in a case study.

Section 1: A Case History

This section will have the following structure and content:

Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

• Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
• Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
• Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
• Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research. 

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Need More Tips?

Here are a few additional pointers to keep in mind when formatting your case study:

• Never refer to the subject of your case study as "the client." Instead, use their name or a pseudonym.
• Read examples of case studies to gain an idea about the style and format.
• Remember to use APA format when citing references .

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach .  BMC Med Res Methodol . 2011;11:100.

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100

Gagnon, Yves-Chantal.  The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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Definition and Introduction

Case analysis is a problem-based teaching and learning method that involves critically analyzing complex scenarios within an organizational setting for the purpose of placing the student in a “real world” situation and applying reflection and critical thinking skills to contemplate appropriate solutions, decisions, or recommended courses of action. It is considered a more effective teaching technique than in-class role playing or simulation activities. The analytical process is often guided by questions provided by the instructor that ask students to contemplate relationships between the facts and critical incidents described in the case.

Cases generally include both descriptive and statistical elements and rely on students applying abductive reasoning to develop and argue for preferred or best outcomes [i.e., case scenarios rarely have a single correct or perfect answer based on the evidence provided]. Rather than emphasizing theories or concepts, case analysis assignments emphasize building a bridge of relevancy between abstract thinking and practical application and, by so doing, teaches the value of both within a specific area of professional practice.

Given this, the purpose of a case analysis paper is to present a structured and logically organized format for analyzing the case situation. It can be assigned to students individually or as a small group assignment and it may include an in-class presentation component. Case analysis is predominately taught in economics and business-related courses, but it is also a method of teaching and learning found in other applied social sciences disciplines, such as, social work, public relations, education, journalism, and public administration.

Ellet, William. The Case Study Handbook: A Student's Guide . Revised Edition. Boston, MA: Harvard Business School Publishing, 2018; Christoph Rasche and Achim Seisreiner. Guidelines for Business Case Analysis . University of Potsdam; Writing a Case Analysis . Writing Center, Baruch College; Volpe, Guglielmo. "Case Teaching in Economics: History, Practice and Evidence." Cogent Economics and Finance 3 (December 2015). doi:https://doi.org/10.1080/23322039.2015.1120977.

How to Approach Writing a Case Analysis Paper

The organization and structure of a case analysis paper can vary depending on the organizational setting, the situation, and how your professor wants you to approach the assignment. Nevertheless, preparing to write a case analysis paper involves several important steps. As Hawes notes, a case analysis assignment “...is useful in developing the ability to get to the heart of a problem, analyze it thoroughly, and to indicate the appropriate solution as well as how it should be implemented” [p.48]. This statement encapsulates how you should approach preparing to write a case analysis paper.

Before you begin to write your paper, consider the following analytical procedures:

• Review the case to get an overview of the situation . A case can be only a few pages in length, however, it is most often very lengthy and contains a significant amount of detailed background information and statistics, with multilayered descriptions of the scenario, the roles and behaviors of various stakeholder groups, and situational events. Therefore, a quick reading of the case will help you gain an overall sense of the situation and illuminate the types of issues and problems that you will need to address in your paper. If your professor has provided questions intended to help frame your analysis, use them to guide your initial reading of the case.
• Read the case thoroughly . After gaining a general overview of the case, carefully read the content again with the purpose of understanding key circumstances, events, and behaviors among stakeholder groups. Look for information or data that appears contradictory, extraneous, or misleading. At this point, you should be taking notes as you read because this will help you develop a general outline of your paper. The aim is to obtain a complete understanding of the situation so that you can begin contemplating tentative answers to any questions your professor has provided or, if they have not provided, developing answers to your own questions about the case scenario and its connection to the course readings,lectures, and class discussions.
• Determine key stakeholder groups, issues, and events and the relationships they all have to each other . As you analyze the content, pay particular attention to identifying individuals, groups, or organizations described in the case and identify evidence of any problems or issues of concern that impact the situation in a negative way. Other things to look for include identifying any assumptions being made by or about each stakeholder, potential biased explanations or actions, explicit demands or ultimatums , and the underlying concerns that motivate these behaviors among stakeholders. The goal at this stage is to develop a comprehensive understanding of the situational and behavioral dynamics of the case and the explicit and implicit consequences of each of these actions.
• Identify the core problems . The next step in most case analysis assignments is to discern what the core [i.e., most damaging, detrimental, injurious] problems are within the organizational setting and to determine their implications. The purpose at this stage of preparing to write your analysis paper is to distinguish between the symptoms of core problems and the core problems themselves and to decide which of these must be addressed immediately and which problems do not appear critical but may escalate over time. Identify evidence from the case to support your decisions by determining what information or data is essential to addressing the core problems and what information is not relevant or is misleading.
• Explore alternative solutions . As noted, case analysis scenarios rarely have only one correct answer. Therefore, it is important to keep in mind that the process of analyzing the case and diagnosing core problems, while based on evidence, is a subjective process open to various avenues of interpretation. This means that you must consider alternative solutions or courses of action by critically examining strengths and weaknesses, risk factors, and the differences between short and long-term solutions. For each possible solution or course of action, consider the consequences they may have related to their implementation and how these recommendations might lead to new problems. Also, consider thinking about your recommended solutions or courses of action in relation to issues of fairness, equity, and inclusion.
• Decide on a final set of recommendations . The last stage in preparing to write a case analysis paper is to assert an opinion or viewpoint about the recommendations needed to help resolve the core problems as you see them and to make a persuasive argument for supporting this point of view. Prepare a clear rationale for your recommendations based on examining each element of your analysis. Anticipate possible obstacles that could derail their implementation. Consider any counter-arguments that could be made concerning the validity of your recommended actions. Finally, describe a set of criteria and measurable indicators that could be applied to evaluating the effectiveness of your implementation plan.

Use these steps as the framework for writing your paper. Remember that the more detailed you are in taking notes as you critically examine each element of the case, the more information you will have to draw from when you begin to write. This will save you time.

NOTE : If the process of preparing to write a case analysis paper is assigned as a student group project, consider having each member of the group analyze a specific element of the case, including drafting answers to the corresponding questions used by your professor to frame the analysis. This will help make the analytical process more efficient and ensure that the distribution of work is equitable. This can also facilitate who is responsible for drafting each part of the final case analysis paper and, if applicable, the in-class presentation.

Framework for Case Analysis . College of Management. University of Massachusetts; Hawes, Jon M. "Teaching is Not Telling: The Case Method as a Form of Interactive Learning." Journal for Advancement of Marketing Education 5 (Winter 2004): 47-54; Rasche, Christoph and Achim Seisreiner. Guidelines for Business Case Analysis . University of Potsdam; Writing a Case Study Analysis . University of Arizona Global Campus Writing Center; Van Ness, Raymond K. A Guide to Case Analysis . School of Business. State University of New York, Albany; Writing a Case Analysis . Business School, University of New South Wales.

Structure and Writing Style

A case analysis paper should be detailed, concise, persuasive, clearly written, and professional in tone and in the use of language . As with other forms of college-level academic writing, declarative statements that convey information, provide a fact, or offer an explanation or any recommended courses of action should be based on evidence. If allowed by your professor, any external sources used to support your analysis, such as course readings, should be properly cited under a list of references. The organization and structure of case analysis papers can vary depending on your professor’s preferred format, but its structure generally follows the steps used for analyzing the case.

Introduction

The introduction should provide a succinct but thorough descriptive overview of the main facts, issues, and core problems of the case . The introduction should also include a brief summary of the most relevant details about the situation and organizational setting. This includes defining the theoretical framework or conceptual model on which any questions were used to frame your analysis.

Following the rules of most college-level research papers, the introduction should then inform the reader how the paper will be organized. This includes describing the major sections of the paper and the order in which they will be presented. Unless you are told to do so by your professor, you do not need to preview your final recommendations in the introduction. U nlike most college-level research papers , the introduction does not include a statement about the significance of your findings because a case analysis assignment does not involve contributing new knowledge about a research problem.

Background Analysis

Background analysis can vary depending on any guiding questions provided by your professor and the underlying concept or theory that the case is based upon. In general, however, this section of your paper should focus on:

• Providing an overarching analysis of problems identified from the case scenario, including identifying events that stakeholders find challenging or troublesome,
• Identifying assumptions made by each stakeholder and any apparent biases they may exhibit,
• Describing any demands or claims made by or forced upon key stakeholders, and
• Highlighting any issues of concern or complaints expressed by stakeholders in response to those demands or claims.

These aspects of the case are often in the form of behavioral responses expressed by individuals or groups within the organizational setting. However, note that problems in a case situation can also be reflected in data [or the lack thereof] and in the decision-making, operational, cultural, or institutional structure of the organization. Additionally, demands or claims can be either internal and external to the organization [e.g., a case analysis involving a president considering arms sales to Saudi Arabia could include managing internal demands from White House advisors as well as demands from members of Congress].

Throughout this section, present all relevant evidence from the case that supports your analysis. Do not simply claim there is a problem, an assumption, a demand, or a concern; tell the reader what part of the case informed how you identified these background elements.

Identification of Problems

In most case analysis assignments, there are problems, and then there are problems . Each problem can reflect a multitude of underlying symptoms that are detrimental to the interests of the organization. The purpose of identifying problems is to teach students how to differentiate between problems that vary in severity, impact, and relative importance. Given this, problems can be described in three general forms: those that must be addressed immediately, those that should be addressed but the impact is not severe, and those that do not require immediate attention and can be set aside for the time being.

All of the problems you identify from the case should be identified in this section of your paper, with a description based on evidence explaining the problem variances. If the assignment asks you to conduct research to further support your assessment of the problems, include this in your explanation. Remember to cite those sources in a list of references. Use specific evidence from the case and apply appropriate concepts, theories, and models discussed in class or in relevant course readings to highlight and explain the key problems [or problem] that you believe must be solved immediately and describe the underlying symptoms and why they are so critical.

Alternative Solutions

This section is where you provide specific, realistic, and evidence-based solutions to the problems you have identified and make recommendations about how to alleviate the underlying symptomatic conditions impacting the organizational setting. For each solution, you must explain why it was chosen and provide clear evidence to support your reasoning. This can include, for example, course readings and class discussions as well as research resources, such as, books, journal articles, research reports, or government documents. In some cases, your professor may encourage you to include personal, anecdotal experiences as evidence to support why you chose a particular solution or set of solutions. Using anecdotal evidence helps promote reflective thinking about the process of determining what qualifies as a core problem and relevant solution .

Throughout this part of the paper, keep in mind the entire array of problems that must be addressed and describe in detail the solutions that might be implemented to resolve these problems.

Recommended Courses of Action

In some case analysis assignments, your professor may ask you to combine the alternative solutions section with your recommended courses of action. However, it is important to know the difference between the two. A solution refers to the answer to a problem. A course of action refers to a procedure or deliberate sequence of activities adopted to proactively confront a situation, often in the context of accomplishing a goal. In this context, proposed courses of action are based on your analysis of alternative solutions. Your description and justification for pursuing each course of action should represent the overall plan for implementing your recommendations.

For each course of action, you need to explain the rationale for your recommendation in a way that confronts challenges, explains risks, and anticipates any counter-arguments from stakeholders. Do this by considering the strengths and weaknesses of each course of action framed in relation to how the action is expected to resolve the core problems presented, the possible ways the action may affect remaining problems, and how the recommended action will be perceived by each stakeholder.

In addition, you should describe the criteria needed to measure how well the implementation of these actions is working and explain which individuals or groups are responsible for ensuring your recommendations are successful. In addition, always consider the law of unintended consequences. Outline difficulties that may arise in implementing each course of action and describe how implementing the proposed courses of action [either individually or collectively] may lead to new problems [both large and small].

Throughout this section, you must consider the costs and benefits of recommending your courses of action in relation to uncertainties or missing information and the negative consequences of success.

The conclusion should be brief and introspective. Unlike a research paper, the conclusion in a case analysis paper does not include a summary of key findings and their significance, a statement about how the study contributed to existing knowledge, or indicate opportunities for future research.

Begin by synthesizing the core problems presented in the case and the relevance of your recommended solutions. This can include an explanation of what you have learned about the case in the context of your answers to the questions provided by your professor. The conclusion is also where you link what you learned from analyzing the case with the course readings or class discussions. This can further demonstrate your understanding of the relationships between the practical case situation and the theoretical and abstract content of assigned readings and other course content.

Problems to Avoid

The literature on case analysis assignments often includes examples of difficulties students have with applying methods of critical analysis and effectively reporting the results of their assessment of the situation. A common reason cited by scholars is that the application of this type of teaching and learning method is limited to applied fields of social and behavioral sciences and, as a result, writing a case analysis paper can be unfamiliar to most students entering college.

After you have drafted your paper, proofread the narrative flow and revise any of these common errors:

• Unnecessary detail in the background section . The background section should highlight the essential elements of the case based on your analysis. Focus on summarizing the facts and highlighting the key factors that become relevant in the other sections of the paper by eliminating any unnecessary information.
• Analysis relies too much on opinion . Your analysis is interpretive, but the narrative must be connected clearly to evidence from the case and any models and theories discussed in class or in course readings. Any positions or arguments you make should be supported by evidence.
• Analysis does not focus on the most important elements of the case . Your paper should provide a thorough overview of the case. However, the analysis should focus on providing evidence about what you identify are the key events, stakeholders, issues, and problems. Emphasize what you identify as the most critical aspects of the case to be developed throughout your analysis. Be thorough but succinct.
• Writing is too descriptive . A paper with too much descriptive information detracts from your analysis of the complexities of the case situation. Questions about what happened, where, when, and by whom should only be included as essential information leading to your examination of questions related to why, how, and for what purpose.
• Inadequate definition of a core problem and associated symptoms . A common error found in case analysis papers is recommending a solution or course of action without adequately defining or demonstrating that you understand the problem. Make sure you have clearly described the problem and its impact and scope within the organizational setting. Ensure that you have adequately described the root causes w hen describing the symptoms of the problem.
• Recommendations lack specificity . Identify any use of vague statements and indeterminate terminology, such as, “A particular experience” or “a large increase to the budget.” These statements cannot be measured and, as a result, there is no way to evaluate their successful implementation. Provide specific data and use direct language in describing recommended actions.
• Unrealistic, exaggerated, or unattainable recommendations . Review your recommendations to ensure that they are based on the situational facts of the case. Your recommended solutions and courses of action must be based on realistic assumptions and fit within the constraints of the situation. Also note that the case scenario has already happened, therefore, any speculation or arguments about what could have occurred if the circumstances were different should be revised or eliminated.

Bee, Lian Song et al. "Business Students' Perspectives on Case Method Coaching for Problem-Based Learning: Impacts on Student Engagement and Learning Performance in Higher Education." Education & Training 64 (2022): 416-432; The Case Analysis . Fred Meijer Center for Writing and Michigan Authors. Grand Valley State University; Georgallis, Panikos and Kayleigh Bruijn. "Sustainability Teaching using Case-Based Debates." Journal of International Education in Business 15 (2022): 147-163; Hawes, Jon M. "Teaching is Not Telling: The Case Method as a Form of Interactive Learning." Journal for Advancement of Marketing Education 5 (Winter 2004): 47-54; Georgallis, Panikos, and Kayleigh Bruijn. "Sustainability Teaching Using Case-based Debates." Journal of International Education in Business 15 (2022): 147-163; .Dean,  Kathy Lund and Charles J. Fornaciari. "How to Create and Use Experiential Case-Based Exercises in a Management Classroom." Journal of Management Education 26 (October 2002): 586-603; Klebba, Joanne M. and Janet G. Hamilton. "Structured Case Analysis: Developing Critical Thinking Skills in a Marketing Case Course." Journal of Marketing Education 29 (August 2007): 132-137, 139; Klein, Norman. "The Case Discussion Method Revisited: Some Questions about Student Skills." Exchange: The Organizational Behavior Teaching Journal 6 (November 1981): 30-32; Mukherjee, Arup. "Effective Use of In-Class Mini Case Analysis for Discovery Learning in an Undergraduate MIS Course." The Journal of Computer Information Systems 40 (Spring 2000): 15-23; Pessoa, Silviaet al. "Scaffolding the Case Analysis in an Organizational Behavior Course: Making Analytical Language Explicit." Journal of Management Education 46 (2022): 226-251: Ramsey, V. J. and L. D. Dodge. "Case Analysis: A Structured Approach." Exchange: The Organizational Behavior Teaching Journal 6 (November 1981): 27-29; Schweitzer, Karen. "How to Write and Format a Business Case Study." ThoughtCo. https://www.thoughtco.com/how-to-write-and-format-a-business-case-study-466324 (accessed December 5, 2022); Reddy, C. D. "Teaching Research Methodology: Everything's a Case." Electronic Journal of Business Research Methods 18 (December 2020): 178-188; Volpe, Guglielmo. "Case Teaching in Economics: History, Practice and Evidence." Cogent Economics and Finance 3 (December 2015). doi:https://doi.org/10.1080/23322039.2015.1120977.

Writing Tip

Ca se Study and Case Analysis Are Not the Same!

Confusion often exists between what it means to write a paper that uses a case study research design and writing a paper that analyzes a case; they are two different types of approaches to learning in the social and behavioral sciences. Professors as well as educational researchers contribute to this confusion because they often use the term "case study" when describing the subject of analysis for a case analysis paper. But you are not studying a case for the purpose of generating a comprehensive, multi-faceted understanding of a research problem. R ather, you are critically analyzing a specific scenario to argue logically for recommended solutions and courses of action that lead to optimal outcomes applicable to professional practice.

To avoid any confusion, here are twelve characteristics that delineate the differences between writing a paper using the case study research method and writing a case analysis paper:

• Case study is a method of in-depth research and rigorous inquiry ; case analysis is a reliable method of teaching and learning . A case study is a modality of research that investigates a phenomenon for the purpose of creating new knowledge, solving a problem, or testing a hypothesis using empirical evidence derived from the case being studied. Often, the results are used to generalize about a larger population or within a wider context. The writing adheres to the traditional standards of a scholarly research study. A case analysis is a pedagogical tool used to teach students how to reflect and think critically about a practical, real-life problem in an organizational setting.
• The researcher is responsible for identifying the case to study; a case analysis is assigned by your professor . As the researcher, you choose the case study to investigate in support of obtaining new knowledge and understanding about the research problem. The case in a case analysis assignment is almost always provided, and sometimes written, by your professor and either given to every student in class to analyze individually or to a small group of students, or students select a case to analyze from a predetermined list.
• A case study is indeterminate and boundless; a case analysis is predetermined and confined . A case study can be almost anything [see item 9 below] as long as it relates directly to examining the research problem. This relationship is the only limit to what a researcher can choose as the subject of their case study. The content of a case analysis is determined by your professor and its parameters are well-defined and limited to elucidating insights of practical value applied to practice.
• Case study is fact-based and describes actual events or situations; case analysis can be entirely fictional or adapted from an actual situation . The entire content of a case study must be grounded in reality to be a valid subject of investigation in an empirical research study. A case analysis only needs to set the stage for critically examining a situation in practice and, therefore, can be entirely fictional or adapted, all or in-part, from an actual situation.
• Research using a case study method must adhere to principles of intellectual honesty and academic integrity; a case analysis scenario can include misleading or false information . A case study paper must report research objectively and factually to ensure that any findings are understood to be logically correct and trustworthy. A case analysis scenario may include misleading or false information intended to deliberately distract from the central issues of the case. The purpose is to teach students how to sort through conflicting or useless information in order to come up with the preferred solution. Any use of misleading or false information in academic research is considered unethical.
• Case study is linked to a research problem; case analysis is linked to a practical situation or scenario . In the social sciences, the subject of an investigation is most often framed as a problem that must be researched in order to generate new knowledge leading to a solution. Case analysis narratives are grounded in real life scenarios for the purpose of examining the realities of decision-making behavior and processes within organizational settings. A case analysis assignments include a problem or set of problems to be analyzed. However, the goal is centered around the act of identifying and evaluating courses of action leading to best possible outcomes.
• The purpose of a case study is to create new knowledge through research; the purpose of a case analysis is to teach new understanding . Case studies are a choice of methodological design intended to create new knowledge about resolving a research problem. A case analysis is a mode of teaching and learning intended to create new understanding and an awareness of uncertainty applied to practice through acts of critical thinking and reflection.
• A case study seeks to identify the best possible solution to a research problem; case analysis can have an indeterminate set of solutions or outcomes . Your role in studying a case is to discover the most logical, evidence-based ways to address a research problem. A case analysis assignment rarely has a single correct answer because one of the goals is to force students to confront the real life dynamics of uncertainly, ambiguity, and missing or conflicting information within professional practice. Under these conditions, a perfect outcome or solution almost never exists.
• Case study is unbounded and relies on gathering external information; case analysis is a self-contained subject of analysis . The scope of a case study chosen as a method of research is bounded. However, the researcher is free to gather whatever information and data is necessary to investigate its relevance to understanding the research problem. For a case analysis assignment, your professor will often ask you to examine solutions or recommended courses of action based solely on facts and information from the case.
• Case study can be a person, place, object, issue, event, condition, or phenomenon; a case analysis is a carefully constructed synopsis of events, situations, and behaviors . The research problem dictates the type of case being studied and, therefore, the design can encompass almost anything tangible as long as it fulfills the objective of generating new knowledge and understanding. A case analysis is in the form of a narrative containing descriptions of facts, situations, processes, rules, and behaviors within a particular setting and under a specific set of circumstances.
• Case study can represent an open-ended subject of inquiry; a case analysis is a narrative about something that has happened in the past . A case study is not restricted by time and can encompass an event or issue with no temporal limit or end. For example, the current war in Ukraine can be used as a case study of how medical personnel help civilians during a large military conflict, even though circumstances around this event are still evolving. A case analysis can be used to elicit critical thinking about current or future situations in practice, but the case itself is a narrative about something finite and that has taken place in the past.
• Multiple case studies can be used in a research study; case analysis involves examining a single scenario . Case study research can use two or more cases to examine a problem, often for the purpose of conducting a comparative investigation intended to discover hidden relationships, document emerging trends, or determine variations among different examples. A case analysis assignment typically describes a stand-alone, self-contained situation and any comparisons among cases are conducted during in-class discussions and/or student presentations.

The Case Analysis . Fred Meijer Center for Writing and Michigan Authors. Grand Valley State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Ramsey, V. J. and L. D. Dodge. "Case Analysis: A Structured Approach." Exchange: The Organizational Behavior Teaching Journal 6 (November 1981): 27-29; Yin, Robert K. Case Study Research and Applications: Design and Methods . 6th edition. Thousand Oaks, CA: Sage, 2017; Crowe, Sarah et al. “The Case Study Approach.” BMC Medical Research Methodology 11 (2011):  doi: 10.1186/1471-2288-11-100; Yin, Robert K. Case Study Research: Design and Methods . 4th edition. Thousand Oaks, CA: Sage Publishing; 1994.

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• What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

Table of contents

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

• Provide new or unexpected insights into the subject
• Challenge or complicate existing assumptions and theories
• Propose practical courses of action to resolve a problem
• Open up new directions for future research

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

• Exemplify a theory by showing how it explains the case under investigation
• Expand on a theory by uncovering new concepts and ideas that need to be incorporated
• Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

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In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Ecological validity

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

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How to conduct a case study? Main stages

Case study implies a search for any problem of relevant information, which must necessarily be properly arranged.

The main task is to generalize covered material and write conclusions. Scientific work envisages conducting new research in practice.

Main stages of research work

• First of all, it is necessary to look through case study topics and select the research topic in order to define the boundaries of the research as strictly as possible.
• The next step is to define the scope of the study (formulate the main questions, the answers to which a student would like to find).
• Then the case study problem should be actualized. A student should identify the problem and determine the direction of future research.
• The fourth stage is the development of a hypothesis (a researcher develop a hypothesis, including unrealistic and provocative ideas).
• The student should identify and systematize approaches to the solution (choose research methods).
• It is necessary to determine the sequence of the study.
• The following stage is the collection and processing of information (to capture the acquired knowledge).
• The next step is an analysis and generalization of the received materials (to structure the received material, using known logic rules and receptions).
• The final stage is the preparation of the report (to give definitions to the basic concepts, to prepare a report on the results of the study).

How to Write a Case Study

Recently, trying to solve the problem of mass “downloading,” scanning or buying term papers, some professors give students topics in their own words or specific problems for research.There must be sufficient literature on this topic. Therefore, it is best to first take a few attractive topics, and then, having got acquainted with the library catalogs or information from the Internet, finally choose one of them.It is recommended not to search for creative ways to present a case study. Just follow the strict requirements.

In accordance with standard requirements, such a paper should include the introduction, the main part, and the conclusion. Writing an introduction is necessary to:

• Show the relevance of the chosen topic and the degree of its scientific development,
• Explain this particular topic was chosen,
• Formulate the goals and objectives of the study,
• List the main literary and information sources and methods of research.

It is important to remember that the formulation of the research objective should coincide with the topic, and the formulation of tasks with the names of the relevant sections and subsections.The main part of the course work is a detailed presentation of answers to case study questions. Usually, it includes 3-4 sections, which, in turn, can be divided into the required number of subsections. If you need a point of sale case study , you will get it in a wink! By tradition, the first section of the work is usually devoted to general theoretical aspects of the chosen topic. Here the essence of the problem is revealed, its place in the theory and practice is shown, the critical review of existing approaches to its research is given.The second section usually discusses the practical side of the issue, including possible difficulties and shortcomings in this area.The third section is made to devote to the formulation of recommendations on the solution of the investigated problem, if possible with reference to the conditions of a particular country (depending on the topic).The conclusion should summarize the main conclusions of the work. They should not contain anything new, which is not mentioned in the work.

It is most convenient to compose the conclusion from the ready conclusions, which were formulated, completing the relevant sections of the work.Having a work plan, it is possible to start collecting materials. Sources on this or that topic can be conditionally divided into primary and secondary (or critical literature). The task of finding the right materials is greatly simplified due to the access to the Internet.  Materials borrowed from the Internet should be indicated in the list of literature. But here it’s not enough just to specify the address of the site; it is needed to point out the full address of which you can find this or that material.

Here are some pieces of advice on using the internet for data searching:

• Avoid “downloading” ready-made articles or abstracts. Case studies available on the Internet are far from being masterpieces, so it is almost impossible to write a good paper on their basis. In addition, many of these materials have become so familiar to teachers that establishing their origin is not a problem. So take some time and try to write something independently.
• Do not link pieces mechanically from different sources: their authors can use different terminology and different approaches, and a  teacher will necessarily ask a student why in one place he is talking, for example, about marginal costs, and in another about ultimate expenses (although this is one and the same).

If the material is collected, it is possible to start writing the text of a case study.

It is about writing, not about mindless copying with the help of all known means of modern technology or simply by mechanical rewriting.When writing the text of any work, it is very important to determine for whom it is intended. This will allow choosing the right style of presentation and avoid unnecessary clarifications and formulations. As for the style of presentation, the following general recommendations are useful:Avoid long and complex sentences. They are incomprehensible in written language.

If the sentences are still too long, try to separate them.Remember that a paragraph longer than a page is allowed only for Leo Tolstoy, and even in this case, it is very easy to lose a thread of reasoning. Do paragraphs more often; however, do not forget that there should be more than one sentence in them.

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