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What is a Case Study?

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A case study is when experts study one person closely to learn more about them. For kids who learn or act differently, this helps people figure out the best way to help that kid. It’s like being a detective, but for understanding how to make learning or living easier for them.

Table of Contents

• Frequently Asked Questions
• Science Person Definition

Real World Example of a Case Study

How does a case study work, recommended products, related topics, frequently asked question.

How is a case study conducted?

It involves observations, interviews, and tests to collect comprehensive data on the child. Experts then analyze this data to offer personalized solutions.

Why are case studies important for kids with special needs?

Case studies provide individualized insights that generic approaches can’t. They help educators and parents create strategies that work best for a specific child.

What kind of data is collected in a case study?

Observational data, interviews with caregivers, and skill assessments are common. This mixed-method approach provides a 360-degree view of the child’s needs.

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Scientific Definition

A case study is a comprehensive research method that focuses on a single subject, often employing multiple forms of data collection, such as observations, interviews, and tests, to understand its behavior, experiences, or conditions. In the context of children with developmental disabilities , case studies provide an in-depth analysis to gather valuable insights into individualized intervention methods. Case studies often serve as critical tools for educators, therapists, and researchers in tailoring strategies that are most effective for a specific child.

Have you ever wondered how a case study could work for a kid like yours? Let’s talk about Charlie. His parents and teachers noticed he was struggling with transitions between activities. They decided a case study was the best way to understand what was happening and how to help him.

• Observations: Experts observed Charlie during transitions between classroom activities.
• Interviews: They chatted with Charlie’s parents, who revealed he also struggled with transitions at home.
• Tests: Charlie took some assessments that gauged his emotional responses to changes in routine.
• Tailored Strategies: Based on the data, the experts suggested implementing a visual timer and simple verbal cues to guide Charlie through transitions.

What’s the outcome? These days, Charlie moves between activities like a champ, and everyone’s breathing a bit easier. See, case studies aren’t just academic mumbo-jumbo. They can bring about real, positive change.

So, how exactly do case studies help kids with special needs? They dig deep into one child’s life to discover what makes them tick and how best to help them. It’s all about customization.

• Observations: Experts watch how the child behaves at home or school.
• Interviews: Parents, teachers, and sometimes even the child share their experiences.
• Tests: Think of skills assessments or behavior surveys.
• Data Crunch: All this info gets analyzed to tailor help specifically for that child.

Case studies are the Swiss Army knives for understanding a child’s unique needs. They help everyone involved get a game plan for making daily life much smoother.

Curious how Goally fits in? Well, after a case study identifies a child’s needs, you can use Goally ‘s digital visual schedules to structure their day. For example, suppose the study finds your kid struggles with morning routines. In that case, Goally’s “Get Ready for School” app can set up reminders for brushing teeth, eating breakfast, and so on. It makes sticking to routines a breeze.

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Methodology

• 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.

Prevent plagiarism. Run a free check.

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.

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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McCombes, S. (2023, November 20). What Is a Case Study? | Definition, Examples & Methods. Scribbr. Retrieved April 10, 2024, from https://www.scribbr.com/methodology/case-study/

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• Methodology
• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

Published on 5 May 2022 by Shona McCombes . Revised on 30 January 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organisation, 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 analyse the case.

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.

Prevent plagiarism, run a free check.

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

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.

If you find yourself aiming to simultaneously investigate and solve an issue, consider conducting action research . As its name suggests, action research conducts research and takes action at the same time, and is highly iterative and flexible. 

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

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 .

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

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 analyse 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.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

McCombes, S. (2023, January 30). Case Study | Definition, Examples & Methods. Scribbr. Retrieved 9 April 2024, from https://www.scribbr.co.uk/research-methods/case-studies/

Is this article helpful?

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Case Study – Methods, Examples and Guide

Table of Contents

A case study is a research method that involves an in-depth examination and analysis of a particular phenomenon or case, such as an individual, organization, community, event, or situation.

It is a qualitative research approach that aims to provide a detailed and comprehensive understanding of the case being studied. Case studies typically involve multiple sources of data, including interviews, observations, documents, and artifacts, which are analyzed using various techniques, such as content analysis, thematic analysis, and grounded theory. The findings of a case study are often used to develop theories, inform policy or practice, or generate new research questions.

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

A single-case study is an in-depth analysis of a single case. This type of case study is useful when the researcher wants to understand a specific phenomenon in detail.

For Example , A researcher might conduct a single-case study on a particular individual to understand their experiences with a particular health condition or a specific organization to explore their management practices. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a single-case study are often used to generate new research questions, develop theories, or inform policy or practice.

Multiple-Case Study

A multiple-case study involves the analysis of several cases that are similar in nature. This type of case study is useful when the researcher wants to identify similarities and differences between the cases.

For Example, a researcher might conduct a multiple-case study on several companies to explore the factors that contribute to their success or failure. The researcher collects data from each case, compares and contrasts the findings, and uses various techniques to analyze the data, such as comparative analysis or pattern-matching. The findings of a multiple-case study can be used to develop theories, inform policy or practice, or generate new research questions.

Exploratory Case Study

An exploratory case study is used to explore a new or understudied phenomenon. This type of case study is useful when the researcher wants to generate hypotheses or theories about the phenomenon.

For Example, a researcher might conduct an exploratory case study on a new technology to understand its potential impact on society. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as grounded theory or content analysis. The findings of an exploratory case study can be used to generate new research questions, develop theories, or inform policy or practice.

Descriptive Case Study

A descriptive case study is used to describe a particular phenomenon in detail. This type of case study is useful when the researcher wants to provide a comprehensive account of the phenomenon.

For Example, a researcher might conduct a descriptive case study on a particular community to understand its social and economic characteristics. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a descriptive case study can be used to inform policy or practice or generate new research questions.

Instrumental Case Study

An instrumental case study is used to understand a particular phenomenon that is instrumental in achieving a particular goal. This type of case study is useful when the researcher wants to understand the role of the phenomenon in achieving the goal.

For Example, a researcher might conduct an instrumental case study on a particular policy to understand its impact on achieving a particular goal, such as reducing poverty. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of an instrumental case study can be used to inform policy or practice or generate new research questions.

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

Interviews involve asking questions to individuals who have knowledge or experience relevant to the case study. Interviews can be structured (where the same questions are asked to all participants) or unstructured (where the interviewer follows up on the responses with further questions). Interviews can be conducted in person, over the phone, or through video conferencing.

Observations

Observations involve watching and recording the behavior and activities of individuals or groups relevant to the case study. Observations can be participant (where the researcher actively participates in the activities) or non-participant (where the researcher observes from a distance). Observations can be recorded using notes, audio or video recordings, or photographs.

Documents can be used as a source of information for case studies. Documents can include reports, memos, emails, letters, and other written materials related to the case study. Documents can be collected from the case study participants or from public sources.

Surveys involve asking a set of questions to a sample of individuals relevant to the case study. Surveys can be administered in person, over the phone, through mail or email, or online. Surveys can be used to gather information on attitudes, opinions, or behaviors related to the case study.

Artifacts are physical objects relevant to the case study. Artifacts can include tools, equipment, products, or other objects that provide insights into the case study phenomenon.

How to conduct Case Study Research

Conducting a case study research involves several steps that need to be followed to ensure the quality and rigor of the study. Here are the steps to conduct case study research:

• Define the research questions: The first step in conducting a case study research is to define the research questions. The research questions should be specific, measurable, and relevant to the case study phenomenon under investigation.
• Select the case: The next step is to select the case or cases to be studied. The case should be relevant to the research questions and should provide rich and diverse data that can be used to answer the research questions.
• Collect data: Data can be collected using various methods, such as interviews, observations, documents, surveys, and artifacts. The data collection method should be selected based on the research questions and the nature of the case study phenomenon.
• Analyze the data: The data collected from the case study should be analyzed using various techniques, such as content analysis, thematic analysis, or grounded theory. The analysis should be guided by the research questions and should aim to provide insights and conclusions relevant to the research questions.
• Draw conclusions: The conclusions drawn from the case study should be based on the data analysis and should be relevant to the research questions. The conclusions should be supported by evidence and should be clearly stated.
• Validate the findings: The findings of the case study should be validated by reviewing the data and the analysis with participants or other experts in the field. This helps to ensure the validity and reliability of the findings.
• Write the report: The final step is to write the report of the case study research. The report should provide a clear description of the case study phenomenon, the research questions, the data collection methods, the data analysis, the findings, and the conclusions. The report should be written in a clear and concise manner and should follow the guidelines for academic writing.

Examples of Case Study

Here are some examples of case study research:

• The Hawthorne Studies : Conducted between 1924 and 1932, the Hawthorne Studies were a series of case studies conducted by Elton Mayo and his colleagues to examine the impact of work environment on employee productivity. The studies were conducted at the Hawthorne Works plant of the Western Electric Company in Chicago and included interviews, observations, and experiments.
• The Stanford Prison Experiment: Conducted in 1971, the Stanford Prison Experiment was a case study conducted by Philip Zimbardo to examine the psychological effects of power and authority. The study involved simulating a prison environment and assigning participants to the role of guards or prisoners. The study was controversial due to the ethical issues it raised.
• The Challenger Disaster: The Challenger Disaster was a case study conducted to examine the causes of the Space Shuttle Challenger explosion in 1986. The study included interviews, observations, and analysis of data to identify the technical, organizational, and cultural factors that contributed to the disaster.
• The Enron Scandal: The Enron Scandal was a case study conducted to examine the causes of the Enron Corporation’s bankruptcy in 2001. The study included interviews, analysis of financial data, and review of documents to identify the accounting practices, corporate culture, and ethical issues that led to the company’s downfall.
• The Fukushima Nuclear Disaster : The Fukushima Nuclear Disaster was a case study conducted to examine the causes of the nuclear accident that occurred at the Fukushima Daiichi Nuclear Power Plant in Japan in 2011. The study included interviews, analysis of data, and review of documents to identify the technical, organizational, and cultural factors that contributed to the disaster.

Application of Case Study

Case studies have a wide range of applications across various fields and industries. Here are some examples:

Business and Management

Case studies are widely used in business and management to examine real-life situations and develop problem-solving skills. Case studies can help students and professionals to develop a deep understanding of business concepts, theories, and best practices.

Case studies are used in healthcare to examine patient care, treatment options, and outcomes. Case studies can help healthcare professionals to develop critical thinking skills, diagnose complex medical conditions, and develop effective treatment plans.

Case studies are used in education to examine teaching and learning practices. Case studies can help educators to develop effective teaching strategies, evaluate student progress, and identify areas for improvement.

Social Sciences

Case studies are widely used in social sciences to examine human behavior, social phenomena, and cultural practices. Case studies can help researchers to develop theories, test hypotheses, and gain insights into complex social issues.

Law and Ethics

Case studies are used in law and ethics to examine legal and ethical dilemmas. Case studies can help lawyers, policymakers, and ethical professionals to develop critical thinking skills, analyze complex cases, and make informed decisions.

Purpose of Case Study

The purpose of a case study is to provide a detailed analysis of a specific phenomenon, issue, or problem in its real-life context. A case study is a qualitative research method that involves the in-depth exploration and analysis of a particular case, which can be an individual, group, organization, event, or community.

The primary purpose of a case study is to generate a comprehensive and nuanced understanding of the case, including its history, context, and dynamics. Case studies can help researchers to identify and examine the underlying factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and detailed understanding of the case, which can inform future research, practice, or policy.

Case studies can also serve other purposes, including:

• Illustrating a theory or concept: Case studies can be used to illustrate and explain theoretical concepts and frameworks, providing concrete examples of how they can be applied in real-life situations.
• Developing hypotheses: Case studies can help to generate hypotheses about the causal relationships between different factors and outcomes, which can be tested through further research.
• Providing insight into complex issues: Case studies can provide insights into complex and multifaceted issues, which may be difficult to understand through other research methods.
• Informing practice or policy: Case studies can be used to inform practice or policy by identifying best practices, lessons learned, or areas for improvement.

Advantages of Case Study Research

There are several advantages of case study research, including:

• In-depth exploration: Case study research allows for a detailed exploration and analysis of a specific phenomenon, issue, or problem in its real-life context. This can provide a comprehensive understanding of the case and its dynamics, which may not be possible through other research methods.
• Rich data: Case study research can generate rich and detailed data, including qualitative data such as interviews, observations, and documents. This can provide a nuanced understanding of the case and its complexity.
• Holistic perspective: Case study research allows for a holistic perspective of the case, taking into account the various factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and comprehensive understanding of the case.
• Theory development: Case study research can help to develop and refine theories and concepts by providing empirical evidence and concrete examples of how they can be applied in real-life situations.
• Practical application: Case study research can inform practice or policy by identifying best practices, lessons learned, or areas for improvement.
• Contextualization: Case study research takes into account the specific context in which the case is situated, which can help to understand how the case is influenced by the social, cultural, and historical factors of its environment.

Limitations of Case Study Research

There are several limitations of case study research, including:

• Limited generalizability : Case studies are typically focused on a single case or a small number of cases, which limits the generalizability of the findings. The unique characteristics of the case may not be applicable to other contexts or populations, which may limit the external validity of the research.
• Biased sampling: Case studies may rely on purposive or convenience sampling, which can introduce bias into the sample selection process. This may limit the representativeness of the sample and the generalizability of the findings.
• Subjectivity: Case studies rely on the interpretation of the researcher, which can introduce subjectivity into the analysis. The researcher’s own biases, assumptions, and perspectives may influence the findings, which may limit the objectivity of the research.
• Limited control: Case studies are typically conducted in naturalistic settings, which limits the control that the researcher has over the environment and the variables being studied. This may limit the ability to establish causal relationships between variables.
• Time-consuming: Case studies can be time-consuming to conduct, as they typically involve a detailed exploration and analysis of a specific case. This may limit the feasibility of conducting multiple case studies or conducting case studies in a timely manner.
• Resource-intensive: Case studies may require significant resources, including time, funding, and expertise. This may limit the ability of researchers to conduct case studies in resource-constrained settings.

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Definition of case study

Examples of case study in a sentence.

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'case study.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

1914, in the meaning defined at sense 1

Dictionary Entries Near case study

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“Case study.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/case%20study. Accessed 11 Apr. 2024.

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What Is a Case Study?

Weighing the pros and cons of this method of research

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

Cara Lustik is a fact-checker and copywriter.

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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• bodice-ripper
• cautionary tale
• misdescription
• multi-stranded
• running commentary phrase
• semi-legendary
• shaggy-dog story
• short story
• write something up

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Organizing Your Social Sciences Research Assignments

• Annotated Bibliography
• Analyzing a Scholarly Journal Article
• Group Presentations
• Dealing with Nervousness
• Using Visual Aids
• Grading Someone Else's Paper
• Types of Structured Group Activities
• Group Project Survival Skills
• Leading a Class Discussion
• Multiple Book Review Essay
• Reviewing Collected Works
• Writing a Case Analysis Paper
• Writing a Case Study
• About Informed Consent
• Writing Field Notes
• Writing a Policy Memo
• Writing a Reflective Paper
• Writing a Research Proposal
• Generative AI and Writing
• Acknowledgments

A case study research paper examines a person, place, event, condition, phenomenon, or other type of subject of analysis in order to extrapolate  key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity. A case study research paper usually examines a single subject of analysis, but case study papers can also be designed as a comparative investigation that shows relationships between two or more subjects. The methods used to study a case can rest within a quantitative, qualitative, or mixed-method investigative paradigm.

Case Studies. Writing@CSU. Colorado State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010 ; “What is a Case Study?” In Swanborn, Peter G. Case Study Research: What, Why and How? London: SAGE, 2010.

How to Approach Writing a Case Study Research Paper

General information about how to choose a topic to investigate can be found under the " Choosing a Research Problem " tab in the Organizing Your Social Sciences Research Paper writing guide. Review this page because it may help you identify a subject of analysis that can be investigated using a case study design.

However, identifying a case to investigate involves more than choosing the research problem . A case study encompasses a problem contextualized around the application of in-depth analysis, interpretation, and discussion, often resulting in specific recommendations for action or for improving existing conditions. As Seawright and Gerring note, practical considerations such as time and access to information can influence case selection, but these issues should not be the sole factors used in describing the methodological justification for identifying a particular case to study. Given this, selecting a case includes considering the following:

• The case represents an unusual or atypical example of a research problem that requires more in-depth analysis? Cases often represent a topic that rests on the fringes of prior investigations because the case may provide new ways of understanding the research problem. For example, if the research problem is to identify strategies to improve policies that support girl's access to secondary education in predominantly Muslim nations, you could consider using Azerbaijan as a case study rather than selecting a more obvious nation in the Middle East. Doing so may reveal important new insights into recommending how governments in other predominantly Muslim nations can formulate policies that support improved access to education for girls.
• The case provides important insight or illuminate a previously hidden problem? In-depth analysis of a case can be based on the hypothesis that the case study will reveal trends or issues that have not been exposed in prior research or will reveal new and important implications for practice. For example, anecdotal evidence may suggest drug use among homeless veterans is related to their patterns of travel throughout the day. Assuming prior studies have not looked at individual travel choices as a way to study access to illicit drug use, a case study that observes a homeless veteran could reveal how issues of personal mobility choices facilitate regular access to illicit drugs. Note that it is important to conduct a thorough literature review to ensure that your assumption about the need to reveal new insights or previously hidden problems is valid and evidence-based.
• The case challenges and offers a counter-point to prevailing assumptions? Over time, research on any given topic can fall into a trap of developing assumptions based on outdated studies that are still applied to new or changing conditions or the idea that something should simply be accepted as "common sense," even though the issue has not been thoroughly tested in current practice. A case study analysis may offer an opportunity to gather evidence that challenges prevailing assumptions about a research problem and provide a new set of recommendations applied to practice that have not been tested previously. For example, perhaps there has been a long practice among scholars to apply a particular theory in explaining the relationship between two subjects of analysis. Your case could challenge this assumption by applying an innovative theoretical framework [perhaps borrowed from another discipline] to explore whether this approach offers new ways of understanding the research problem. Taking a contrarian stance is one of the most important ways that new knowledge and understanding develops from existing literature.
• The case provides an opportunity to pursue action leading to the resolution of a problem? Another way to think about choosing a case to study is to consider how the results from investigating a particular case may result in findings that reveal ways in which to resolve an existing or emerging problem. For example, studying the case of an unforeseen incident, such as a fatal accident at a railroad crossing, can reveal hidden issues that could be applied to preventative measures that contribute to reducing the chance of accidents in the future. In this example, a case study investigating the accident could lead to a better understanding of where to strategically locate additional signals at other railroad crossings so as to better warn drivers of an approaching train, particularly when visibility is hindered by heavy rain, fog, or at night.
• The case offers a new direction in future research? A case study can be used as a tool for an exploratory investigation that highlights the need for further research about the problem. A case can be used when there are few studies that help predict an outcome or that establish a clear understanding about how best to proceed in addressing a problem. For example, after conducting a thorough literature review [very important!], you discover that little research exists showing the ways in which women contribute to promoting water conservation in rural communities of east central Africa. A case study of how women contribute to saving water in a rural village of Uganda can lay the foundation for understanding the need for more thorough research that documents how women in their roles as cooks and family caregivers think about water as a valuable resource within their community. This example of a case study could also point to the need for scholars to build new theoretical frameworks around the topic [e.g., applying feminist theories of work and family to the issue of water conservation].

Eisenhardt, Kathleen M. “Building Theories from Case Study Research.” Academy of Management Review 14 (October 1989): 532-550; Emmel, Nick. Sampling and Choosing Cases in Qualitative Research: A Realist Approach . Thousand Oaks, CA: SAGE Publications, 2013; Gerring, John. “What Is a Case Study and What Is It Good for?” American Political Science Review 98 (May 2004): 341-354; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Seawright, Jason and John Gerring. "Case Selection Techniques in Case Study Research." Political Research Quarterly 61 (June 2008): 294-308.

Structure and Writing Style

The purpose of a paper in the social sciences designed around a case study is to thoroughly investigate a subject of analysis in order to reveal a new understanding about the research problem and, in so doing, contributing new knowledge to what is already known from previous studies. In applied social sciences disciplines [e.g., education, social work, public administration, etc.], case studies may also be used to reveal best practices, highlight key programs, or investigate interesting aspects of professional work.

In general, the structure of a case study research paper is not all that different from a standard college-level research paper. However, there are subtle differences you should be aware of. Here are the key elements to organizing and writing a case study research paper.

I.  Introduction

As with any research paper, your introduction should serve as a roadmap for your readers to ascertain the scope and purpose of your study . The introduction to a case study research paper, however, should not only describe the research problem and its significance, but you should also succinctly describe why the case is being used and how it relates to addressing the problem. The two elements should be linked. With this in mind, a good introduction answers these four questions:

• What is being studied? Describe the research problem and describe the subject of analysis [the case] you have chosen to address the problem. Explain how they are linked and what elements of the case will help to expand knowledge and understanding about the problem.
• Why is this topic important to investigate? Describe the significance of the research problem and state why a case study design and the subject of analysis that the paper is designed around is appropriate in addressing the problem.
• What did we know about this topic before I did this study? Provide background that helps lead the reader into the more in-depth literature review to follow. If applicable, summarize prior case study research applied to the research problem and why it fails to adequately address the problem. Describe why your case will be useful. If no prior case studies have been used to address the research problem, explain why you have selected this subject of analysis.
• How will this study advance new knowledge or new ways of understanding? Explain why your case study will be suitable in helping to expand knowledge and understanding about the research problem.

Each of these questions should be addressed in no more than a few paragraphs. Exceptions to this can be when you are addressing a complex research problem or subject of analysis that requires more in-depth background information.

II.  Literature Review

The literature review for a case study research paper is generally structured the same as it is for any college-level research paper. The difference, however, is that the literature review is focused on providing background information and  enabling historical interpretation of the subject of analysis in relation to the research problem the case is intended to address . This includes synthesizing studies that help to:

• Place relevant works in the context of their contribution to understanding the case study being investigated . This would involve summarizing studies that have used a similar subject of analysis to investigate the research problem. If there is literature using the same or a very similar case to study, you need to explain why duplicating past research is important [e.g., conditions have changed; prior studies were conducted long ago, etc.].
• Describe the relationship each work has to the others under consideration that informs the reader why this case is applicable . Your literature review should include a description of any works that support using the case to investigate the research problem and the underlying research questions.
• Identify new ways to interpret prior research using the case study . If applicable, review any research that has examined the research problem using a different research design. Explain how your use of a case study design may reveal new knowledge or a new perspective or that can redirect research in an important new direction.
• Resolve conflicts amongst seemingly contradictory previous studies . This refers to synthesizing any literature that points to unresolved issues of concern about the research problem and describing how the subject of analysis that forms the case study can help resolve these existing contradictions.
• Point the way in fulfilling a need for additional research . Your review should examine any literature that lays a foundation for understanding why your case study design and the subject of analysis around which you have designed your study may reveal a new way of approaching the research problem or offer a perspective that points to the need for additional research.
• Expose any gaps that exist in the literature that the case study could help to fill . Summarize any literature that not only shows how your subject of analysis contributes to understanding the research problem, but how your case contributes to a new way of understanding the problem that prior research has failed to do.
• Locate your own research within the context of existing literature [very important!] . Collectively, your literature review should always place your case study within the larger domain of prior research about the problem. The overarching purpose of reviewing pertinent literature in a case study paper is to demonstrate that you have thoroughly identified and synthesized prior studies in relation to explaining the relevance of the case in addressing the research problem.

III.  Method

In this section, you explain why you selected a particular case [i.e., subject of analysis] and the strategy you used to identify and ultimately decide that your case was appropriate in addressing the research problem. The way you describe the methods used varies depending on the type of subject of analysis that constitutes your case study.

If your subject of analysis is an incident or event . In the social and behavioral sciences, the event or incident that represents the case to be studied is usually bounded by time and place, with a clear beginning and end and with an identifiable location or position relative to its surroundings. The subject of analysis can be a rare or critical event or it can focus on a typical or regular event. The purpose of studying a rare event is to illuminate new ways of thinking about the broader research problem or to test a hypothesis. Critical incident case studies must describe the method by which you identified the event and explain the process by which you determined the validity of this case to inform broader perspectives about the research problem or to reveal new findings. However, the event does not have to be a rare or uniquely significant to support new thinking about the research problem or to challenge an existing hypothesis. For example, Walo, Bull, and Breen conducted a case study to identify and evaluate the direct and indirect economic benefits and costs of a local sports event in the City of Lismore, New South Wales, Australia. The purpose of their study was to provide new insights from measuring the impact of a typical local sports event that prior studies could not measure well because they focused on large "mega-events." Whether the event is rare or not, the methods section should include an explanation of the following characteristics of the event: a) when did it take place; b) what were the underlying circumstances leading to the event; and, c) what were the consequences of the event in relation to the research problem.

If your subject of analysis is a person. Explain why you selected this particular individual to be studied and describe what experiences they have had that provide an opportunity to advance new understandings about the research problem. Mention any background about this person which might help the reader understand the significance of their experiences that make them worthy of study. This includes describing the relationships this person has had with other people, institutions, and/or events that support using them as the subject for a case study research paper. It is particularly important to differentiate the person as the subject of analysis from others and to succinctly explain how the person relates to examining the research problem [e.g., why is one politician in a particular local election used to show an increase in voter turnout from any other candidate running in the election]. Note that these issues apply to a specific group of people used as a case study unit of analysis [e.g., a classroom of students].

If your subject of analysis is a place. In general, a case study that investigates a place suggests a subject of analysis that is unique or special in some way and that this uniqueness can be used to build new understanding or knowledge about the research problem. A case study of a place must not only describe its various attributes relevant to the research problem [e.g., physical, social, historical, cultural, economic, political], but you must state the method by which you determined that this place will illuminate new understandings about the research problem. It is also important to articulate why a particular place as the case for study is being used if similar places also exist [i.e., if you are studying patterns of homeless encampments of veterans in open spaces, explain why you are studying Echo Park in Los Angeles rather than Griffith Park?]. If applicable, describe what type of human activity involving this place makes it a good choice to study [e.g., prior research suggests Echo Park has more homeless veterans].

If your subject of analysis is a phenomenon. A phenomenon refers to a fact, occurrence, or circumstance that can be studied or observed but with the cause or explanation to be in question. In this sense, a phenomenon that forms your subject of analysis can encompass anything that can be observed or presumed to exist but is not fully understood. In the social and behavioral sciences, the case usually focuses on human interaction within a complex physical, social, economic, cultural, or political system. For example, the phenomenon could be the observation that many vehicles used by ISIS fighters are small trucks with English language advertisements on them. The research problem could be that ISIS fighters are difficult to combat because they are highly mobile. The research questions could be how and by what means are these vehicles used by ISIS being supplied to the militants and how might supply lines to these vehicles be cut off? How might knowing the suppliers of these trucks reveal larger networks of collaborators and financial support? A case study of a phenomenon most often encompasses an in-depth analysis of a cause and effect that is grounded in an interactive relationship between people and their environment in some way.

NOTE:   The choice of the case or set of cases to study cannot appear random. Evidence that supports the method by which you identified and chose your subject of analysis should clearly support investigation of the research problem and linked to key findings from your literature review. Be sure to cite any studies that helped you determine that the case you chose was appropriate for examining the problem.

IV.  Discussion

The main elements of your discussion section are generally the same as any research paper, but centered around interpreting and drawing conclusions about the key findings from your analysis of the case study. Note that a general social sciences research paper may contain a separate section to report findings. However, in a paper designed around a case study, it is common to combine a description of the results with the discussion about their implications. The objectives of your discussion section should include the following:

Reiterate the Research Problem/State the Major Findings Briefly reiterate the research problem you are investigating and explain why the subject of analysis around which you designed the case study were used. You should then describe the findings revealed from your study of the case using direct, declarative, and succinct proclamation of the study results. Highlight any findings that were unexpected or especially profound.

Explain the Meaning of the Findings and Why They are Important Systematically explain the meaning of your case study findings and why you believe they are important. Begin this part of the section by repeating what you consider to be your most important or surprising finding first, then systematically review each finding. Be sure to thoroughly extrapolate what your analysis of the case can tell the reader about situations or conditions beyond the actual case that was studied while, at the same time, being careful not to misconstrue or conflate a finding that undermines the external validity of your conclusions.

Relate the Findings to Similar Studies No study in the social sciences is so novel or possesses such a restricted focus that it has absolutely no relation to previously published research. The discussion section should relate your case study results to those found in other studies, particularly if questions raised from prior studies served as the motivation for choosing your subject of analysis. This is important because comparing and contrasting the findings of other studies helps support the overall importance of your results and it highlights how and in what ways your case study design and the subject of analysis differs from prior research about the topic.

Consider Alternative Explanations of the Findings Remember that the purpose of social science research is to discover and not to prove. When writing the discussion section, you should carefully consider all possible explanations revealed by the case study results, rather than just those that fit your hypothesis or prior assumptions and biases. Be alert to what the in-depth analysis of the case may reveal about the research problem, including offering a contrarian perspective to what scholars have stated in prior research if that is how the findings can be interpreted from your case.

Acknowledge the Study's Limitations You can state the study's limitations in the conclusion section of your paper but describing the limitations of your subject of analysis in the discussion section provides an opportunity to identify the limitations and explain why they are not significant. This part of the discussion section should also note any unanswered questions or issues your case study could not address. More detailed information about how to document any limitations to your research can be found here .

Suggest Areas for Further Research Although your case study may offer important insights about the research problem, there are likely additional questions related to the problem that remain unanswered or findings that unexpectedly revealed themselves as a result of your in-depth analysis of the case. Be sure that the recommendations for further research are linked to the research problem and that you explain why your recommendations are valid in other contexts and based on the original assumptions of your study.

V.  Conclusion

As with any research paper, you should summarize your conclusion in clear, simple language; emphasize how the findings from your case study differs from or supports prior research and why. Do not simply reiterate the discussion section. Provide a synthesis of key findings presented in the paper to show how these converge to address the research problem. If you haven't already done so in the discussion section, be sure to document the limitations of your case study and any need for further research.

The function of your paper's conclusion is to: 1) reiterate the main argument supported by the findings from your case study; 2) state clearly the context, background, and necessity of pursuing the research problem using a case study design in relation to an issue, controversy, or a gap found from reviewing the literature; and, 3) provide a place to persuasively and succinctly restate the significance of your research problem, given that the reader has now been presented with in-depth information about the topic.

Consider the following points to help ensure your conclusion is appropriate:

• If the argument or purpose of your paper is complex, you may need to summarize these points for your reader.
• If prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the conclusion of your paper to describe your main points and explain their significance.
• Move from a detailed to a general level of consideration of the case study's findings that returns the topic to the context provided by the introduction or within a new context that emerges from your case study findings.

Note that, depending on the discipline you are writing in or the preferences of your professor, the concluding paragraph may contain your final reflections on the evidence presented as it applies to practice or on the essay's central research problem. However, the nature of being introspective about the subject of analysis you have investigated will depend on whether you are explicitly asked to express your observations in this way.

Problems to Avoid

Overgeneralization One of the goals of a case study is to lay a foundation for understanding broader trends and issues applied to similar circumstances. However, be careful when drawing conclusions from your case study. They must be evidence-based and grounded in the results of the study; otherwise, it is merely speculation. Looking at a prior example, it would be incorrect to state that a factor in improving girls access to education in Azerbaijan and the policy implications this may have for improving access in other Muslim nations is due to girls access to social media if there is no documentary evidence from your case study to indicate this. There may be anecdotal evidence that retention rates were better for girls who were engaged with social media, but this observation would only point to the need for further research and would not be a definitive finding if this was not a part of your original research agenda.

Failure to Document Limitations No case is going to reveal all that needs to be understood about a research problem. Therefore, just as you have to clearly state the limitations of a general research study , you must describe the specific limitations inherent in the subject of analysis. For example, the case of studying how women conceptualize the need for water conservation in a village in Uganda could have limited application in other cultural contexts or in areas where fresh water from rivers or lakes is plentiful and, therefore, conservation is understood more in terms of managing access rather than preserving access to a scarce resource.

Failure to Extrapolate All Possible Implications Just as you don't want to over-generalize from your case study findings, you also have to be thorough in the consideration of all possible outcomes or recommendations derived from your findings. If you do not, your reader may question the validity of your analysis, particularly if you failed to document an obvious outcome from your case study research. For example, in the case of studying the accident at the railroad crossing to evaluate where and what types of warning signals should be located, you failed to take into consideration speed limit signage as well as warning signals. When designing your case study, be sure you have thoroughly addressed all aspects of the problem and do not leave gaps in your analysis that leave the reader questioning the results.

Case Studies. Writing@CSU. Colorado State University; Gerring, John. Case Study Research: Principles and Practices . New York: Cambridge University Press, 2007; Merriam, Sharan B. Qualitative Research and Case Study Applications in Education . Rev. ed. San Francisco, CA: Jossey-Bass, 1998; Miller, Lisa L. “The Use of Case Studies in Law and Social Science Research.” Annual Review of Law and Social Science 14 (2018): TBD; Mills, Albert J., Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Putney, LeAnn Grogan. "Case Study." In Encyclopedia of Research Design , Neil J. Salkind, editor. (Thousand Oaks, CA: SAGE Publications, 2010), pp. 116-120; Simons, Helen. Case Study Research in Practice . London: SAGE Publications, 2009;  Kratochwill,  Thomas R. and Joel R. Levin, editors. Single-Case Research Design and Analysis: New Development for Psychology and Education .  Hilldsale, NJ: Lawrence Erlbaum Associates, 1992; Swanborn, Peter G. Case Study Research: What, Why and How? London : SAGE, 2010; Yin, Robert K. Case Study Research: Design and Methods . 6th edition. Los Angeles, CA, SAGE Publications, 2014; Walo, Maree, Adrian Bull, and Helen Breen. “Achieving Economic Benefits at Local Events: A Case Study of a Local Sports Event.” Festival Management and Event Tourism 4 (1996): 95-106.

Writing Tip

At Least Five Misconceptions about Case Study Research

Social science case studies are often perceived as limited in their ability to create new knowledge because they are not randomly selected and findings cannot be generalized to larger populations. Flyvbjerg examines five misunderstandings about case study research and systematically "corrects" each one. To quote, these are:

Misunderstanding 1 :  General, theoretical [context-independent] knowledge is more valuable than concrete, practical [context-dependent] knowledge. Misunderstanding 2 :  One cannot generalize on the basis of an individual case; therefore, the case study cannot contribute to scientific development. Misunderstanding 3 :  The case study is most useful for generating hypotheses; that is, in the first stage of a total research process, whereas other methods are more suitable for hypotheses testing and theory building. Misunderstanding 4 :  The case study contains a bias toward verification, that is, a tendency to confirm the researcher’s preconceived notions. Misunderstanding 5 :  It is often difficult to summarize and develop general propositions and theories on the basis of specific case studies [p. 221].

While writing your paper, think introspectively about how you addressed these misconceptions because to do so can help you strengthen the validity and reliability of your research by clarifying issues of case selection, the testing and challenging of existing assumptions, the interpretation of key findings, and the summation of case outcomes. Think of a case study research paper as a complete, in-depth narrative about the specific properties and key characteristics of your subject of analysis applied to the research problem.

Flyvbjerg, Bent. “Five Misunderstandings About Case-Study Research.” Qualitative Inquiry 12 (April 2006): 219-245.

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Early Childhood Education: How to do a Child Case Study-Best Practice

• Creating an Annotated Bibliography
• Lesson Plans and Rubrics
• Children's literature
• Podcasts and Videos
• Cherie's Recommended Library
• Great Educational Articles
• Great Activities for Children
• Professionalism in the Field and in a College Classroom
• Professional Associations
• Pennsylvania Certification
• Manor's Early Childhood Faculty
• Manor Lesson Plan Format
• Manor APA Formatting, Reference, and Citation Policy for Education Classes
• Conducting a Literature Review for a Manor education class
• Manor College's Guide to Using EBSCO Effectively
• How to do a Child Case Study-Best Practice
• ED105: From Teacher Interview to Final Project
• Pennsylvania Initiatives

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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• Research article
• Open access
• Published: 09 May 2019

Diagnostic validity of the MINI-KID disorder classifications in specialized child and adolescent psychiatric outpatient clinics in Sweden

• Camilla Högberg 1 ,
• Eva Billstedt   ORCID: orcid.org/0000-0002-4200-2149 2 ,
• Caroline Björck 3 ,
• Per-Olof Björck 1 ,
• Stephan Ehlers 5 ,
• Lars-Henry Gustle 4 ,
• Clara Hellner   ORCID: orcid.org/0000-0002-8375-9447 6 ,
• Henrik Höök 1 ,
• Eva Serlachius   ORCID: orcid.org/0000-0001-7115-6422 6 ,
• Mats A. Svensson 4 &
• Jan-Olov Larsson   ORCID: orcid.org/0000-0002-8198-9070 7  

BMC Psychiatry volume  19 , Article number:  142 ( 2019 ) Cite this article

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Metrics details

Missing diagnostic information often results poor accuracy of the clinical diagnostic decision process. The Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) is a short standardized diagnostic interview and covers a rather broad range of diagnoses applicable to children and adolescents. MINI-KID disorder classifications have shown test-retest reliability and validity comparable to other standardized diagnostic interviews and is claimed to be a useful tool for diagnostic screening in Child and Adolescent Psychiatric care. The concordance between the Swedish language version of the MINI-KID Interview and LEAD (Longitudinal, Expert, All Data) research diagnoses was studied in secondary child and adolescent psychiatric outpatient care.

MINI-KID interviews were performed for 101 patients, boys n  = 50, girls n  = 51, aged 4 to 18 years. The duration of the interview was on average 46 min, the child/adolescent participating together with the parent(s) in most cases. The seven most prevalent diagnoses were included in the analyses.

The average overall percent agreement (OPA) between MINI-KID and LEAD was 79.5%, the average percent positive agreement (PPA) 35.4 and the average percent negative agreement (NPA) 92.7. OPA was highest for Obsessive-Compulsive Disorder (OCD) (0.89), Tic disorders (0.88) and Pervasive developmental disorders (0.81). There were similar results in diagnostic agreement comparing the two versions: the standard MINI-KID and MINI-KID for parents. The specific screening questions in MINI-KID resulted in additional preliminary diagnoses compared with the regular initial clinical assessment.

Conclusions

Overall, there was an acceptable agreement between MINI-KID disorder classifications and research diagnoses according to LEAD. The standardized interview MINI-KID could be considered as a tool with the possibility to give valuable information in the diagnostic process in child and adolescent care which is similar to the setting in the present study.

Peer Review reports

Clinical interviews in Child and Adolescent Psychiatry obtain information about symptoms and impairment related to various disorders, however, missing diagnostic information often gives poor accuracy of the clinical diagnostic decision process [ 1 , 2 ]. Missing diagnostic information could be caused by deciding on a diagnosis before collecting all relevant data and terminating the interview before exploring all alternatives [ 3 ]. One way to increase reliability is to evaluate a child’s mental health status using a standardized diagnostic interview. Consequently many interview instruments have been developed to evaluate the mental health of children and adolescents [ 4 ]. MINI-KID is included in a recent review that describes the characteristics of six published Structured Diagnostic Interviews (SDI), based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) that are available to researchers and clinicians [ 5 , 6 ].

MINI-KID is a short standardized diagnostic interview for DSM-IV [ 7 ] and the International Statistical Classification of Diseases and Related Health Problems - Tenth Revision (ICD-10) [ 8 ] psychiatric disorders in children and adolescents. MINI-KID is an extension of the adult version of the Mini-International Neuropsychiatric Interview (MINI) [ 9 ]. The instrument uses two to four screening questions for each disorder. If the screening questions are positively answered, additional symptom questions are given for the particular disorder. This is in contrast to an unstructured clinical interview running the risk of having to terminate the interview to early. The instrument can be administered by interviewing parent(s) and adolescents together or separately. There is also a newer version of MINI-KID adapted to DSM-5 [ 10 ] available (version7.0.2), not yet translated into Swedish. MINI-KID provides fewer disorders than the more comprehensive Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) [ 11 ] but it covers a rather broad range of diagnoses applicable to children and adolescents and takes much less time to administer. The administration of the K-SADS-PL takes approximately 1.25 h for each parent and child (total time 3 h). MINI-KID has an administration time of 15 to 50 min [ 6 ]. MINI-KID disorder classifications have shown test-retest reliability and validity comparable to other standardized diagnostic interviews. Thus, MINI-KID is claimed to be a useful tool for diagnostic screening in Child and Adolescent Psychiatry [ 5 , 12 , 13 ].

The reliability of the MINI-KID disorder classifications and its validity has been compared with K-SADS-PL, using it as the reference or the gold standard. The authors concluded that MINI-KID generates reliable and valid diagnoses in a much shorter time than K-SADS [ 11 ]. In a recent Swedish study, the K-SADS showed very good validity for most major child psychiatric diagnoses [ 14 ]. However, in that particular study the LEAD assessment included all information from the K-SADS interviews. The administration and interpretation of K-SADS require clinical training and expertise and should be administered by a trained interviewer. Thus, the instrument may not be suitable for use in a clinical setting by an untrained clinician or as the only tool for validation of structured diagnostic interviews. According to Brooks et al., in a review of commonly utilized instruments concerning diagnosis of depressive disorders “Given its extensive demands on time and expertise, and the fact that objective criteria are provided alongside each grade on its 3-point symptom coding scales, its reliability is not particularly impressive” [ 15 ].

A study of the MINI-KID estimated the test–retest reliability for parent-, children- and adolescents-assessed DSM–IV disorders in clinic and general population samples. It compared the factor structure of internalizing and externalizing disorder constructs assessed by the MINI-KID and the Brief Child and Family Phone Interview (BCFPI) as an independent measure of disorder [ 12 ]. The study showed estimates of test–retest reliability and validity comparable to other standardized diagnostic interviews. The authors conclude that “These findings, in addition to the brevity and low administration cost, make the MINI-KID a good candidate for use in epidemiological research and clinical practice.”

However, a recent comprehensive review by Duncan et al. of published evidence on the test–retest reliability of SDIs raises important questions about the overall usefulness of SDI:s in both clinical and research settings [ 16 ]. The pooled test-retest reliability was moderate at Kappa 0.58 and between study heterogeneity was substantial. In addition, previous research has shown low agreement between clinician-generated diagnoses and those from structured diagnostic interviews [ 2 ].

Most prior studies of agreement have not used research diagnoses based on the gold standard methods. One way is to use expert clinical judgements based on information from medical records, to generate best estimate diagnoses in order to come close to the gold standard. Such research diagnoses are operationalized by LEAD (Longitudinal, Expert, All Data) suggested by Spitzer in 1983 [ 17 ]. Spitzer suggests the use of multiple sources of information and monitoring of the patient’s condition and diagnosis over time. In the absence of the established gold standard, LEAD has been widely used in psychopathology research for studying validity of diagnostic procedures [ 2 , 14 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The MINI interview for adults has been validated using expert’s diagnoses [ 28 ]. To the best of our knowledge, MINI-KID has not been validated previously using expert’s diagnoses and the LEAD procedure.

The main goal of the present study was to analyze the concordance between the Swedish language version of the MINI-KID Interview and LEAD (Longitudinal, Expert, All Data) research diagnoses was studied in secondary child and adolescent psychiatric outpatient care. We also studied the relationship between MINI-KID disorder classifications and the diagnoses from the regular initial clinical assessment, expecting a low agreement mainly driven by missing information in the regular initial clinical assessment resulting in lower number of diagnoses compared with the MINI-KID disorder classifications. An additional aim was to compare the two versions of MINI-KID; the standard MINI-KID for children/young persons and the newer version MINI-KID for parents. The MINI-KID disorder classification derived from the two versions were compared with the LEAD assessments.

This is a collaboration project between researchers and clinicians in three parts of Sweden: Stockholm, Gothenburg and the region of Skåne. In Sweden, the child and adolescent mental health services are divided into 1) the primary mental health care with physicians not licensed as specialists in child and adolescent mental disorders and psychologists and 2) the specialized mental health care, secondary level, with staff working in multidisciplinary teams (licensed specialists, i.e. psychiatrics/child psychiatrists, residents, and psychologists, counselors, registered nurses, occupational therapists and others). The present study was conducted in outpatient clinics in group 2. The service is free of charge for the families and part of the general healthcare system in Sweden.

The target population was all new referrals to five outpatient clinics: three in the south-east region of Stockholm (Ektorp, Globen och Farsta), one in the region of Skåne (Lund/Eslöv/Landskrona) and one in Gothenburg (Kungshöjd). Data collection was performed during the years 2013–2016. The exclusion criteria were: 1) recent contact with child and adolescent psychiatry (< 1 year), 2) not spoken Swedish (need of interpreter), 3) known mental retardation (IQ < 70). According to the protocol, the MINI-KID interview in the research project should be conducted after the first regular visit to the clinic, but not more than 6 weeks after the first regular visit. The plan was to use consecutive selection. The study was performed in the regular clinical units and the project coordinator (first author CH) informed the staff and regularly visited the clinics. In spite of these efforts, the study took longer time to perform than we originally expected. The main reason was that a very small proportion of the families in the target population accepted to participate in the study. Another reason was that many families were not asked by the staff to participate. For example, 53 patients were included in the study from the three clinics in Stockholm though having a total of 11,409 new referrals during 2013–2016. There were also logistical difficulties performing the MINI-KID interviews within the time limit (not more than 6 weeks after the first regular visit to the outpatient unit) for the families who were willing to participate in the study. Thus, the sampling procedure resulted in a sample of convenience. Demographics of the study group are presented in the first paragraph of the Results section.

Initial clinical assessment

The initial clincial assessment and preliminary / tentative diagnosis was made by the patient’s regular clinician at the unit in accordance with clinical practice for outpatient care within each region. The clinician performing the initial clincial assessment is either a resident in child and adolescent psychiatry, psychologist, counselor or a registered nurse. In the present study “initial” was defined as all visits and assessements made during 6 weeks after the first regular visit to the outpatient unit. During the first 6 weeks, the average number of visits was 1.9, median 1 SD 1.3, min 1, max 8. The clinician-generated diagnoses were mainly generated through unstructured interviews, that is not using SDI:s; in a few cases short questionnaires were used, for example regarding symptoms of depression.

MINI-KID interview in the research project: was conducted after the first regular visit to the unit, but not more than 6 weeks after the first regular visit. The clinician at the unit performing the clinical assessment did not receive any information about the results of the research MINI-KID interview. The outcome of the MINI-KID interview was not returned directly to the patient/parents and not included in the medical record. However, the patients/parents were offered to be informed of the results of the MINI-KID interview after the LEAD assessment was completed. The parents were not reimbursed for their time but the children were given movie tickets.

The interviewers were physicians ( n  = 2), psychologists (8), social workers (5) and registered nurses (2). The number of interviewers in the three sites were: Stockholm n  = 11, Gothenburg n  = 4, and Skåne n  = 2. They underwent a one-day project-specific education followed by training interviews. Each person conducted 3 interviews to be certified by the MIN-KID trainers. The interviewers who were approved were offered supervision when needed and participated in a follow-up of the training day after 6 months. The MINI-KID interviews were video recorded and a random selection was examined to check for the interviewers’ compliance with the method.

It is a brief semi-structured interview for children between the ages of 4 and 17, developed in collaboration between psychiatrists / clinicians in the USA and Europe for diagnoses [ 5 ]. MINI-KID includes modules covering depressive disorders, suicidality, bipolar disorders, anxiety disorders, obsessive compulsive disorder, posttraumatic stress disorder, alcohol abuse, substance abuse, tic disorders, ADHD, disruptive disorders, psychotic disorders, eating disorders and pervasive developmental disorders. The available Swedish translation is based on DSM-IV and ICD-10. The instrument screens for 24 DSM-IV and ICD-10 psychiatric disorders and suicidality. According to previous studies the interview takes about 30 min to complete after training and sufficient basic knowledge in psychiatric disorders. It is supposed to be sufficient as a short yet reliable interview that can be used both for research and clinical purposes [ 5 ]. The interview often takes place with both parent and child present at the same time, but it can also be done with the young person separately. In addition to the standard version of MINI-KID, the MINI-KID-P version was used. This version is rather recently translated into Swedish and is used when the parent is the main respondent. MINI KID-P is recommended when the child is between 4 and 11 years old, but for children between 8 and 11 years there is a choice between the two versions depending on the child’s developmental level. In the text we use MINI-KID as the general designation for the SDI, MINI-KID-S and MINI-KID-P when specifically describing the standard or parent version.

The message at the project-specific education of the interviewers was that the structure of MINI-KID had to be followed: 1) All modules should be presented in order as well as the screening and follow-up questions. 2) The wording of the questions should be followed but sometimes reformulations and clarifications could be made. 3) It was not permitted to add new questions. Following suggestions by Sheehan [ 5 ] it was recommended that the interview in most cases should be administered with the child/adolescent and parent(s) together. Separate interviews with the informants were not performed. An instruction specific for the present study was made concerning younger children where some screening questions (alcohol, addiction and suicide) were reworded to be more appropriate for this age group. The interviewers were also given the freedom to stop posing questions when they thought they had enough information (although the instruction according to MINI-KID is to ask all follow-up questions for scoring if screening is positive). After an assessment of the answers, the interviewer using paper/pencil completed the form with diagnoses on the first pages in the MINI-KID questionnaire.

The LEAD assessments were performed by six clinical senior experts, psychiatrists and psychologists with many years of clinical experience and profound knowledge of the diagnostic procedure using DSM-IV (Mean 24.2 years, Standard deviation (SD) 6.6). The experts were trained by making LEAD assessments based on the medical records for three patients. Prior to this procedure, the LEAD protocol had been scrutinized and revised during several meetings with the LEAD assessors. Then LEAD assessment was made six months after the patient’s first visit to the child and adolescent psychiatric outpatient clinic. In the assessment, two clinical experts reviewed all data in the patient’s medical record. In the first step, the diagnoses at the initial assessment were extracted from the medical record. In the second step, the LEAD assessors scrutinized the complete medical record data spanning 6 months. The assessment was meant to capture the diagnoses that best represent the 6-month period. Independently of each other, the assessors assigned the most appropriate DSM-IV diagnoses, followed by a discussion and further scrutinizing of the data until there was consensus concerning the diagnosis/diagnoses. The idea was to have meetings with all LEAD assessors in case non-consensus. However, consensus was achieved in all cases. Thus, the patients were followed up in the medical records spanning 6 months. During that period, the total number of visits after the first visit to the unit was on average 7.5 visits (median 7, SD 4.3, min 2, max 21, the 25th percentile was 4 visits). There was an ongoing contact with the unit after 6 months in 65% of the patients. Out of these, 53.1% were still in a state of assessment or on waiting list for neuropsychiatric assessment and 46.9% were receiving treatment. The average duration of contact with the unit was 3.4 months for those patients who finished the contact before 6 months. The documentation in the medical records serving as a base for the clinical diagnostic procedure was rated by the LEAD-experts. The documentation was very well founded in 15.5%, rather well founded in 54.6%, quite unfounded in 20.6% and very unfounded in 9.3%. “Very unfounded” was defined as medical records with very sparse information as a base for the clinical diagnostic procedure and consequently also for the LEAD procedure. The initial clinical assessment and LEAD assessments resulted in some instances of diagnoses not covered by MINI-KID. This is described in Table  1 .

Statistical methods

First a comparison was made between the diagnoses from the MINI-KID disorder classifications and the diagnoses from the regular initial clinical assessment at the outpatient unit. Then the diagnoses in the MINI-KID were compared with the LEAD diagnoses. The most prevalent composite diagnoses according to MINI-KID were used in the comparative analyses; Any anxiety disorder, Any Attention Deficit/Hyperactivity Disorder (ADHD), Any behavioural/disruptive disorder (Oppositional Defiant Disorder (ODD) and or Conduct Disorder (CD)), Any depressive disorder, Any OCD, Any tic disorder and Any pervasive developmental disorder. In addition, “Any diagnosis” was included in the analyses, defined as any of the most prevalent seven diagnoses. Either DSM and ICD-codes or both could be presented in the medical records. The DSM-codes were translated to ICD-10 codes using the mapping tables in the Swedish version of the short version of DSM-5 [ 29 ].

The diagnostic accuracy of a test refers, in this case MINI-KID, to the extent of agreement between the outcome of the new test and a reference standard. We compare a new measurement system MINI-KID with a well-known diagnostic system LEAD. However, when comparing the diagnoses from the MINI-KID disorder classifications with LEAD diagnoses this could be regarded as comparing a new test is evaluated by comparison to an imperfect gold-standard [ 30 ]. In this situation, according to U.S. Food and Drug Administration (2007), you cannot directly calculate unbiased estimates of sensitivity and specificity [ 31 ]. Therefore, the terms sensitivity and specificity are not appropriate to describe the comparative results. Instead, the same numerical calculations are made, but the estimates are called positive percent agreement (PPA) and negative percent agreement (NPA), rather than sensitivity and specificity. This reflects that the estimates are not of accuracy but of agreement of the new test with the non-reference standard. PPA is the proportion of non-reference standard (LEAD) positive patients in whom the new test (MINI-KID) is positive. NPA is the proportion of LEAD negative subjects in whom MINI-KID is negative.

As measures of inter-agreement between the diagnostic procedures/tests we also calculated the following: the overall percent agreement (OPA) (the proportion of subjects in whom the new test (MINI-KID) and the non-reference standard (LEAD) give the same outcome), predictive value of a positive result (PPV) (the proportion MINI-KID positive patients who have the target condition according to LEAD, predictive value of a negative result NPV (the proportion of MINI-KID negative patients who do not have the target condition according to LEAD).

The predictive values described above are not invariant characteristics of the tests and significantly depend on the prevalence of the disease in the population tested. In order to solve this problem, the Likelihood Ratio (LR) was used as a measure which is independent of prevalence. Thus, we also calculated the positive likelihood ratio (PLR) ((1-PPA)/NPA) and negative likelihood ratio (NLR) (PPA/(1-NPA)). However, it should be noted that these calculations were performed using an imperfect reference standard, the research diagnoses according to LEAD. The Likelihood Ratio (LR) is the likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that that same result would be expected in a patient without the target disorder. LR is regarded as one of the most clinically useful measures. PLR is usually a number greater than one and the NLR ratio usually is smaller than one. As a guide to interpretation, PLR above 10 are considered to provide strong evidence to rule in a diagnosis, whereas those between 5 to 10 provide moderate evidence, and those between 2 and 5 provide weak evidence. NLR below 0.1 are considered to provide strong evidence to rule out a diagnosis, whereas those between 0.1 and 0.2 provide moderate evidence, and those between 0.2 and 0.5 provide weak evidence [ 32 ].

Data analysis was conducted using the statistical software Stata [ 33 ].

The study group was 50 boys, 51 girls, by region (n), Gothenburg (30), Lund (18), Stockholm (53). The patients’ age varied from four to almost 18 years at the time of MINI-KID interview (M 11.4, median 11.3, SD 3.5, min 4.2, max 17,9). The boys were on average 10.4 years (median 9.9, SD 3.4, min 4.4, max 17.7) and the girls 12.5 (median 12.9, SD 3.3, min 4.3, max 17.9).

The contact with the child psychiatric outpatient unit started with the regular initial clinical assessment and during the first 6 weeks, the average number of visits was 1.9 (median 1 SD 1.3, min 1, max 8). Within these 6 weeks the MINI-KID interview was performed parallel to and blind to the initial assessment. Each interviewer ( n  = 17) performed on average MINI-KID-interviews with four patients. ( M  = 5.3, median 4, min 1, max 21). The duration of the interview was on average 46 min. In 88 of 101 interviews at least one parent participated together with the patient. In five of 101 interviews the patient was interviewed alone (median age 15.0 years) and in eight cases of 101 the parent was interviewed alone (median age 6.1 years). MINI-KID-P was used in 86.3% of the interviews for children younger than 11.3 years (the median age in the study sample). MINI-KID-S was used in 86.0% for children older than 11.3 years.

In Table 1 the total number of each syndromal diagnosis according to the MINI-KID disorder classifications, the regular initial clinical assessment and the research diagnoses according to LEAD is presented. The total number of diagnoses according to MINI-KID was almost double in the initial assessment. The MINI-KID interview yielded a higher number of diagnoses especially for anxiety disorders, behavioral/disruptive disorder (ADHD not included), OCD and tic disorders. The number of diagnoses was calculated for patients with any anxiety disorder; the average number of anxiety diagnoses per patient was 1.6 (min 1 max 4) according to the MINI-KID interview and 1.1 (min 1 max 2) according to the regular initial clinical assessment.

Table  2 presents analyses of the agreement between the MINI-KID disorder classifications and the regular initial clinical assessment according to the medical record. The prevalence was statistically significantly higher for each category of diagnosis for the MINI-KID-interview with one exception – pervasive developmental disorder. OPA for the seven most common diagnoses (any diagnosis not included) between MINI-KID and diagnoses according to the regular initial clinical assessment was 80.6%, PPA 24.0 and NPA 95.2. OPA was highest for Tic disorders (91.1) and Pervasive developmental disorders (88.1). PLR varied from 1.2 to 6.5 and NLR from 0.0 to 0.9.

Table  3 shows the agreement between the MINI-KID disorder classifications and the LEAD assessment. OPA between MINI-KID and LEAD was 79.5%, PPA 35.4 and NPA 92.7. The average OPA was highest for OCD (0.89), Tic disorders (0.88) and Pervasive developmental disorders (0.81). PLR varied from 1.6 to 9.6 and NLR from 0.3 to 0.8.

Table  4 shows measures of agreement between MINI-KID disorder classifications and the research diagnoses according to LEAD calculated in two different groups of patients, the MINI-KID-S group (49 patients) and MINI-KID-P group (51 patients). There were no statistically significant differences for any of the diagnoses comparing MINI-KID-S and MINI-KID-P with respect to OPA.

This study provides additional information on the diagnostic properties of the MINI-KID disorder classifications. We present data from a Child and Adolescent outpatient clinical sample aged 3.5 to 17.9 years ( n  = 101) describing the concordance between the Swedish language version of the MINI-KID Interview and LEAD research diagnoses in secondary child and adolescent psychiatric outpatient care. There was acceptable agreement between MINI-KID disorder classifications and LEAD showing an average overall percent agreement 79.5 between MINI-KID and LEAD, PPA 35.4, and NPA 92.7. According PLR MINI-KID provided moderate evidence to rule in OCD (PLR 9.6) and weaker evidence to rule in depressive disorder, behavioural/disruptive disorder, tic disorder, ADHD and anxiety disorder (PLR:s from 4.2 to 2.3).

We also present measures of agreement between diagnoses from the MINI-KID disorder classifications with the regular initial clinical assessment. There was similar agreement between MINI-KID disorder classifications and the regular initial assessment with regard to OPA 80.6%, PPA 24.0% and NPA 95.2%.

In the study by Sheehan et al. [ 5 ] the measures of agreement between MINI-KID disorder classifications and K-SADS-PL were generally somewhat higher than we have found comparing MINI-KID with an initial clinical assessment and LEAD after 6 months. The main question about true validity was put forward by Sheehan et al.: “How well does the MINI-KID, or for that matter other instruments like the K-SADS-PL, actually identify “true” cases in the child and adolescent population?” [ 5 ]. We have tried to come closer to true diagnoses using expert clinical opinion based on information from medical records, to generate best estimate diagnoses operationalized by Spitzer’s (1983) LEAD (Longitudinal, Expert, and All Data) Standard [ 17 ].

Validity represent the extent to which an instrument is actually measuring what it is intending to measure. Reliability is required as a base for validity, and is the ability of an instrument to differentiate between individuals. The review by Duncan et al. showed a pooled test-retest reliability with Kappa 0.58 and highly variable. Reliability varied across psychiatric disorders and informants [ 16 ]. The relatively low levels of agreement in the present study between MINI-KID disorder classifications and LEAD could depend on measurement errors and low reliability associated with the implementation of MINI-KID in the present study. The results could also be an example of a general SDI limitation in clinical and research contexts [ 16 ].

The two versions of MINI-KID were compared and their accuracy was similar. The versions were used in two separate groups, the MINI-KID-S group (49 patients) and MINI-KID-P group (51 patients). As recommended by Sheehan [ 5 ], the interview was administered with the child/adolescent together with the parent(s) in most cases. In a few interviews the teenager was interviewed alone and the parent alone for a few younger children about 6 years of age. MINI KID-P is recommended when the child is between 4 and 11 years old, but for children between 8 and 11 years there is a choice between the two versions depending on the child’s developmental level. We found no statistically significant differences tested for each of the diagnoses in the proportions (percent agreement) between MINI-KID-S version for children/adolescents and the parent version of MINI-KID-P.

In the psychometric evaluation by Duncan et al. [ 12 ] the adolescents and parent were interviewed separately, administering the MINI-KID-S to adolescents and the MINI-KID-P to parents. They found generally low agreement between parent and adolescent classification of disorders. On one hand, it could be an effective way to have both the parent and the child/adolescent in the room to get their views at the same time. On the other hand, in some cases it could be difficult for a teenager to tell everything when together with a parent. Thus, MINI-KID has been used in somewhat different ways in the recent studies. Another example is the epidemiological study by Li et al. [ 34 ] using MINI-KID-P where only the parent or guardian was interviewed.

The main aim of the present study was to evaluate the diagnostic properties of MINI-KID disorder classifications in comparison with LEAD. In order to avoid bias in the estimates of the concordance between the results of the MINI-KID Interview and the research diagnoses according to LEAD, the MINI-KID interview was done separately from the regular initial clinical assessment and the following clinical work-up. No information of the results of MINI-KID were included in the LEAD assessment. This is in contrast to other validity studies of standardized diagnostic interviews including the results of the interview in focus for the study when performing the LEAD assessment for example KSADS [ 14 ].

As expected, MINI-KID disorder classifications doubled in the total number of preliminary diagnoses compared to the regular initial clinical assessment. It is arguable that many of these diagnoses from MINI-KID were not actually false. The regular initial clinical assessment could miss diagnostic information and decisions on a diagnosis by not collecting all relevant data or terminating the interview before exploring all alternatives [ 3 ]. According to our clinical experience, many clinicians are hesitant to suggest diagnoses at an initial phase of the diagnostic procedure. The phase of assessment seemed also very extended since many patients in our study were still in a state of assessment or on waiting list for further assessment even after 6 months. This resulted in a problem with the LEAD assessments since some of the medical records, at least in 9.3%, had very sparse information as a base for the LEAD assessment.

The MINI-KID interview resulted in a higher number of anxiety disorders, up to four separate anxiety diagnoses, compared with the regular initial clinical assessment of up to two diagnoses. In addition, the difference in the number of diagnoses were pronounced for behavioural/ disruptive disorder, OCD and Tic disorder. It seems probable that the specific screening questions in MINI-KID reveal important problems at an early phase of the assessment, that may not be asked about or documented in the regular initial clinical assessment. These problems were not always found later on in in the assessment according to LEAD. Nevertheless, the difference in the number between MINI-KID disorder classifications and LEAD diagnoses were less pronounced than between MINI-KID and the initial clinical assessment.

There were on average almost two (1.9) visits during the regular initial clinical assessment during the first 6 weeks but for many patients several more visits. A visit to the outpatient clinics is most often scheduled to 45–60 min. The MINI-KID interview took only about 30 min to complete in the study by Sheehan et al. [ 5 ] and in our study somewhat longer, on average 46 min. It could to be time-efficient to use MINI-KID at the initial clinical assessment in child and adolescent care similar to the setting in the present study. It does not take long time and gives information having the potential to be useful in the diagnostic process.

This study has several strengths: it includes an evaluation of the two versions of MINI-KID, MINI-KID-S for youth and parents MINI-KID-P in a secondary level outpatient child and adolescent psychiatry setting. The validity of the most prevalent MINI-KID diagnoses was calculated based on comparisons with LEAD after 6 months’ follow-up as the criterion. The MINI-KID disorder classifications were also compared with the initial clinical diagnoses. The design included blindness between MINI-KID and the other two measures, LEAD and the initial clinical diagnosis. This made it possible to study the MINI-KID results per se in a non-biased way. Several clinicians performed the interviews after training and the situation was very similar with a natural clinical setting and this avoided bias compared to a situation with very few research-interviewers.

There are limitations as well: A larger sample size would have made it possible to study a higher number of the diagnoses included in MINI-KID and not only the seven most prevalent diagnoses. There are also several levels in the data: the patients/the interviewers/the clinics/the three regions. Due to the limited sample size ( n  = 101) it was considered not meaningful to adjust the statistical calculations with regard to the hierarchical structure of the data. The reason for the longer period of data collection, than we previously expected, was that generally a very small proportion of the families in the target population were asked by the staff / accepted to participate in the study, given that for example the three clinics in Stockholm had 11,409 new referrals during 2013–2016. There were also logistic difficulties performing the MINI-KID interviews within the time limit (not more than 6 weeks after the first regular visit to the outpatient unit) for the families who were willing to participate in the study. The blindness between MINI-KID and LEAD could be looked upon as a strength in the design but it also caused a limitation for the LEAD assessment. LEAD had probably come closer to “true” diagnoses if based on all available data.

There was an overall acceptable agreement between MINI-KID disorder classifications and research diagnoses according to LEAD. The two versions MINI-KID-S and MINI-KID-P had a similar accuracy. MINI-KID-P could be recommended when the child is between 4 and 11 years old, but for children between 8 and 11 years there is a choice between the two versions depending on child’s developmental level. The specific screening questions in MINI-KID resulted in additional preliminary diagnoses compared with the regular initial clinical assessment. It seems probable that the specific screening questions in MINI-KID reveal important problems at an early phase of the assessment. The standardized interview MINI-KID could be considered as a tool with the potential to give valuable information in the diagnostic process in child and adolescent care similar to the setting in the present study.

Abbreviations

Attention Deficit/Hyperactivity Disorder

Brief Child and Family Phone Interview

Conduct Disorder

Diagnostic and Statistical Manual of Mental Disorders

International Statistical Classification of Diseases and Related Health Problems

Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version

Longitudinal, Expert, All Data

Likelihood Ratio

Mini-International Neuropsychiatric Interview

The Mini International Neuropsychiatric Interview for Children and Adolescents

Parent version of MINI-KID

Standard version of MINI-KID

Negative likelihood ratio

Average percent negative agreement

Predictive value of a negative result

Not Statistically Significant

Obsessive-Compulsive Disorder

Oppositional Defiant Disorder

Average overall percent agreement

Positive likelihood ratio

Average percent positive agreement

Predictive value of a positive result

Standard deviation

Structured diagnostic interviews

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Acknowledgements

We thank the staff at the out-patient clinics especially the 17 MINI-KID-interviewers. The research team would like to thank the participating children and parents who generously shared their time and experiences. We thank Anna Spyrous for English language review.

We received no external funding. The study was supported by the County Councils involved.

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The datasets analysed during the current study are available from the corresponding author on reasonable request.

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Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden

Camilla Högberg, Per-Olof Björck & Henrik Höök

Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden

Eva Billstedt

Function Allied Health professionals, Stockholm County Council, Karolinska University hospital, Solna, Sweden

Caroline Björck

Child and Adolescent Psychiatry, Region of Skåne, Lund, Sweden

Lars-Henry Gustle & Mats A. Svensson

Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden

Stephan Ehlers

Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden

Clara Hellner & Eva Serlachius

Department of Women’s and Children’s Health, Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, S-171 77, Stockholm, Sweden

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Contributions

CH, CB, SE, LHG, CH, ES and JOL planned the study design. CH was the coordinator for the clinical study and together with CB responsible for the training of the MINI-KID interviewers. EB, POB, SE, LHG, HH, MS and JOL performed the LEAD assessments. JOL analyzed the data. CH and JOL drafted, edited and finalized the manuscript. All authors edited the manuscript and read and approved the final version.

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Correspondence to Jan-Olov Larsson .

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The Stockholm regional ethical review board gave ethical approval (2013/1254–31/3). All parents and children from age 15 gave their informed written consent prior to their inclusion in the study.

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Högberg, C., Billstedt, E., Björck, C. et al. Diagnostic validity of the MINI-KID disorder classifications in specialized child and adolescent psychiatric outpatient clinics in Sweden. BMC Psychiatry 19 , 142 (2019). https://doi.org/10.1186/s12888-019-2121-8

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Received : 17 September 2018

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DOI : https://doi.org/10.1186/s12888-019-2121-8

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