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ADHD Research Roundup: New Studies, Findings & Insights

Adhd research continues to reveal new insights about attention deficit — its relationship to trauma, race, emotional dysregulation, rejection sensitive dysphoria, and treatments ranging from medication to video games. we’ve curated the most significant news of the past year., adhd research continues to reveal new truths.

ADHD research has produced groundbreaking and impactful discoveries in the past year. Our understanding of the relationship between health care and race has deepened. Alternative treatments, like video games and neurofeedback, are showing encouraging promise while ADHD stimulant medication continues to demonstrate benefits for patients of all ages. The connections between comorbid conditions, gender, and ADHD are better understood than ever before. And we are encouraged by the ongoing work coming from the world’s leading research teams.

Read below to catch up on the most significant news and research from 2020, and stay updated on new findings as they are published by subscribing to ADDitude’s free monthly research digest .

General ADHD Research

Study: Long-Term Health Outcomes of Childhood ADHD are Chronic, Severe November 24, 2020 Childhood ADHD should be considered a chronic health problem that increases the likelihood of adverse long-term health outcomes, according to a population-based birth cohort study of children with ADHD and psychiatric disorders. Further research on the impact of treatment is needed.

Study: Living with ADHD Causes Significant Socioeconomic Burden October 21, 2020 Living with ADHD poses a significant economic burden, according to a new study of the Australian population that found the annual social and economic cost of ADHD was $12.76 billion, with per person costs of $15,664 over a lifetime.

Study: Unmedicated ADHD Increases the Risk of Contracting COVID-19 July 23, 2020 The COVID-19 infection rate is nearly 50% higher among individuals with unmedicated ADHD compared to individuals without ADHD , according to a study of 14,022 patients in Israel. The study found that ADHD treatment with stimulant medication significantly reduces the risk of virus exposure among individuals with ADHD symptoms like hyperactivity and impulsivity.

[ Does My Child Have ADHD? Take This Test to Find Out ]

Study: Poverty Increases Risk for ADHD and Learning Disabilities March 23, 2020 Children from families living below the poverty level, and those whose parents did not pursue education beyond high school, are more likely to be diagnosed with ADHD or learning disabilities, according to a new U.S. data brief that introduces more questions than it answers.

ADHD and Children

Study: Diagnosed and Subthreshold ADHD Equally Impair Educational Outcomes in Children December 21, 2020 Children with diagnosed and subthreshold ADHD both experienced impaired academic and non-academic performance compared to controls used in an Australian study examining the two community cohorts.

Study: Children with ADHD More Likely to Bully — and to Be Bullied November 23, 2020 Children with ADHD are more likely than their neurotypical peers to be the bully, the victim of bullying, or both, according to a new study.

Study: ADHD Symptoms in Girls Diminish with Extracurricular Sports Activity October 16, 2020 Consistent participation in organized sports reliably predicted improved behavior and attentiveness in girls with ADHD, according to a recent study of elementary school students active — and not active — in extracurricular activities. No such association was found for boys with ADHD.

[ Do I Have ADHD? Take This Test to Find Out ]

Study: ADHD in Toddlers May Be Predicted by Infant Attentional Behaviors August 12, 2020 Infants who exhibit behaviors such as “visually examining, acting on, or exploring nonsocial stimuli including objects, body parts, or sensory features” may be more likely to demonstrate symptoms of ADHD as a toddler, according to a new study that also found a correlation between this Nonsocial Sensory Attention and later symptoms of executive dysfunction.

Study Shows Gender Disparities in ADHD Symptoms of Hyperactivity and Poor Response Inhibition June 26, 2020 Girls with ADHD are less physically hyperactive than are boys with the condition, and experience fewer problems with inhibition and cognitive flexibility, according to a new meta-analysis that says more accurate screening tools are needed to recognize the subtler manifestations of ADHD in girls.

Study: Raising a Child with ADHD Negatively Impacts Caregivers’ Mental Wellbeing July 27, 2020 Caring for a child with ADHD negatively impacts caregivers’ quality of sleep, relationships, and satisfaction with free time, among other indicators of mental wellbeing, according to a recent study from the United Kingdom. The significant deficit in sleep and leisure satisfaction led researchers to conclude that caregivers may benefit from greater support — for example, coordinated health and social care — that focuses on these areas.

Study: ADHD, Diet, Exercise, Screen Time All Directly or Indirectly Impact Sleep July 27, 2020 A child with ADHD is more likely to experience sleep problems, in part because ADHD symptoms influence diet and physical activity — two factors that directly impact sleep. This finding comes from a new study that also shows how screen time impacts exercise, which in turn impacts sleep. Understanding these interwoven lifestyle factors may help caregivers and practitioners better treat children with ADHD.

ADHD and Adolescents

Teens with ADHD Should Be Regularly Screened for Substance Use Disorder: International Consensus Reached July 17, 2020 Adolescents with ADHD should be regularly screened for comorbid substance use disorder, and vice versa. This was one of 36 statements and recommendations regarding SUD and ADD recently published in the European Research Addiction Journal.

Study: Girls with ADHD Face Increased Risk for Teen Pregnancy February 12, 2020 Teenagers with ADHD face an increased risk for early pregnancy, according to a new study in Taiwan. However, long-term use of ADHD medications does reduce the risk for teen pregnancies. Researchers suggested that ADHD treatment reduces the risk of any pregnancy and early pregnancy both directly by reducing impulsivity and risky sexual behaviors and indirectly by lowering risk and severity of the associated comorbidities, such as disruptive behavior and substance use disorders.

Study: Teens with ADHD Face Increased Risk for Nicotine Addiction January 27, 2020 Young people with ADHD find nicotine use more pleasurable and reinforcing after just their first smoking or vaping experience, and this may lead to higher rates of dependence, according to findings from a new study published in the Journal of Neuropsychopharmacology .

Study: Adolescent Health Risks Associated with ADHD Go Unmonitored by Doctors February 27, 2020 The health risks facing adolescents with ADHD — teen pregnancy, unsafe driving, medication diversion, and more — are well documented. Yet, according to new research, primary care doctors still largely fail to address and monitor these urgent topics during their patients’ transition to young adulthood.

Study: Emotional Dysregulation Associated with Weak, Risky Romantic Relationships Among Teens with ADHD May 20, 2020 Severe emotional dysregulation increases the chances that an adolescent with ADHD will engage in shallow, short-lived romantic relationships and participate in unprotected sex, according to a new study that suggests negative patterns developed in adolescence may continue to harm the romantic relationships and health of adults with ADHD .

ADHD and Adults

Study: Discontinuing Stimulant Medication Negatively Impacts Pregnant Women with ADHD December 17, 2020 Women with ADHD experience negative impacts on mood and family functioning when they discontinue stimulant medication use during pregnancy, according to a new observational cohort study that suggests medical professionals should consider overall functioning and mental health when offering treatment guidance to expectant mothers.

New Study: Adult ADHD Diagnosis Criteria Should Include Emotional Symptoms April 21, 2020 The ADHD diagnosis criteria in the DSM-5 does not currently include emotional symptoms, despite research indicating their importance. Now, a new replication analysis has found that ADHD in adults presents in two subtypes: attentional and emotional. Researchers suggest that this system offers a more clinically relevant approach to diagnosing ADHD in adults than does the DSM-5 .

Study: Stimulant ADHD Medication Relatively Safe and Effective for Older Adults June 30, 2020 Older adults with ADHD largely experience symptom improvement when taking a low dose of stimulant medication, which is well tolerated and does not cause clinically significant cardiovascular changes. This is the finding of a recent study examining the effects of stimulant medication among adults aged 55 to 79 with ADHD, some of whom had a pre-existing cardiovascular risk profile.

ADHD, Race, and Culture

Study Explores Medication Decision Making for African American Children with ADHD June 23, 2020 In a synthesis of 14 existing studies, researchers have concluded that African American children with ADHD are significantly less likely than their White counterparts to treat their symptoms with medication for three main reasons: caregiver perspectives on ADHD and ADHD-like behaviors; beliefs regarding the risks and benefits associated with stimulant medications; and the belief that ADHD represents a form of social control.

Culturally Adapted Treatment Improves Understanding of ADHD In Latinx Families August 31, 2020 Latinx parents are more likely to recognize and understand ADHD after engaging in culturally adapted treatment (CAT) that includes parent management training sessions adapted to be more culturally appropriate and acceptable, plus home visits to practice skills. This recent review of ADHD knowledge among Latinx parents found that CAT outperformed evidence-based treatment (EBT) in terms of parent-reported knowledge of ADHD.

Treating ADHD

Study: New Parent Behavior Therapy Yields Longer ADHD Symptom Control in Children October 6, 2020 ADHD symptom relapse was significantly reduced in children of parents who participated in a new schema-enhanced parent behavior therapy, compared to those whose parents participated in standard PBT.

Research: Physical Exercise Is the Most Effective Natural Treatment for ADHD — and Severely Underutilized January 22, 2020 A new meta-analysis shows that physical exercise is the most effective natural treatment for controlling ADHD symptoms such as inhibition, attention, and working memory . At the same time, a comprehensive study reveals that children with ADHD are significantly less likely to engage in daily physical activity than are their neurotypical peers.

A Video Game Prescription for ADHD? FDA Approves First-Ever Game-Based Therapy for Attention June 18, 2020 Akili Interactive’s EndeavorRx is the first game-based digital therapeutic device approved by the FDA for the treatment of attention function in children with ADHD. The history-making FDA OK followed a limited-time release of the device during the coronavirus pandemic, and several years of testing the device in randomized controlled trials.

Study: Neurofeedback Effectively Treats ADHD April 9, 2020 Neurofeedback is an effective treatment for ADHD , according to a new quantitative review that used benchmark studies to measure efficacy and effectiveness against stimulant medication and behavior therapy. These findings relate to standard neurofeedback protocols, not “unconventional” ones, for which significant evidence was not found.

Study: Mindfulness-Enhanced Behavioral Parent Training More Beneficial for ADHD Families June 29, 2020 Behavioral parent training (BPT) enhanced with mindfulness meditation techniques provides additional benefits to parents of children with ADHD, such as improved discipline practices and parental behavioral regulation. This is the finding of a new randomized control trial conducted by researchers who compared mindfulness-enhanced to standard BPT.

Mapping the ADHD Brain: MRI Scans May Unlock Better Treatment and Even Symptom Prevention March 9, 2020 Brain MRI is a new and experimental tool in the world of ADHD research. Though brain scans cannot yet reliably diagnose ADHD, some scientists are using them to identify environmental and prenatal factors that affect symptoms, and to better understand how stimulant medications trigger symptom control vs. side effects.

New Clinical Guidelines: Holistic Treatment Is Best for Children with ADHD and Comorbidities February 3, 2020 The Society for Developmental and Behavioral Pediatrics (SDBP) says that children and teens with ADHD plus comorbidities should receive psychosocial treatment, such as classroom-based management tools, in addition to ADHD medication.

Study: Mindfulness Exercises Effectively Reduce Symptoms in Boys with ADHD and ODD May 19, 2020 Boys with both ADHD and ODD were less hyperactive and more attentive after attending a multi-week mindfulness training program, according to a new study that finds promise in this treatment as a viable complement or alternative to medication.

ADHD and Comorbid Conditions

Study: Risk for Diabetes 50% Higher for Adults with ADHD October 23, 2020 A diagnosis of ADHD increased the likelihood of diabetes by as much as 50% for adults with ADHD, according to a recent study from the National Health Interview Survey that found the strong correlation independent of BMI.

Study: ADHD Symptoms Associated with More Severe Gambling Disorder and Emotional Dysregulation January 28, 2020 Roughly one-fifth of individuals diagnosed with gambling disorder in the study also tested positive for ADHD symptoms. This population is more likely to experience severe or acute symptoms of gambling disorder, which is tied to higher emotional dysregulation, according to a new study of 98 Spanish men.

ADHD Research: Next Steps

• Read: New Insights Into Rejection Sensitive Dysphoria
• Download: The All-Time Best Books on ADHD
• Learn: What Is ADHD? Definition, Myths & Truths

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ADHD: Reviewing the Causes and Evaluating Solutions

Luis núñez-jaramillo.

1 División de Ciencias de la Salud, Universidad de Quintana Roo, Chetumal 77039, Quintana Roo, Mexico; xm.ude.oorqu@zenunl

Andrea Herrera-Solís

2 Laboratorio Efectos Terapéuticos de los Canabinoides, Subdirección de Investigación Biomédica, Hospital General Dr. Manuel Gea González, Calz. de Tlalpan 4800, Belisario Domínguez Secc 16, Tlalpan 14080, Ciudad de México, Mexico; moc.liamg@shaerdnaard

Wendy Verónica Herrera-Morales

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in which patients present inattention, hyperactivity, and impulsivity. The etiology of this condition is diverse, including environmental factors and the presence of variants of some genes. However, a great diversity exists among patients regarding the presence of these ADHD-associated factors. Moreover, there are variations in the reported neurophysiological correlates of ADHD. ADHD is often treated pharmacologically, producing an improvement in symptomatology, albeit there are patients who are refractory to the main pharmacological treatments or present side effects to these drugs, highlighting the importance of developing other therapeutic options. Different non-pharmacological treatments are in this review addressed, finding diverse results regarding efficacy. Altogether, ADHD is associated with different etiologies, all of them producing changes in brain development, leading to the characteristic symptomatology of this condition. Given the heterogeneous etiology of ADHD, discussion is presented about the convenience of personalizing ADHD treatment, whether pharmacological or non-pharmacological, to reach an optimum effect in the majority of patients. Approaches to personalizing both pharmacological therapy and neurofeedback are presented.

1. Introduction

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder (NDD) presenting with inattention, hyperactivity, and impulsivity. It can be classified in three subtypes, depending on the intensity of the symptoms: predominantly inattentive, predominantly hyperactive–impulsive, and combined [ 1 , 2 ]. ADHD has a global prevalence of 5.9% to 7.1% in children and 1.2% to 7.3% in adults [ 3 ].

While most studies address ADHD in children from 7 to 17 years old, it is important to outline that this condition is also present in adults. It has been proposed that the number of adults with ADHD has increased over the last 20 years. A part of this increase is due to the permanence of ADHD symptoms in the adult age in 76% of diagnosed patients. ADHD implies important challenges for academic, personal, and job performance [ 4 ].

As for any other condition affecting brain function, in order to find an adequate treatment for ADHD, it is important to first understand its physiological basis. As with other NDDs, the causes of ADHD are aberrant neural development, affecting neurogenesis, synaptogenesis, myelination, and neuronal and glial proliferation and migration. Even though symptoms begin to appear in childhood, neuronal development is affected from early embryogenesis [ 5 ].

The etiology of ADHD is diverse—gestational, perinatal, and genetic factors have been associated with ADHD incidence. However, each patient presents only a few of them.

2. Environmental Factors Associated with ADHD

The incidence of ADHD is associated with a number of environmental factors during different stages of central nervous system (CNS) development, such as gestational and perinatal periods. In this section, we will address some of the environmental factors that have been associated with ADHD.

2.1. Preconceptional, Gestational, and Perinatal Conditions

Premature birth is an important risk factor for ADHD, since it has been reported that it occurs 2.6 to 4 times more frequently in babies born with low weight or very low weight. Premature birth is associated with alterations in neurogenesis and cell death [ 6 ], and these are in turn associated with reduced cortical expansion, as reported in ADHD patients [ 7 ]. One possible reason for increased risk of developing ADHD in preterm children is inflammation; an increase in inflammation-related molecules is associated with increased risk of developing ADHD symptoms [ 8 ].

Perinatal hypoxia is an environmental factor that increases the risk of developing AHDH, probably due to its effects on dopaminergic transmission and neurotropic signaling [ 9 ].

The intake of nutrients during gestation is very important for proper brain development. An important element during neural development is the polyunsaturated fatty acid docosahexaenoic acid (DHA), promoting proliferation and neural differentiation of neural progenitor cells. Decreased levels of DHA during brain development have been associated with ADHD and other neurodevelopmental disorders [ 10 ], and decreased levels of serum DHA levels have been reported in adult ADHD patients [ 11 ]. Additionally, malnutrition or immune activation in the pregnant mother is a risk factor for ADHD and other neurodevelopmental disorders [ 12 ]. High sucrose consumption during pregnancy is possibly related with ADHD incidence. A study performed on rats reported that high sucrose intake in pregnant rats led to the appearance of ADHD-like symptoms in the offspring, who showed increased locomotor activity, decreased attention, and increased impulsivity. Furthermore, the offspring also presented increased dopamine transporter (DAT) and a decrease in dopamine receptors and mRNA expression in the striatum [ 13 ].

Interestingly, there is evidence in a rat model of the influence of preconceptional conditions on ADHD incidence. Offspring of Female rats administered with ethanol for 8 weeks before mating presented ADHD-like symptoms such as hyperlocomotive activity, impulsivity, and attention deficit. These rats also presented low levels of striatal DAT and increased presence of norepinephrine transporter (NET) in the frontal cortex [ 14 ]. A later work by this group revealed that paternal preconceptional alcohol exposure also produced ADHD-like symptoms in the offspring, presenting decreased expression of DAT mRNA and DAT protein in the cortex and striatum. Furthermore, authors report epigenetic changes in both the sperm of these alcohol-exposed male rats and in the frontal cortex and striatum of the offspring, presenting increased methylation in a CpG region of DAT gene promoter, which is in agreement with the reduced expression of DAT in the offspring [ 15 ].

Another environmental factor associated with ADHD is pesticide exposure during development. A study addressing the issue, both at experimental and epidemiological levels, reported that exposure to the pesticide deltamethrin during gestation and lactation in rats led to ADHD-like symptoms, such as working memory and attention deficits, hyperactivity, and impulsive-like behavior. It also produced increased presence of DAT and D1 receptor in the striatum, as well as increased dopamine release and increased presence of D1 dopamine receptor in the nucleus accumbens. Interestingly, the authors also performed an epidemiological study in humans, revealing that children (6 to 15 years old) with detectable levels of pyrethroid metabolites in urine had more than twice the probability of being diagnosed with ADHD [ 16 ].

2.2. Heavy Metal Exposure

One of the most reported environmental factors associated with ADHD is exposure to neurotoxic heavy metals. A study performed on school children revealed that children (6–7 years old) with ADHD presented higher levels of salivary mercury. However, when including all age groups studied (12–13 years and 15–16 years), no significant correlation was found between increased salivary mercury and ADHD, although a mild tendency was observed [ 17 ].

In the case of manganese, both too high and too low blood levels are associated with cognitive deficits. High concentration of manganese in blood is associated with deficits in thinking, reading, and calculations, as well as with lower learning quotient (indicative of learning disability) and more errors in the continuous performance test (measuring attention and response inhibition). Conversely, low blood level of manganese is associated with a poorer performance in the Stroop test, which is used to assess cognitive inhibition [ 18 ]. Similarly, a study addressing the relationship between manganese in drinking water and ADHD found a higher risk of developing this condition (inattentive but not combined subtype) as exposure to manganese in drinking water increased [ 19 ]. However, a study on manganese in children’s deciduous teeth failed to find an association between this metal and cognitive deficits [ 20 ].

The presence of lead in children’s deciduous teeth is positively associated with hyperactivity or impulsivity, as well as inattention and oppositional or defiant disorder [ 20 ]. A study on children from a lead-contaminated region reported that blood levels of cadmium, lead, and manganese correlated with conduct problems and antisocial behavior [ 21 ]. Another work found a higher concentration of blood lead in ADHD children, which was correlated with hyperactivity–impulsivity symptoms but not with inattention [ 22 , 23 ]. Both genetic [ 24 ] and epigenetic [ 25 ] factors have been reported to contribute to lead-related pathogenesis of ADHD. Moreover, a study carried out in Argentina found that children with high blood concentrations of lead are more likely to develop ADHD [ 26 ].

A review on the effects of prenatal and childhood metal exposure on cognition found suggestive evidence of a relation between cadmium exposure and impaired cognitive ability in children. They did not find evidence of a relationship between cadmium exposure and ADHD [ 27 ]. A more recent study addressing cadmium exposure during pregnancy revealed that a higher blood cadmium concentration during pregnancy is associated with higher scores in ADHD diagnostic tests in female children at 6 years of age, but not in the case of male children [ 28 ].

A recently published work reported that ADHD children present higher urine concentrations of chromium, manganese, cobalt, nickel, copper, molybdenum, tin, barium, and lead [ 29 ]. A recent study analyzing serum concentrations of different metals in ADHD children reported low levels of chromium, manganese, and zinc, as well as increased copper/zinc ratios in these children [ 30 ]. A meta-analysis on the relation between blood and hair zinc and ADHD found no statistical difference between ADHD and control children [ 31 ].

Thus, there are a number of environmental factors associated with ADHD incidence. While environmental factors are not found in all ADHD cases, the data reviewed herein highlight the importance of environment in different developmental stages—and even before conception—in regard to the risk of developing ADHD.

3. Sleep Disorders and ADHD

Sleep deprivation, either acute or chronic, produces decreased cognitive functioning (one of the main traits of ADHD). Interestingly, it also produces the externalizing symptoms observed in ADHD patients. For example, a very tired child might become hyperactive, while in a sleepy adult in a condition where it is not possible to sleep (for example, while driving), the externalizing behavior will help them to remain awake. Thus, both of the core ADHD symptoms can be produced by sleep deprivation. Conversely, hyperactivity in children or high internal activity in adults in the evening might lead to sleep disruption [ 32 ].

Among the sleep disorders found in ADHD patients are delayed sleep phase disorders, insomnia, sleep-disordered breathing, increased motor activity during the night, sleep anxiety, clenching teeth, periodic limb movement, restless legs, increased sleep onset latency and shorter sleep time, night awakenings, narcolepsy, and parasomnias [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Among them, delayed sleep phase disorder is one of the most frequently found, being present in 73–78% of both ADHD children and adults. This condition consists of a delay between the sleep propensity cycle and the circadian cycle, leading to increased daytime sleepiness and decreased cognitive functioning [ 32 ].

Sleep disturbance have an impact on daytime vigilance, producing excessive sleepiness [ 32 , 37 , 39 ], and can exacerbate inattention, impulsivity, and hyperactivity as means to remain awake [ 32 , 37 ]. Additionally, stimulant medication might also cause sleep disturbances, although OROS methylphenidate produces less adverse effects on sleep [ 34 , 36 ]. LDX, a stimulant prodrug that undergoes hydrolysis in the bloodstream releasing d-amphetamine, and atomoxetine, a non-stimulant pharmacological treatment for ADHD, do not produce adverse effects on sleep [ 36 ].

Sleep disturbances in ADHD patients can produce significant impairments in attention, mood, and behavior [ 32 , 35 ]. Physiologically, there is evidence supporting an overlap between brain centers regulating sleep and those regulating attention and arousal, so it is possible that affectation of one of these systems also affects the other. Similarly, affectation of noradrenergic and dopaminergic pathways is found in both ADHD and sleep disturbances [ 40 ].

Conversely, during wake time, sleep disturbances produces symptoms resembling those observed in ADHD patients [ 35 , 41 , 42 ]. It is, thus, recommended to assess sleep disorders in patients with ADHD symptoms in order to avoid misdiagnosis [ 41 , 42 ].

The relationship between sleep disorders and ADHD is complex. While ADHD might produce sleep disorders, they could also be coincident conditions [ 36 ]. Moreover, sleep disorders have been proposed to be not only one of the intrinsic features of ADHD, but also might be one of its causes [ 32 , 36 ]. Another possible explanation for this interaction would be an underlying common neurological disease leading to both sleep disorders ad ADHD [ 36 ]. A recent review on the subject proposed that chronic sleep disorders are some of the main causes of ADHD symptoms [ 32 ]. The authors suggested that patients presenting ADHD symptoms should undergo quantification of sleep and sleep problems in order to rule them out as the sole cause of ADHD symptoms. Thus, ADHD treatment should address both the symptoms (with classic ADHD treatment) and the sleep problem [ 32 , 34 , 35 , 36 ], although the effect of this combined treatment still requires further research [ 32 ].

4. Genetic Factors Associated with ADHD

Different studies have revealed an important genetic influence in the etiology of ADHD [ 43 ]. It is a polygenic condition with an important number of genes involved, as confirmed by a genome-wide association study on ADHD reporting 12 significant loci associated with this condition [ 44 ]. Many of the genes reported to be associated with ADHD participate in processes such as neurotransmission, neuritogenesis, synaptogenesis, or receptor location in synapses [ 45 ]. In this review, we will focus on two genes, a neurotrophin (brain-derived neurotrophic factor –BDNF-) and a molecule involved in dopaminergic signaling (DAT).

Brain-derived neurotrophic factor (BDNF) is a neurotrophin with high expression in the brain that is highly concentrated in the hippocampus and cortex. It has an important role in neuronal development, being important for neuronal proliferation, migration, differentiation, and maturation, as well as for synaptogenesis [ 46 ].

BDNF has been implied in ADHD pathophysiology. It has been proposed that low levels of this neurotrophin may explain the reduction in brain volume observed in ADHD patients, and it has also been implied in dopaminergic system homeostasis. Some pharmacological treatments for ADHD promote the regulation of plasma BDNF levels [ 47 ].

4.1.1. Circulating BDNF

Since BDNF is able to cross the blood–brain barrier and plasma concentrations of BDNF are highly correlated with its levels on cerebrospinal fluid, a number of studies have searched for a difference in plasma concentrations of BDNF in ADHD patients when compared against controls. There are reports indicating a lower concentration of BDNF in plasma of ADHD patients, both in children [ 48 ] and adults [ 49 ]. In another study involving children, an increase in plasma BDNF was observed after 6 weeks of treatment with an effective dose of methylphenidate [ 50 ]. In accordance, a recent study revealed that methylphenidate treatment produces an increase in serum BDNF in boys with ADHD [ 51 ]. However, this has not always been replicated, since there are also articles reporting no difference in serum BDNF between children with ADHD and controls [ 52 , 53 , 54 ].

A recently published meta-analysis encompassing studies comparing BDNF levels in ADHD patients without any other comorbidity found no overall difference between ADHD patients and controls. However, when analyzing males and females separately, they found significantly higher levels of plasma BDNF in males with AHDH than in control males, while no difference was found between females with and without ADHD [ 55 ].

Thus, different and even contrary results have been obtained regarding BDNF concentrations in plasma or sera of ADHD patients. While this suggests that the link between BDNF and ADHD is not completely clear, other alternatives should be considered. For example, fluctuations in serum BDNF concentrations in morning and evening samples have been reported [ 56 ], meaning the lack of relation between peripheral BDNF concentration and ADHD might be due to the time of the day when the sample was obtained.

4.1.2. Genetics of BDNF

There are a number single nucleotide polymorphisms (SNP) of the BDNF gene that have been associated with ADHD. Among the most studied variations in the BDNF gene, there is a polymorphism called Val66Met (also known as rs6265), in which a change in codon 66 produces a substitution of the original amino acid (valine) by methionine. The anatomical effects of this variation are more apparent in the hippocampus and cortex [ 46 ]. While some studies have assessed the presence of this SNP in ADHD patients [ 57 , 58 , 59 ], other studies failed to find an association between this polymorphism and ADHD [ 46 , 60 , 61 , 62 , 63 ].

Another SNP of the BDNF gene whose association with ADHD is not conclusive is rs2030324, since some studies report an association between this polymorphism and ADHD [ 57 , 58 , 59 , 64 ], while other reports fail to find this association [ 46 , 60 , 61 , 62 , 63 ].

There are other SNPs of the BDNF gene that have been studied so far, with positive correlations being shown between ADHD and the presence of C270T (rs27656701) [ 58 , 61 ], rs11030101 [ 62 , 64 , 65 ], and rs10835210 [ 62 , 63 ]. There are also reports addressing SNPs of the BDNF gene for which no association with ADHD has been found, including rs12291186, rs7103411 [ 63 ], and rs7103873 [ 62 , 63 ].

Moreover, rare single nucleotide variants of BDNF gen have also been associated with a higher risk of developing ADHD [ 66 ]. However, this is an area that requires further research.

As observed with peripheral BDNF concentrations, genetic variants of the BDNF gene have been associated with ADHD in numerous cases, although in some cases there are contradictory results in different articles (see Table 1 ). Moreover, some of the genetic variants of the BDNF gene associated with ADHD have also been studied in association with other neurological conditions and treatments. For example, C270T is reported to be associated with intellectual disabilities [ 58 ]. Moreover, rs11030101 is associated with a better response to electroconvulsive shock therapy for treatment-resistant depression [ 67 ], with body weight gain in schizophrenic patients treated with atypical antipsychotics [ 68 ], as well as with the presence of major depressive disorder [ 69 ], schizophrenia, and bipolar disorder [ 70 ], although there is another publication in which no evidence of association between this SNP and bipolar disorder was found [ 71 ]. Additionally, rs10835210 has been associated with bipolar disorder, schizophrenia [ 70 ], and phobic disorders [ 72 ].

Polymorphisms of the BDNF gene studied in relation with ADHD incidence. * Polymorphisms for which contradictory results have been reported. rs, reference SNP ID number.

For rs6265 (Val66Met), there are many articles addressing the association of this SNP with different conditions, and in some of them it has been found. For example, some articles report an association of this SNP with major depressive disorder [ 69 , 73 ], while other studies fail to find this association [ 74 , 75 ]. An association has also been reported between rs6265 and amnestic mild cognitive impairment, as well as with the transition from this condition to Alzheimer’s disease [ 76 ]. However, in patients with early-stage breast cancer, this SNP is associated with a lower probability of presenting cognitive impairment after chemotherapy [ 77 ].

4.1.3. Other Neurotrophines

While BDNF has been widely studied in association with ADHD, it is not the only neurotrophin studied in relation with this condition, given the important role of neurotrophines in central nervous system development and synaptic plasticity. In this regard, there are studies addressing the participation of fibroblast growth factor (FGF), vascular endothelial growth factor, insulin-like growth factor (IGF2) [ 47 ], glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF), and neurotrophin-3 (NTF-3) [ 47 , 53 ] in ADHD pathophysiology.

BDNF is a molecule highly involved in synaptic plasticity and has an undisputed role in central nervous system development. Therefore, it is not surprising to find a number of studies associating alterations in the presence of this neurotrophin in serum, or different SNPs of its gene, with ADHD. However, its role in ADHD development is not a constant for every sample of ADHD patients studied so far, and for many of the aspects of this molecule (serum levels, SNPs) there are reports indicating associations, with others finding no association at all. This does not mean that the alterations associated with this molecule are not important for ADHD, but rather highlight the variable etiology of this condition.

4.2. Dopaminergic System

The dopaminergic system emerges in early stages of CNS embryonic development, and an imbalance in this system might affect brain development. It is related with cell proliferation, neuronal differentiation and migration, synaptogenesis, and neurogenesis. Thus, it is not surprising that a role of this neurotransmitter system has been reported in different neurological diseases, including ADHD [ 78 ].

One of the most studied molecules of the dopaminergic system in relation to ADHD is DAT, a molecule responsible for dopamine reuptake, and the main target of two commonly used pharmacological treatments for ADHD, methylphenidate and amphetamines [ 78 ]. Genetic studies support the importance of this neurotransmission system for ADHD. Mice heterozygous for the DAT gene (+/− heterozygotes) are reported to present altered attentional function [ 79 , 80 ] and hyperactivity [ 80 ], while rat models with this heterozygous genotype do not present major affectations [ 81 , 82 ]. However, DAT knockout rats present hyperactivity [ 81 , 82 ], as well as a dysregulation in frontostriatal BDNF function [ 82 ]. Hyperactivity in these rats can be counteracted by amphetamine, haloperidol, and methylphenidate [ 82 ].

In humans, ADHD patients present lower DAT availability in the basal ganglia, caudate nucleus, and putamen [ 83 ]. The DAT gene presents a variable tandem repeat region (VNTR) at the untranslated 3′region, and there are different alleles for this VNTR, with the 9-repeat and 10-repeat alleles being the most frequently encountered. The reported effects of this VNTR on DAT expression vary in different articles, however the most recent results indicate that the 9-repeat allele is associated with a higher DAT expression than the 10-repeat allele. [ 84 ]. The possible association between this VNTR and ADHD has been addressed in various studies. For example, an analysis of both patients and the literature found an association of the 10-repeat/10-repeat genotype with ADHD only in adolescents [ 85 ], studies performed in children reported an association between the 10-repeat/10-repeat genotype and ADHD [ 86 , 87 ], while a recently published meta-analysis reported an association of the 10-repeat allele with ADHD in children and adolescents, specifically in European population [ 88 ]. However, there are also reports indicating no association at all between ADHD and the VNTR of DAT gene (9-repeat/10-repeat, 10-repeat/10-repeat, and 10-repeat/11-repeat genotypes) [ 89 ], no association between the 10-repeat/10-repeat allele with ADHD [ 90 ], and no association between ADHD and the 9-repeat or the 10-repeat alleles for this polymorphism [ 91 ]. The last three studies were performed in children.

Additionally, the relevance of this VNTR has been studied in relation to cognitive function in healthy subjects. Again, mixed results were found. A meta-analysis published in 2016 addressing studies performed in healthy subjects did not find any association between DAT VNTR and different cognitive functions, such as executive functions, inhibition, attention, and long-term declarative memory [ 92 ]. A study performed in children aged 3 to 5 years old addressing the presence of the 9-repeats and 10-repeats alleles revealed that the presence of the 10-repeat allele of the DAT gene is associated with diminished ability to voluntarily regulate reactivity in healthy children [ 93 ]. A recent study on both ADHD and healthy children reported an effect of the specific genotype in the performance of children on attentional switching when studying the whole research sample, in which children carrying the 9-repeat allele performed worse than those carrying the 10-reapet homozygous or the 10-repeat/11-repeat heterozygous allele [ 91 ]

The participation of the dopaminergic system in the pathophysiology of ADHD has been widely reported [ 78 ]. Herein, we study a particular variation of the DAT gene, a VNTR in the 3′ region of the gene, finding articles supporting a role of this polymorphism in ADHD, as well as works failing to find an association between this VNTR and ADHD. This does not imply a lack of importance of this variation, but rather highlights the variability in the genetic etiology of this condition. Moreover, while the dopaminergic system is highly involved in the pathophysiology of ADHD, given its role in CNS development, it is also strongly related with other neuropsychiatric conditions, such as autism [ 78 , 94 , 95 ] and schizophrenia [ 78 , 94 , 96 , 97 ].

5. Changes in Brain Structure and Function in ADHD Patients

As an NDD, ADHD involves alterations of mechanisms such as neurogenesis and synaptogenesis. There are a number of possible mechanisms through which these alterations take place, both environmental and genetic, some of which have been mentioned in the present review. In the end, all of these altered mechanisms produce an altered brain function affecting attention and impulse control, functions regulated by the central nervous system. Understanding the changes in brain function associated with ADHD might shed some light not only on the functional causes of this condition, but also on possible ways to deal with it.

5.1. Brain Imaging Studies

Children with ADHD present atypical connectivity in reward circuitry when compared with control children. Increased connectivity of the nucleus accumbens with the prefrontal cortex was observed to be associated with greater impulsivity [ 98 ].

Hypofunction and abnormal cortico-striatal pathways of the cortico-striato-thalamo-cortical (CSTC) circuit are associated with ADHD. Five different CSTC circuits have been reported: the sustained attention circuit, emotion circuit, selective attention circuit, hyperactivity circuit, and impulsivity–compulsivity circuit. Four of them (except emotion circuit) have been related with ADHD diagnostic criteria. However, pathogenesis of the emotion circuit is also related with ADHD [ 99 ]

A study on ADHD children reported significantly decreased white matter volume, as well as decreased volume in the cortex and caudate nucleus, although it did not reach statistical significance. Cortical thickness was reduced in ADHD patients bilaterally in the frontal cortex and in the right cingulate cortex, structures related with executive function and attention. Regarding default mode network, functional connectivity was reduced in ADHD children in the anterior and posterior cingulate cortexes, lateral prefrontal cortex, left precuneus, and thalamus. However, connectivity was increased in the bilateral posterior medial frontal cortex [ 100 ].

A study on male adolescents with ADHD and controls reported decreased gray matter volume in the left anterior cingulate cortex and bilateral decreases in the occipital cortex, hippocampus–amygdala complex, and cerebellum in ADHD adolescents [ 101 ]. Such decreases in cerebellar volume have been previously reported in both female and male ADHD patients [ 102 ].

An important issue with many of the imaging studies in ADHD patients has been small sample size. A large-scale study performed on children, adolescents, and adults with ADHD reported decreased surface area in children, mainly in the frontal, cingulate, and temporal regions. This effect was more pronounced in younger children (4–9 years old). Moreover, cortical thickness in ADHD children is also reduced in the fusiform gyrus and temporal lobe, an effect more prominent in children of 10 and 11 years old. No change in surface area or cortical thickness was observed in adolescent or adult ADHD patients [ 103 ].

There are important changes in brain morphology in ADHD patients. An elegant study performed in ADHD patients and controls from 6 to 28 years of age analyzed differences in neurodevelopmental trajectories. This study reported that ADHD patients present overall reduced cortical volume, mainly in frontal lobes, and primarily due to a decrease in surface area and gyrification. Interestingly, although both groups presented maturational changes due to age, they presented different trajectories for these changes, suggesting that ADHD is associated with developmentally persistent changes in the whole cortex, mostly due to decreased surface expansion (reduced surface area and less convolution) [ 7 ].

When comparing children with comorbid epilepsy and ADHD with control children, a widespread decrease in cortical thickness is observed, along with decreased volume in some subcortical structures and the brainstem. These alterations were observed early in the course of epilepsy, thus the authors suggested that neurodevelopmental changes occurred before epilepsy onset [ 104 ]. In children with comorbid autism spectrum disorder and ADHD, when compared with typically developing controls, presented significantly lower volumes in left postcentral gyrus. This was observed through magnetic resonance imaging in both children and preadolescents, but was absent in adolescents. The authors suggested that pathophysiology in these comorbid patients may be related to somatosensory deficits and delayed maturation in this area [ 105 ].

5.2. Quantitative Electroencephalography

All these changes lead to alterations in brain function. A frequently used technique for the study of brain activity is quantitative electroencephalography (qEEG), since it has a low cost, a high temporal resolution, and does not need special facilities to be performed. Furthermore, qEEG has also been used to determine the effects of pharmacological treatments on brain activity in order to assess effectiveness [ 106 , 107 ], to choose the correct pharmacological option for a patient [ 108 ], to study the effects of previous pharmacological treatments on the current one [ 109 , 110 ], as well as to determine a possible cognitive effect of the chosen pharmacological treatment [ 111 ].

During the last decades, several studies have performed qEEG analyses on ADHD patients. A review on the subject published in 2012 addressed the main associations between brain activity and ADHD, including increased frontocentral theta activity. Another frequently reported factor, although not always replicated, is an increased theta/beta ratio. For beta and alpha bands, most of the reports have indicated decreased activity, although there are also reports that have indicated increased activity in these frequency bands in ADHD patients [ 112 ]. One of the most used indicators for ADHD is the theta/beta ratio in the Cz region. It has been reported that ADHD children (inattentive and combined subtypes) present increased theta/beta ratios [ 1 ]. Another study found that children with ADHD presented more delta and theta activity [ 113 ]. However, some authors have mentioned that this measure is not necessarily useful for diagnosis, since among other issues, it presents variations according to age [ 114 ].

Another example of the influence of age on brain electrical activity associated with ADHD is a study comparing children with and without ADHD, as well as adults with and without ADHD. Interestingly, children with ADHD presented higher delta and theta activity than control children, while in adults no difference was found between ADHD group and controls in the frequency bands analyzed [ 115 ]. Among the few differences in qEEG activity found in adults with ADHD is a higher gamma activity (39.25–48 Hz), suggesting a functional alteration in dorsal attention network [ 116 ].

ADHD patients often present comorbidities [ 117 ], which might influence qEEG in a different way to the findings in ADHD only patients. For example, children with ADHD and problematic Internet use present differences in qEEG when compared to ADHD only patients. However, no differences were found between ADHD only patients and ADHD patients with depression [ 118 ]. Another study found that adolescents with ADHD and Internet gaming disorder presented lower relative delta power and greater relative beta power than adolescents with ADHD only [ 119 ].

It is noteworthy that although a number of studies have been published regarding neurophysiological correlates of ADHD through qEEG, there are still some differences in the results reported by different authors. Beyond possible methodological differences, there are a number of factors reported to influence qEEG activity in ADHD patients, which might be responsible—at least in part—for the differences reported so far, and which might be of importance when using qEEG information to choose or design a therapeutic approach. These factors include comorbidities [ 4 , 120 ] and the ages of the patients [ 114 , 116 , 121 ]. Other factors reported to affect qEEG activity in other populations and conditions are ethnicity [ 122 , 123 , 124 , 125 , 126 ], sociocultural environment during development [ 127 , 128 ], and the degree of advancement of a psychiatric condition, as reported for alcohol dependence [ 129 , 130 , 131 ].

6. Therapeutic Approaches

6.1. pharmacological treatment.

Both stimulant and non-stimulant pharmacological treatments have proven to be effective in diminishing ADHD symptoms in children and adolescents [ 132 , 133 ], although stimulant medication seems to have greater effectiveness [ 133 , 134 ]. Herein, we will address one frequently used stimulant (methylphenidate) and one frequently used non-stimulant (atomoxetine)

6.1.1. Methylphenidate

Methylphenidate is one of the most used drugs for ADHD treatment. It has been present in the market for 50 years and it reduces excessive hyperactivity, impulsivity, and inattention in children and adolescents with ADHD. In the United States, it is prescribed to 8% of children and adolescents under 15 years of age and to around 3% to 5% of the same population in Europe [ 135 ].

Methylphenidate blocks DAT and NET, reducing reuptake and producing an increase in available dopamine and norepinephrine in the synaptic cleft [ 135 , 136 , 137 ], leading to increased dopamine and norepinephrine transmission in the prefrontal cortex [ 132 ]. A meta-analysis on the effects of methylphenidate treatment on ADHD in adults found it effective in improving neurocognitive performance, accomplishing better results than placebo groups in terms of working memory, reaction time variability, vigilance, driving, and response inhibition [ 136 ].

6.1.2. Atomoxetine

Atomoxetine has been reported to be effective for ADHD treatment [ 138 ], being more effective in adults than in children [ 134 ].

Atomoxetine blocks norepinephrine reuptake, producing increased presence of norepinephrine and dopamine in prefrontal cortex [ 132 ]. Since atomoxetine does not produce an increase of dopamine or norepinephrine in the nucleus accumbens, it lacks abuse potential [ 132 , 139 ]. This drug is associated with improvements in quality of life in children adolescents and adults, although this parameter is not further increased with long-term use [ 139 ].

6.1.3. Adverse Effects

Both stimulant and non-stimulant pharmacological treatments for ADHD produce adverse effects in a percentage of treated patients. The main adverse effects found for these drugs (% of patients treated with stimulants/% of patients treated with non-stimulants) are decreased appetite (28.6%/14.2%), nausea (7.9%/10.3%), headache (14.5%/20.8%), insomnia (12.3%/8.6%), nasopharyngitis (6.0%/7.1%), dizziness (5.1%/10.0%), abdominal pain (7.8%/11.5%), irritability (9.3%/6.9%), and somnolence (4.4%/34.1%) [ 133 ].

A systematic review on the adverse effects of methylphenidate in children and adolescents revealed that about 1 in 100 patients present serious adverse events after methylphenidate treatment (including death, cardiac problems and psychiatric disorders), while more than half of the patients treated with methylphenidate suffer one or more adverse events. The authors concluded that it is important to identify subgroups of patients who might be harmed by methylphenidate treatment and highlight the importance of remaining alert to possible adverse events in patients with this treatment [ 135 ]. There might also be uncommon adverse effects. For example, there is a report of 3 cases of systemic sclerosis associated with methylphenidate treatment [ 140 ]. The authors of the last study suggested that patients with signs of autoimmune or vasospastic conditions should be briefed about this possible side effect before commencing methylphenidate treatment.

A systematic review on possible adverse effects of atomoxetine, including decreased growth rate, cardiovascular and hepatic effects, aggression, psychosis, seizures, and suicidal ideation, determined that evidence indicates it is safe to use in ADHD patients [ 141 ]. Furthermore, the presence of comorbidities does not interfere with treatment efficacy, nor does treatment exacerbate comorbid symptoms [ 142 , 143 ]. However, it is important to be alert to other possible adverse effects. A case report and review indicated that the appearance of tics is a common side effect of atomoxetine treatment [ 144 ].

Methylphenidate and atomoxetine are known to increase heart rate and blood pressure, raising concern regarding possible cardiovascular effects of these drugs in ADHD patients. A review on the cardiovascular effects of these drugs in healthy subjects found the drug to be safe to use. Most of these studies were performed in children and adolescents, although there have also been some studies performed on adults, with no serious risk being reported in these subjects either. However, patient blood pressure and heart rate should be monitored on a regular basis. Moreover, careful follow-up should be performed for patients presenting certain cardiovascular conditions [ 145 ].

Weight loss has also been reported after atomoxetine treatment, occurring during the first two years of treatment. However, evidence suggests this decrease begins to be compensated between 2 and 5 years after the beginning of treatment [ 141 ]. Similarly, methylphenidate has been associated with adverse effects such as anorexia, weight loss, and insomnia [ 146 ].

A comparative study on short-term effects of methylphenidate and atomoxetine on ADHD reported significantly higher weight loss in children treated with atomoxetine [ 147 ]. However, a more recent study reported that children present significantly more weight loss after methylphenidate than after atomoxetine treatment [ 148 ].

A meta-analysis on gastrointestinal adverse effects of methylphenidate reported increased risk of decreased appetite, weight loss, and abdominal pain in children and adolescents under this pharmacological treatment [ 149 ].

A comparison between the presence of adverse effects after methylphenidate and atomoxetine treatments in ADHD children indicated methylphenidate as a safer option, since children under atomoxetine treatment presented higher incidence rates of anorexia, nausea, somnolence, dizziness, and vomiting than children under methylphenidate treatment [ 147 ]. A more recent study reported similar results, since children treated with atomoxetine presented higher incidence rates of mild adverse effects, such as decreased appetite, weight loss, dyspepsia, abdominal pain, stomach ache, irritability, mood disorders, and dizziness. As for severe adverse effects, patients under atomoxetine treatment presented higher incidence rates of gastrointestinal, neuropsychiatric, and cardiovascular effects [ 150 ].

6.1.4. Long-Term Adverse Effects

Long-term adverse effects of methylphenidate are the subject of intense study, given that it is the first-line stimulant drug used for ADHD treatment in children, adolescents, and adults [ 11 , 151 ]. A review on the subject addressed different adverse effects studied in patients after long-term (over one year) administration of methylphenidate, including low mood or depression, anxiety, irritability or emotional reactivity, suicidal behavior or ideation, bipolar disorder, psychotic symptoms, substance use disorders, tics, seizures or EEG abnormalities, and sleep disorders. The authors concluded that existing information indicates that methylphenidate is safe to use, although caution should be taken when prescribing this drug to specific groups, such as preschool children, patients prone to psychosis or tics, and high-risk adolescents [ 152 ]. However, the need for more studies on the long-term effects of treatment with this drug is highlighted, since studies in humans are rather scarce and with a high degree of heterogeneity in terms of methodological approach [ 151 , 152 ].

6.1.5. Long-Term Therapeutic Effect

Given that ADHD is a chronic disorder and that many of the children presenting ADHD will still present symptoms in adulthood, it is particularly important to determine the long-term effectiveness of pharmacological treatments. However, very few studies address this issue, and no conclusion can yet be drawn regarding the long-term effects (years) of pharmacological treatment of ADHD on symptom reduction and quality of life. Thus, the long-term efficacy of drug treatment for ADHD remains under debate [ 153 , 154 , 155 , 156 ]

Current pharmacological treatments for ADHD have proven to be safe and effective. The efficacy of these treatments on ADHD symptoms is clear, and thus pharmacological therapy is often used to treat ADHD patients [ 136 , 138 , 141 , 152 ]. However, there are also some drawbacks to this therapeutic approach, including the time required to reach the effective dose for each patient [ 3 , 157 ]; the lack of response in some patients [ 121 , 158 , 159 , 160 ]; the unresolved issue of long-term effectiveness (of great importance given that in many cases the treatment must go on for years) [ 153 , 154 , 155 , 156 ]; the presence of adverse effects, which although not life threatening in most cases, are nevertheless upsetting [ 133 , 135 , 144 ]; and the existence of specific groups of patients with whom a greater caution must be taken [ 140 , 145 , 152 ]. Altogether, these drawbacks have led to the search of new therapeutic approaches. One of the strategies studied so far is the possibility of using other drugs to treat ADHD, including drugs interacting with serotoninergic (metadoxine, paroxetine, duloxetine, buspirone), glutamatergic (memantine), cholinergic (AZD3480, AZD1446, lobeline, galantamine, mecamylamine), histaminergic (mk-0249), and catecholaminergic neurotransmission systems (modafinil, droxidopa, desipramine, bupropion, nomifensine, reboxetine, venlafaxine, duloxetine, guanfacine, aripiprazol, dasotraline, selegiline), as well as lithium [ 161 ].

6.2. Non-Pharmacological Therapies

Pharmacological therapy is effective although presents some inconveniences, including the existence of adverse effects in some patients and lack of effect in others. Therefore, there are also different non-pharmacological approaches for ADHD treatment.

6.2.1. Behavioral Parent Training

The goal of parent training is to equip parents with techniques that will be useful in managing ADHD-related behavior presented by their children. A systematic review published on 2011 found no reliable effect of ADHD children’s behavior, although it may lead to increased confidence and decreased stress in parents [ 162 ]. Later studies found an effect of behavioral parent training on ADHD symptoms, which is not increased by previous working memory training, although this combination did produce positive effects on working memory storage and processing [ 163 ]. It is noteworthy that cognitive functioning of both parents and children influences the effectiveness of this therapeutic approach on ADHD symptoms. Better working memory in children and higher parental response caution presented an association with improvements in inattention. As for conduct problems, better parental self-regulation was associated with a better result in this area. However, none of the measured cognitive functions in children or parents were associated with improvements in hyperactivity [ 164 ]. Moreover, behavioral parent training improves coexistence at home, since a reduction in the frequency and severity of problematic situations is produced, along with a reduction of stress in parents [ 165 ].

6.2.2. Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) has also been used to treat ADHD. A review performed on the subject found CBT to be effective in reducing ADHD symptoms in adults, however only when improvement was evaluated by the patient and not when evaluated by the clinician [ 166 ], although a more recent meta-analysis on the subject reported a good effect of CBT on ADHD adults [ 167 ]. A Cochrane systematic review concluded that CBT has a positive effect on ADHD symptoms, either alone or in conjunction with other therapies, although considered the evidence to be low-quality in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group approach. [ 168 ]. A meta-analysis found that CBT is one of the most effective non-pharmacological options to treat ADHD, ranking just after physical exercise [ 169 ]. A later systematic review confirmed the effects of CBT on ADHD symptoms [ 170 ]. A recent study reported CBT to be effective in reducing ADHD symptoms in patients, either with or without conjunct medication [ 171 ].

6.2.3. Attention Training Techniques

Attention training techniques are often used to improve life quality and increase well-being. Given the effect of these techniques on brain activity, as well as on attention and self-regulation, their use to reduce ADHD symptoms and improve life quality in these patients is currently under study [ 172 ].

Mindfulness can be defined as paying attention to the present, an activity that implies sustained attention. A systematic review on the effects of mindfulness-based interventions on ADHD found that such approaches were popular among adults with ADHD, finding improvements in attention, although the effects of such approaches in children and adolescents are still unclear [ 173 ]. A recent meta-review reported a large effect size of mindfulness on ADHD [ 174 ]. A review on the effects of mindfulness-based cognitive therapy on ADHD adults reported good effects of this therapeutic approach, especially when used in conjunction with pharmacological therapy [ 175 ], while a systematic review analyzing the effects of meditation-based techniques (either on parents and children or on children only) on ADHD children could not draw a clear conclusion regarding beneficial effects [ 176 ].

Adult ADHD patients that underwent an 8-week mindfulness awareness practice period presented decreased ADHD, depression, and anxiety symptoms [ 177 ]. Similarly, a study performed with children revealed that an 8-week period of mindfulness-oriented meditation produced improvements in the performance of neuropsychological tests, as well as in ADHD symptoms. Although encouraging, the authors stated that the results are still preliminary, given the small number of children participating in the study [ 178 ]. There are also results indicating that this technique produces an improvement in ADHD symptoms in ADHD children with oppositional defiant disorder [ 179 ].

6.2.4. Neurofeedback

Neurofeedback (NFB) is a therapy in which patients learn to modify EEG patterns through operant conditioning. There are articles reporting the induction of plastic changes after NFB training [ 180 , 181 , 182 , 183 ], supporting a theory explaining the effects of NFB on different brain disorders through the induction of synaptic plasticity, leading to an homeostatic set point. Additionally, besides some unusual cases of headache, no collateral effects have been reported with this technique. One of the most interesting aspects of NFB is the induction of plastic changes from within the brain under normal physiological conditions, without the need for an external stimuli such as pharmacological treatments or transcranial stimulation to alter brain activity, thus the probability of adverse effects is minimal [ 181 ].

Specific NFB protocols have been developed over the decades. These protocols were designed based on articles reporting specific qEEG variations in neurological patients or qEEG patterns associated with cognitive function. Some of these standardized protocols have been studied in terms of their ability to treat ADHD [ 184 ].

Several articles have addressed the use of NFB in ADHD patients. The results have been mixed and numerous meta-analyses have been published on the subject. The conclusions of these meta-analyses have also been mixed. There are meta-analyses reporting good effects of NFB on ADHD [ 185 , 186 , 187 ], not finding reliable effects [ 188 ], not reaching a conclusion on the subject of efficacy [ 189 ], finding a minor effect of this therapeutic approach significantly below what is observed with pharmacological treatment [ 190 ], or finding a minor effect only in the presence of pharmacological treatment [ 191 ].

An overview of recent publications gave the same impression. Some reports found effects of NFB theta/beta or theta/alpha protocols on ADHD, measurable at follow-up 8 weeks or 12 months after treatment completion [ 192 , 193 ]. Other reports found no effect [ 194 , 195 , 196 ]. Moreover, there are reports revealing a minor effect of NFB, below the effect levels of other therapeutic approaches [ 197 , 198 , 199 ].

NFB is a therapeutic approach widely studied for ADHD treatment. The results so far have been mixed. However, given the absence of side effects and its ability to induce synaptic plasticity [ 181 ], it is an option worth keeping in mind.

6.2.5. Other Non-Pharmacological Approaches

The use of non-pharmacological supplementations, such as polyunsaturated fatty acids, peptides, amino acids, plat extracts, probiotics, micronutrients, and herbal supplementation, is currently being studied in order to determine their usefulness in treating ADHD. However, further research is still needed in this area [ 200 ].

A study performed in ADHD children under methylphenidate treatment for whom zinc supplementation was added reported no significant effect of zinc supplementation on the total score for a parent’s questionnaire for ADHD or in the hyperactivity and impulsivity subscales. However, zinc-supplemented children present improvements in inattention scores [ 201 ].

A meta-analysis on non-pharmacological interventions for ADHD patients found that physical exercise produced a good effect on ADHD cognitive symptoms, especially aerobic exercise targeting executive functions [ 169 ].

7. Treatment Personalization

In the first sections of this review, we addressed some of the factors associated with ADHD incidence, ranging from a variety of environmental factors to the presence of different genetic polymorphisms. However, these different etiologies are not always present, since patients might present one or another (see Section 2 and Section 3 ). Similarly, while there are some changes in brain activity associated with ADHD, they are not always the same (see Section 4 ). Accordingly, there is also variation in the response of patients to both pharmacological and non-pharmacological treatments (see Section 5 ).

Since the etiology of ADHD could be very different from patient to patient, the precise nature of the physiological changes underlying the clinical manifestations of ADHD in each case could be slightly different, affecting the effectiveness of the chosen treatment and possibly explaining the variation in the effect of the same treatment on different patients. This can be observed in the variations in qEEG activity observed in different studies [ 112 , 113 , 114 , 116 , 121 ]. However, the design of personalized treatments based on specific characteristics of each patient could lead to better clinical results. In this regard, strategies to adjust therapeutic approaches based on patients’ characteristics have been used for both pharmacological and non-pharmacological therapies.

Selecting the appropriate pharmacological treatment and the dose to be used takes some time, given the large inter-individual variability regarding treatment efficacy, leading to a delay in reaching a therapeutic effect, and in some cases producing an early termination of treatment due to frustration, either by the provider or the family [ 157 ]. Moreover, there is some variability regarding patient response to methylphenidate, including patients that do not achieve adequate symptom control or experience adverse effects with commonly used doses. Therefore, dose optimization has been proposed as a means to achieve an adequate effect for most of the patients, enhancing both the efficacy and safety of methylphenidate treatment [ 3 ]. This has led to the search for strategies to find adequate treatments for each patient, such as pharmacogenomics, in which a patient’s genotype for a particular gene is used to predict the effects of medication in that patient. However, in spite of the progress that has already been made, no pharmacogenomic test so far has been found to be helpful in treatment selection [ 157 ].

Treatment resistance has been reported for both atomoxetine [ 158 ] and methylphenidate [ 121 , 159 , 160 ]. For this reason, qEEG can be used as a source of information to determine at an earlier point whether methylphenidate [ 121 , 160 , 202 ] or atomoxetine [ 107 , 202 ] is effective or if an alternative treatment is needed for a patient.

Most of the reports on the use of NFB for ADHD use a standardized protocol, either equal for all participants or adapted to each patients after qEEG analysis. However, there is another more personalized approach known as qEEG-informed (or qEEG-guided) NFB. In this variant of NFB, rather than selecting a particular protocol (for example, theta/beta ratio) and applying it to all participants, subjects receive a NFB protocol selected for them after qEEG analysis. This type of NFB has been successfully used in schizophrenia [ 203 ], obsessive compulsive disorder [ 204 ], migraine [ 205 ], dementia [ 206 ], and with learning-disabled children [ 207 , 208 ].

There are so far only two studies applying qEEG-informed NFB in ADHD patients, so it is not yet possible to perform a meta-analysis on the effects of this type of NFB on ADHD. However, a positive effect of NFB has been reported in both published studies [ 209 , 210 ].

8. Discussion

ADHD is an NDD with a complex etiology. While it is clear that its main cause is alterations in neurodevelopmental processes such as synaptogenesis, myelination, and neurogenesis [ 5 ], the causes of these neurodevelopmental alterations are diverse. In some cases they might be associated with environmental factors such as premature birth [ 6 ], perinatal problems [ 9 ], nutrition during pregnancy [ 10 ], or exposure to heavy metals [ 17 , 18 , 19 , 26 , 27 , 29 ]. Additionally, there is strong evidence of genetic influence on ADHD [ 43 , 44 ], and an interaction between environmental and genetic factors cannot be discarded.

The purpose of this review is not to fully describe all factors associated with ADHD appearance, but rather to address some of the main etiologies described so far, in order to clarify the high diversity of factors associated with this NDD. When analyzing the different sections of this review, one thing becomes evident—that ADHD patients are diverse regarding the etiology of their condition and their responses to treatment. This heterogeneity outlines the high variability in patients’ particular conditions regarding ADHD symptom manifestation and treatment, since it is probable that the underlying neurophysiological alterations for each patient are at least slightly different. Thus, standardized treatment (either pharmacological or non-pharmacological) may not be equally efficient in all cases.

Moreover, there could be other factors that are usually disregarded in relation with ADHD incidence, but which might play an important role in this condition. Recently, the gut microbiome has been the subject of intense research as an ADHD-associated factor, and even though further research is needed in order to determine its precise influence on ADHD, there are already reports indicating a possible link between them [ 211 , 212 , 213 , 214 ].

In the end, all of these factors produce changes in brain structure and function [ 1 , 7 , 112 , 113 , 114 , 115 ], leading to the symptomatology observed in ADHD patients. Therapeutic approaches to treat this condition have the objective of compensating such alterations in order to reduce symptoms and improve quality of life. However, as we have observed in this review, not all patients present the same neurophysiological changes. Studies performed on qEEG activity have yielded different results regarding brain electrical activity in ADHD patients [ 4 , 112 , 114 , 120 ]. Additionally, both brain imaging and qEEG techniques have revealed that changes are not consistent throughout the lifespan, being different in children and adults [ 114 , 115 , 116 , 121 ]. Therefore, there is a need for treatment personalization for each ADHD patient in order to achieve greater effect with minimal adverse effects.

Pharmacological treatments, both stimulants and non-stimulants have proven to be effective and safe for ADHD patients [ 132 , 133 ], and thus are widely prescribed to treat this condition. However, the pharmacological approach to ADHD treatment has some drawbacks, mostly regarding difficulties in reaching effectiveness in all patients [ 3 , 121 , 157 , 158 , 159 , 160 ] and the presence of adverse effects [ 133 , 135 , 144 ].

The search for other therapeutic options has led to the assessment of the effects of other drugs on ADHD [ 161 ], as well as the design of non-pharmacological treatments, such as behavioral parent training, CBT, attention-improving techniques, and NFB.

The effects of behavioral parent training on ADHD symptoms in children are not consistent, with some articles finding effects [ 163 ] and others not finding any [ 162 ]. However, behavioral parent training does reduce stress in parents and promotes a better coexistence at home, which is favorable for children [ 162 , 165 ]. In the case of CBT, there is more evidence indicating a good effect in reducing ADHD symptoms [ 167 , 168 , 169 , 170 , 171 ]

Attention training techniques are still under intense study. There is some evidence regarding the effect of this technique on ADHD in adults [ 173 , 175 ], while in children and adolescents the results are not clear so far [ 173 , 176 ].

A number of studies on the effect of NFB on ADHD symptoms have yielded different results, either finding a positive effect [ 185 , 186 , 187 , 192 , 193 ], a mild effect [ 190 , 197 , 198 , 199 ], or no effect at all [ 188 , 194 , 195 , 196 ]. However, NFB has a number of advantages that encourage the search for an adequate protocol to treat ADHD patients. It is targeted directly to change brain activity associated with the condition under treatment, it has virtually no side effects, and the therapeutic effect is due to the induction of plastic changes in the central nervous system, thus it might establish a long-term changes [ 180 , 181 , 182 , 183 ].

9. Conclusions

In the present review, we have gone through some of the factors associated with ADHD, and it is clear that a great heterogeneity exists in the etiology of this condition. Therapeutic approaches, although functional in many cases, also show heterogeneity in their effects in certain groups of patients. The diverse range of effects of the therapeutic approaches used should not be a surprise, given the diversity of etiologies found in ADHD. Even though clinical manifestations of this condition might be similar (diagnosis is based on the presence certain symptoms), the same clinical manifestations could occur with different underlying physiological changes, considering the variations in qEEG activity in different groups of patients [ 112 , 113 , 114 , 116 , 121 ]. Thus, these neurophysiological changes presented by patients may not necessarily respond in equal form to a given therapeutic approach. Given the inter-personal variance in the etiology of ADHD, it is advisable to personalize the therapeutic approach. Regarding pharmacological therapies, dosage optimization [ 3 ], pharmacogenomics [ 157 ], and the use of qEEG to select the adequate drug for a given patient have been proposed [ 107 , 121 , 160 , 202 ].

Regarding non-pharmacological options, the use of qEEG-informed NFB has been proposed for personalized treatment in ADHD patients. The studies carried out to date have shown positive results [ 209 , 210 ], although the number of studies is still too small to draw a conclusion. However, given the advantages of NFB [ 181 ] and the positive effects of this approach reported for other conditions [ 203 , 204 , 205 , 206 , 207 , 208 ], it is worth performing further studies on the effectiveness of this type of NFB on ADHD.

Author Contributions

Conceptualization, L.N.-J. and W.V.H.-M. writing—reviewing and editing, L.N.-J., W.V.H.-M., and A.H.-S. All authors have read and agreed to the published version of the manuscript.

This research received no external funding

Conflicts of Interest

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Attention Deficit Hyperactivity Disorder (ADHD): A Case Study and Exploration of Causes and Interventions

• Bijal Chheda-Varma 5  
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The male to female ratio of ADHD is 4:1. This chapter on ADHD provides a wide perspective on understanding, diagnosis and treatment for ADHD. It relies on a neurodevelopmental perspective of ADHD. Signs and symptoms of ADHD are described through the DSM-V criteria. A case example (K, a patient of mine) is illustrated throughout the chapter to provide context and illustrations, and demonstrates the relative merits of “doing” (i.e. behavioural interventions) compared to cognitive insight, or medication alone. Finally, a discussion of the Cognitive Behavioral Modification Model (CBM) for the treatment of ADHD provides a snapshot of interventions used by clinicians providing psychological help.

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Chheda-Varma, B. (2019). Attention Deficit Hyperactivity Disorder (ADHD): A Case Study and Exploration of Causes and Interventions. In: Barry, J.A., Kingerlee, R., Seager, M., Sullivan, L. (eds) The Palgrave Handbook of Male Psychology and Mental Health. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-04384-1_15

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How to Write a Case Study: Bookmarkable Guide & Template

Published: November 30, 2023

Earning the trust of prospective customers can be a struggle. Before you can even begin to expect to earn their business, you need to demonstrate your ability to deliver on what your product or service promises.

Sure, you could say that you're great at X or that you're way ahead of the competition when it comes to Y. But at the end of the day, what you really need to win new business is cold, hard proof.

One of the best ways to prove your worth is through a compelling case study. In fact, HubSpot’s 2020 State of Marketing report found that case studies are so compelling that they are the fifth most commonly used type of content used by marketers.

Below, I'll walk you through what a case study is, how to prepare for writing one, what you need to include in it, and how it can be an effective tactic. To jump to different areas of this post, click on the links below to automatically scroll.

Case Study Definition

Case study templates, how to write a case study.

• How to Format a Case Study

Business Case Study Examples

A case study is a specific challenge a business has faced, and the solution they've chosen to solve it. Case studies can vary greatly in length and focus on several details related to the initial challenge and applied solution, and can be presented in various forms like a video, white paper, blog post, etc.

In professional settings, it's common for a case study to tell the story of a successful business partnership between a vendor and a client. Perhaps the success you're highlighting is in the number of leads your client generated, customers closed, or revenue gained. Any one of these key performance indicators (KPIs) are examples of your company's services in action.

When done correctly, these examples of your work can chronicle the positive impact your business has on existing or previous customers and help you attract new clients.

Free Case Study Templates

Showcase your company's success using these three free case study templates.

• Data-Driven Case Study Template
• Product-Specific Case Study Template
• General Case Study Template

You're all set!

Click this link to access this resource at any time.

Why write a case study? 

I know, you’re thinking “ Okay, but why do I need to write one of these? ” The truth is that while case studies are a huge undertaking, they are powerful marketing tools that allow you to demonstrate the value of your product to potential customers using real-world examples. Here are a few reasons why you should write case studies. 

1. Explain Complex Topics or Concepts

Case studies give you the space to break down complex concepts, ideas, and strategies and show how they can be applied in a practical way. You can use real-world examples, like an existing client, and use their story to create a compelling narrative that shows how your product solved their issue and how those strategies can be repeated to help other customers get similar successful results.  

2. Show Expertise

Case studies are a great way to demonstrate your knowledge and expertise on a given topic or industry. This is where you get the opportunity to show off your problem-solving skills and how you’ve generated successful outcomes for clients you’ve worked with. 

3. Build Trust and Credibility

In addition to showing off the attributes above, case studies are an excellent way to build credibility. They’re often filled with data and thoroughly researched, which shows readers you’ve done your homework. They can have confidence in the solutions you’ve presented because they’ve read through as you’ve explained the problem and outlined step-by-step what it took to solve it. All of these elements working together enable you to build trust with potential customers.

4. Create Social Proof

Using existing clients that have seen success working with your brand builds social proof . People are more likely to choose your brand if they know that others have found success working with you. Case studies do just that — putting your success on display for potential customers to see. 

All of these attributes work together to help you gain more clients. Plus you can even use quotes from customers featured in these studies and repurpose them in other marketing content. Now that you know more about the benefits of producing a case study, let’s check out how long these documents should be. 

How long should a case study be?

The length of a case study will vary depending on the complexity of the project or topic discussed. However, as a general guideline, case studies typically range from 500 to 1,500 words. 

Whatever length you choose, it should provide a clear understanding of the challenge, the solution you implemented, and the results achieved. This may be easier said than done, but it's important to strike a balance between providing enough detail to make the case study informative and concise enough to keep the reader's interest.

The primary goal here is to effectively communicate the key points and takeaways of the case study. It’s worth noting that this shouldn’t be a wall of text. Use headings, subheadings, bullet points, charts, and other graphics to break up the content and make it more scannable for readers. We’ve also seen brands incorporate video elements into case studies listed on their site for a more engaging experience. 

Ultimately, the length of your case study should be determined by the amount of information necessary to convey the story and its impact without becoming too long. Next, let’s look at some templates to take the guesswork out of creating one. 

To help you arm your prospects with information they can trust, we've put together a step-by-step guide on how to create effective case studies for your business with free case study templates for creating your own.

Tell us a little about yourself below to gain access today:

And to give you more options, we’ll highlight some useful templates that serve different needs. But remember, there are endless possibilities when it comes to demonstrating the work your business has done.

1. General Case Study Template

Do you have a specific product or service that you’re trying to sell, but not enough reviews or success stories? This Product Specific case study template will help.

This template relies less on metrics, and more on highlighting the customer’s experience and satisfaction. As you follow the template instructions, you’ll be prompted to speak more about the benefits of the specific product, rather than your team’s process for working with the customer.

4. Bold Social Media Business Case Study Template

You can find templates that represent different niches, industries, or strategies that your business has found success in — like a bold social media business case study template.

In this template, you can tell the story of how your social media marketing strategy has helped you or your client through collaboration or sale of your service. Customize it to reflect the different marketing channels used in your business and show off how well your business has been able to boost traffic, engagement, follows, and more.

5. Lead Generation Business Case Study Template

It’s important to note that not every case study has to be the product of a sale or customer story, sometimes they can be informative lessons that your own business has experienced. A great example of this is the Lead Generation Business case study template.

If you’re looking to share operational successes regarding how your team has improved processes or content, you should include the stories of different team members involved, how the solution was found, and how it has made a difference in the work your business does.

Now that we’ve discussed different templates and ideas for how to use them, let’s break down how to create your own case study with one.

• Get started with case study templates.
• Determine the case study's objective.
• Establish a case study medium.
• Find the right case study candidate.
• Contact your candidate for permission to write about them.
• Ensure you have all the resources you need to proceed once you get a response.
• Download a case study email template.
• Define the process you want to follow with the client.
• Ensure you're asking the right questions.
• Layout your case study format.
• Publish and promote your case study.

1. Get started with case study templates.

Telling your customer's story is a delicate process — you need to highlight their success while naturally incorporating your business into their story.

If you're just getting started with case studies, we recommend you download HubSpot's Case Study Templates we mentioned before to kickstart the process.

2. Determine the case study's objective.

All business case studies are designed to demonstrate the value of your services, but they can focus on several different client objectives.

Your first step when writing a case study is to determine the objective or goal of the subject you're featuring. In other words, what will the client have succeeded in doing by the end of the piece?

The client objective you focus on will depend on what you want to prove to your future customers as a result of publishing this case study.

Your case study can focus on one of the following client objectives:

• Complying with government regulation
• Lowering business costs
• Becoming profitable
• Generating more leads
• Closing on more customers
• Generating more revenue
• Expanding into a new market
• Becoming more sustainable or energy-efficient

3. Establish a case study medium.

Next, you'll determine the medium in which you'll create the case study. In other words, how will you tell this story?

Case studies don't have to be simple, written one-pagers. Using different media in your case study can allow you to promote your final piece on different channels. For example, while a written case study might just live on your website and get featured in a Facebook post, you can post an infographic case study on Pinterest and a video case study on your YouTube channel.

Here are some different case study mediums to consider:

Written Case Study

Consider writing this case study in the form of an ebook and converting it to a downloadable PDF. Then, gate the PDF behind a landing page and form for readers to fill out before downloading the piece, allowing this case study to generate leads for your business.

Video Case Study

Plan on meeting with the client and shooting an interview. Seeing the subject, in person, talk about the service you provided them can go a long way in the eyes of your potential customers.

Infographic Case Study

Use the long, vertical format of an infographic to tell your success story from top to bottom. As you progress down the infographic, emphasize major KPIs using bigger text and charts that show the successes your client has had since working with you.

Podcast Case Study

Podcasts are a platform for you to have a candid conversation with your client. This type of case study can sound more real and human to your audience — they'll know the partnership between you and your client was a genuine success.

4. Find the right case study candidate.

Writing about your previous projects requires more than picking a client and telling a story. You need permission, quotes, and a plan. To start, here are a few things to look for in potential candidates.

Product Knowledge

It helps to select a customer who's well-versed in the logistics of your product or service. That way, he or she can better speak to the value of what you offer in a way that makes sense for future customers.

Remarkable Results

Clients that have seen the best results are going to make the strongest case studies. If their own businesses have seen an exemplary ROI from your product or service, they're more likely to convey the enthusiasm that you want prospects to feel, too.

One part of this step is to choose clients who have experienced unexpected success from your product or service. When you've provided non-traditional customers — in industries that you don't usually work with, for example — with positive results, it can help to remove doubts from prospects.

Recognizable Names

While small companies can have powerful stories, bigger or more notable brands tend to lend credibility to your own. In fact, 89% of consumers say they'll buy from a brand they already recognize over a competitor, especially if they already follow them on social media.

Customers that came to you after working with a competitor help highlight your competitive advantage and might even sway decisions in your favor.

5. Contact your candidate for permission to write about them.

To get the case study candidate involved, you have to set the stage for clear and open communication. That means outlining expectations and a timeline right away — not having those is one of the biggest culprits in delayed case study creation.

Most importantly at this point, however, is getting your subject's approval. When first reaching out to your case study candidate, provide them with the case study's objective and format — both of which you will have come up with in the first two steps above.

To get this initial permission from your subject, put yourself in their shoes — what would they want out of this case study? Although you're writing this for your own company's benefit, your subject is far more interested in the benefit it has for them.

Benefits to Offer Your Case Study Candidate

Here are four potential benefits you can promise your case study candidate to gain their approval.

Brand Exposure

Explain to your subject to whom this case study will be exposed, and how this exposure can help increase their brand awareness both in and beyond their own industry. In the B2B sector, brand awareness can be hard to collect outside one's own market, making case studies particularly useful to a client looking to expand their name's reach.

Employee Exposure

Allow your subject to provide quotes with credits back to specific employees. When this is an option for them, their brand isn't the only thing expanding its reach — their employees can get their name out there, too. This presents your subject with networking and career development opportunities they might not have otherwise.

Product Discount

This is a more tangible incentive you can offer your case study candidate, especially if they're a current customer of yours. If they agree to be your subject, offer them a product discount — or a free trial of another product — as a thank-you for their help creating your case study.

Backlinks and Website Traffic

Here's a benefit that is sure to resonate with your subject's marketing team: If you publish your case study on your website, and your study links back to your subject's website — known as a "backlink" — this small gesture can give them website traffic from visitors who click through to your subject's website.

Additionally, a backlink from you increases your subject's page authority in the eyes of Google. This helps them rank more highly in search engine results and collect traffic from readers who are already looking for information about their industry.

6. Ensure you have all the resources you need to proceed once you get a response.

So you know what you’re going to offer your candidate, it’s time that you prepare the resources needed for if and when they agree to participate, like a case study release form and success story letter.

Let's break those two down.

Case Study Release Form

This document can vary, depending on factors like the size of your business, the nature of your work, and what you intend to do with the case studies once they are completed. That said, you should typically aim to include the following in the Case Study Release Form:

• A clear explanation of why you are creating this case study and how it will be used.
• A statement defining the information and potentially trademarked information you expect to include about the company — things like names, logos, job titles, and pictures.
• An explanation of what you expect from the participant, beyond the completion of the case study. For example, is this customer willing to act as a reference or share feedback, and do you have permission to pass contact information along for these purposes?
• A note about compensation.

Success Story Letter

As noted in the sample email, this document serves as an outline for the entire case study process. Other than a brief explanation of how the customer will benefit from case study participation, you'll want to be sure to define the following steps in the Success Story Letter.

7. Download a case study email template.

While you gathered your resources, your candidate has gotten time to read over the proposal. When your candidate approves of your case study, it's time to send them a release form.

A case study release form tells you what you'll need from your chosen subject, like permission to use any brand names and share the project information publicly. Kick-off this process with an email that runs through exactly what they can expect from you, as well as what you need from them. To give you an idea of what that might look like, check out this sample email:

8. Define the process you want to follow with the client.

Before you can begin the case study, you have to have a clear outline of the case study process with your client. An example of an effective outline would include the following information.

The Acceptance

First, you'll need to receive internal approval from the company's marketing team. Once approved, the Release Form should be signed and returned to you. It's also a good time to determine a timeline that meets the needs and capabilities of both teams.

The Questionnaire

To ensure that you have a productive interview — which is one of the best ways to collect information for the case study — you'll want to ask the participant to complete a questionnaire before this conversation. That will provide your team with the necessary foundation to organize the interview, and get the most out of it.

The Interview

Once the questionnaire is completed, someone on your team should reach out to the participant to schedule a 30- to 60-minute interview, which should include a series of custom questions related to the customer's experience with your product or service.

The Draft Review

After the case study is composed, you'll want to send a draft to the customer, allowing an opportunity to give you feedback and edits.

The Final Approval

Once any necessary edits are completed, send a revised copy of the case study to the customer for final approval.

Once the case study goes live — on your website or elsewhere — it's best to contact the customer with a link to the page where the case study lives. Don't be afraid to ask your participants to share these links with their own networks, as it not only demonstrates your ability to deliver positive results and impressive growth, as well.

9. Ensure you're asking the right questions.

Before you execute the questionnaire and actual interview, make sure you're setting yourself up for success. A strong case study results from being prepared to ask the right questions. What do those look like? Here are a few examples to get you started:

• What are your goals?
• What challenges were you experiencing before purchasing our product or service?
• What made our product or service stand out against our competitors?
• What did your decision-making process look like?
• How have you benefited from using our product or service? (Where applicable, always ask for data.)

Keep in mind that the questionnaire is designed to help you gain insights into what sort of strong, success-focused questions to ask during the actual interview. And once you get to that stage, we recommend that you follow the "Golden Rule of Interviewing." Sounds fancy, right? It's actually quite simple — ask open-ended questions.

If you're looking to craft a compelling story, "yes" or "no" answers won't provide the details you need. Focus on questions that invite elaboration, such as, "Can you describe ...?" or, "Tell me about ..."

In terms of the interview structure, we recommend categorizing the questions and flowing them into six specific sections that will mirror a successful case study format. Combined, they'll allow you to gather enough information to put together a rich, comprehensive study.

Open with the customer's business.

The goal of this section is to generate a better understanding of the company's current challenges and goals, and how they fit into the landscape of their industry. Sample questions might include:

• How long have you been in business?
• How many employees do you have?
• What are some of the objectives of your department at this time?

Cite a problem or pain point.

To tell a compelling story, you need context. That helps match the customer's need with your solution. Sample questions might include:

• What challenges and objectives led you to look for a solution?
• What might have happened if you did not identify a solution?
• Did you explore other solutions before this that did not work out? If so, what happened?

Discuss the decision process.

Exploring how the customer decided to work with you helps to guide potential customers through their own decision-making processes. Sample questions might include:

• How did you hear about our product or service?
• Who was involved in the selection process?
• What was most important to you when evaluating your options?

Explain how a solution was implemented.

The focus here should be placed on the customer's experience during the onboarding process. Sample questions might include:

• How long did it take to get up and running?
• Did that meet your expectations?
• Who was involved in the process?

Explain how the solution works.

The goal of this section is to better understand how the customer is using your product or service. Sample questions might include:

• Is there a particular aspect of the product or service that you rely on most?
• Who is using the product or service?

End with the results.

In this section, you want to uncover impressive measurable outcomes — the more numbers, the better. Sample questions might include:

• How is the product or service helping you save time and increase productivity?
• In what ways does that enhance your competitive advantage?
• How much have you increased metrics X, Y, and Z?

10. Lay out your case study format.

When it comes time to take all of the information you've collected and actually turn it into something, it's easy to feel overwhelmed. Where should you start? What should you include? What's the best way to structure it?

To help you get a handle on this step, it's important to first understand that there is no one-size-fits-all when it comes to the ways you can present a case study. They can be very visual, which you'll see in some of the examples we've included below, and can sometimes be communicated mostly through video or photos, with a bit of accompanying text.

Here are the sections we suggest, which we'll cover in more detail down below:

• Title: Keep it short. Develop a succinct but interesting project name you can give the work you did with your subject.
• Subtitle: Use this copy to briefly elaborate on the accomplishment. What was done? The case study itself will explain how you got there.
• Executive Summary : A 2-4 sentence summary of the entire story. You'll want to follow it with 2-3 bullet points that display metrics showcasing success.
• About the Subject: An introduction to the person or company you served, which can be pulled from a LinkedIn Business profile or client website.
• Challenges and Objectives: A 2-3 paragraph description of the customer's challenges, before using your product or service. This section should also include the goals or objectives the customer set out to achieve.
• How Product/Service Helped: A 2-3 paragraph section that describes how your product or service provided a solution to their problem.
• Results: A 2-3 paragraph testimonial that proves how your product or service specifically benefited the person or company and helped achieve its goals. Include numbers to quantify your contributions.
• Supporting Visuals or Quotes: Pick one or two powerful quotes that you would feature at the bottom of the sections above, as well as a visual that supports the story you are telling.
• Future Plans: Everyone likes an epilogue. Comment on what's ahead for your case study subject, whether or not those plans involve you.
• Call to Action (CTA): Not every case study needs a CTA, but putting a passive one at the end of your case study can encourage your readers to take an action on your website after learning about the work you've done.

When laying out your case study, focus on conveying the information you've gathered in the most clear and concise way possible. Make it easy to scan and comprehend, and be sure to provide an attractive call-to-action at the bottom — that should provide readers an opportunity to learn more about your product or service.

11. Publish and promote your case study.

Once you've completed your case study, it's time to publish and promote it. Some case study formats have pretty obvious promotional outlets — a video case study can go on YouTube, just as an infographic case study can go on Pinterest.

But there are still other ways to publish and promote your case study. Here are a couple of ideas:

Lead Gen in a Blog Post

As stated earlier in this article, written case studies make terrific lead-generators if you convert them into a downloadable format, like a PDF. To generate leads from your case study, consider writing a blog post that tells an abbreviated story of your client's success and asking readers to fill out a form with their name and email address if they'd like to read the rest in your PDF.

Then, promote this blog post on social media, through a Facebook post or a tweet.

Published as a Page on Your Website

As a growing business, you might need to display your case study out in the open to gain the trust of your target audience.

Rather than gating it behind a landing page, publish your case study to its own page on your website, and direct people here from your homepage with a "Case Studies" or "Testimonials" button along your homepage's top navigation bar.

Format for a Case Study

The traditional case study format includes the following parts: a title and subtitle, a client profile, a summary of the customer’s challenges and objectives, an account of how your solution helped, and a description of the results. You might also want to include supporting visuals and quotes, future plans, and calls-to-action.

Image Source

The title is one of the most important parts of your case study. It should draw readers in while succinctly describing the potential benefits of working with your company. To that end, your title should:

• State the name of your custome r. Right away, the reader must learn which company used your products and services. This is especially important if your customer has a recognizable brand. If you work with individuals and not companies, you may omit the name and go with professional titles: “A Marketer…”, “A CFO…”, and so forth.
• State which product your customer used . Even if you only offer one product or service, or if your company name is the same as your product name, you should still include the name of your solution. That way, readers who are not familiar with your business can become aware of what you sell.
• Allude to the results achieved . You don’t necessarily need to provide hard numbers, but the title needs to represent the benefits, quickly. That way, if a reader doesn’t stay to read, they can walk away with the most essential information: Your product works.

The example above, “Crunch Fitness Increases Leads and Signups With HubSpot,” achieves all three — without being wordy. Keeping your title short and sweet is also essential.

2. Subtitle

Your subtitle is another essential part of your case study — don’t skip it, even if you think you’ve done the work with the title. In this section, include a brief summary of the challenges your customer was facing before they began to use your products and services. Then, drive the point home by reiterating the benefits your customer experienced by working with you.

The above example reads:

“Crunch Fitness was franchising rapidly when COVID-19 forced fitness clubs around the world to close their doors. But the company stayed agile by using HubSpot to increase leads and free trial signups.”

We like that the case study team expressed the urgency of the problem — opening more locations in the midst of a pandemic — and placed the focus on the customer’s ability to stay agile.

3. Executive Summary

The executive summary should provide a snapshot of your customer, their challenges, and the benefits they enjoyed from working with you. Think it’s too much? Think again — the purpose of the case study is to emphasize, again and again, how well your product works.

The good news is that depending on your design, the executive summary can be mixed with the subtitle or with the “About the Company” section. Many times, this section doesn’t need an explicit “Executive Summary” subheading. You do need, however, to provide a convenient snapshot for readers to scan.

In the above example, ADP included information about its customer in a scannable bullet-point format, then provided two sections: “Business Challenge” and “How ADP Helped.” We love how simple and easy the format is to follow for those who are unfamiliar with ADP or its typical customer.

4. About the Company

Readers need to know and understand who your customer is. This is important for several reasons: It helps your reader potentially relate to your customer, it defines your ideal client profile (which is essential to deter poor-fit prospects who might have reached out without knowing they were a poor fit), and it gives your customer an indirect boon by subtly promoting their products and services.

Feel free to keep this section as simple as possible. You can simply copy and paste information from the company’s LinkedIn, use a quote directly from your customer, or take a more creative storytelling approach.

In the above example, HubSpot included one paragraph of description for Crunch Fitness and a few bullet points. Below, ADP tells the story of its customer using an engaging, personable technique that effectively draws readers in.

5. Challenges and Objectives

The challenges and objectives section of your case study is the place to lay out, in detail, the difficulties your customer faced prior to working with you — and what they hoped to achieve when they enlisted your help.

In this section, you can be as brief or as descriptive as you’d like, but remember: Stress the urgency of the situation. Don’t understate how much your customer needed your solution (but don’t exaggerate and lie, either). Provide contextual information as necessary. For instance, the pandemic and societal factors may have contributed to the urgency of the need.

Take the above example from design consultancy IDEO:

“Educational opportunities for adults have become difficult to access in the United States, just when they’re needed most. To counter this trend, IDEO helped the city of South Bend and the Drucker Institute launch Bendable, a community-powered platform that connects people with opportunities to learn with and from each other.”

We love how IDEO mentions the difficulties the United States faces at large, the efforts its customer is taking to address these issues, and the steps IDEO took to help.

6. How Product/Service Helped

This is where you get your product or service to shine. Cover the specific benefits that your customer enjoyed and the features they gleaned the most use out of. You can also go into detail about how you worked with and for your customer. Maybe you met several times before choosing the right solution, or you consulted with external agencies to create the best package for them.

Whatever the case may be, try to illustrate how easy and pain-free it is to work with the representatives at your company. After all, potential customers aren’t looking to just purchase a product. They’re looking for a dependable provider that will strive to exceed their expectations.

In the above example, IDEO describes how it partnered with research institutes and spoke with learners to create Bendable, a free educational platform. We love how it shows its proactivity and thoroughness. It makes potential customers feel that IDEO might do something similar for them.

The results are essential, and the best part is that you don’t need to write the entirety of the case study before sharing them. Like HubSpot, IDEO, and ADP, you can include the results right below the subtitle or executive summary. Use data and numbers to substantiate the success of your efforts, but if you don’t have numbers, you can provide quotes from your customers.

We can’t overstate the importance of the results. In fact, if you wanted to create a short case study, you could include your title, challenge, solution (how your product helped), and result.

8. Supporting Visuals or Quotes

Let your customer speak for themselves by including quotes from the representatives who directly interfaced with your company.

Visuals can also help, even if they’re stock images. On one side, they can help you convey your customer’s industry, and on the other, they can indirectly convey your successes. For instance, a picture of a happy professional — even if they’re not your customer — will communicate that your product can lead to a happy client.

In this example from IDEO, we see a man standing in a boat. IDEO’s customer is neither the man pictured nor the manufacturer of the boat, but rather Conservation International, an environmental organization. This imagery provides a visually pleasing pattern interrupt to the page, while still conveying what the case study is about.

9. Future Plans

This is optional, but including future plans can help you close on a more positive, personable note than if you were to simply include a quote or the results. In this space, you can show that your product will remain in your customer’s tech stack for years to come, or that your services will continue to be instrumental to your customer’s success.

Alternatively, if you work only on time-bound projects, you can allude to the positive impact your customer will continue to see, even after years of the end of the contract.

10. Call to Action (CTA)

Not every case study needs a CTA, but we’d still encourage it. Putting one at the end of your case study will encourage your readers to take an action on your website after learning about the work you've done.

It will also make it easier for them to reach out, if they’re ready to start immediately. You don’t want to lose business just because they have to scroll all the way back up to reach out to your team.

To help you visualize this case study outline, check out the case study template below, which can also be downloaded here .

You drove the results, made the connection, set the expectations, used the questionnaire to conduct a successful interview, and boiled down your findings into a compelling story. And after all of that, you're left with a little piece of sales enabling gold — a case study.

To show you what a well-executed final product looks like, have a look at some of these marketing case study examples.

1. "Shopify Uses HubSpot CRM to Transform High Volume Sales Organization," by HubSpot

What's interesting about this case study is the way it leads with the customer. This reflects a major HubSpot value, which is to always solve for the customer first. The copy leads with a brief description of why Shopify uses HubSpot and is accompanied by a short video and some basic statistics on the company.

Notice that this case study uses mixed media. Yes, there is a short video, but it's elaborated upon in the additional text on the page. So, while case studies can use one or the other, don't be afraid to combine written copy with visuals to emphasize the project's success.

2. "New England Journal of Medicine," by Corey McPherson Nash

When branding and design studio Corey McPherson Nash showcases its work, it makes sense for it to be visual — after all, that's what they do. So in building the case study for the studio's work on the New England Journal of Medicine's integrated advertising campaign — a project that included the goal of promoting the client's digital presence — Corey McPherson Nash showed its audience what it did, rather than purely telling it.

Notice that the case study does include some light written copy — which includes the major points we've suggested — but lets the visuals do the talking, allowing users to really absorb the studio's services.

3. "Designing the Future of Urban Farming," by IDEO

Here's a design company that knows how to lead with simplicity in its case studies. As soon as the visitor arrives at the page, he or she is greeted with a big, bold photo, and two very simple columns of text — "The Challenge" and "The Outcome."

Immediately, IDEO has communicated two of the case study's major pillars. And while that's great — the company created a solution for vertical farming startup INFARM's challenge — it doesn't stop there. As the user scrolls down, those pillars are elaborated upon with comprehensive (but not overwhelming) copy that outlines what that process looked like, replete with quotes and additional visuals.

4. "Secure Wi-Fi Wins Big for Tournament," by WatchGuard

Then, there are the cases when visuals can tell almost the entire story — when executed correctly. Network security provider WatchGuard can do that through this video, which tells the story of how its services enhanced the attendee and vendor experience at the Windmill Ultimate Frisbee tournament.

5. Rock and Roll Hall of Fame Boosts Social Media Engagement and Brand Awareness with HubSpot

In the case study above , HubSpot uses photos, videos, screenshots, and helpful stats to tell the story of how the Rock and Roll Hall of Fame used the bot, CRM, and social media tools to gain brand awareness.

6. Small Desk Plant Business Ups Sales by 30% With Trello

This case study from Trello is straightforward and easy to understand. It begins by explaining the background of the company that decided to use it, what its goals were, and how it planned to use Trello to help them.

It then goes on to discuss how the software was implemented and what tasks and teams benefited from it. Towards the end, it explains the sales results that came from implementing the software and includes quotes from decision-makers at the company that implemented it.

7. Facebook's Mercedes Benz Success Story

Facebook's Success Stories page hosts a number of well-designed and easy-to-understand case studies that visually and editorially get to the bottom line quickly.

Each study begins with key stats that draw the reader in. Then it's organized by highlighting a problem or goal in the introduction, the process the company took to reach its goals, and the results. Then, in the end, Facebook notes the tools used in the case study.

Showcasing Your Work

You work hard at what you do. Now, it's time to show it to the world — and, perhaps more important, to potential customers. Before you show off the projects that make you the proudest, we hope you follow these important steps that will help you effectively communicate that work and leave all parties feeling good about it.

Editor's Note: This blog post was originally published in February 2017 but was updated for comprehensiveness and freshness in July 2021.

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“I Couldn’t Focus On Anything” : An ADHD Case Study

By: Practical Cures

by Andrea M. Darcy

Do you worry that you, or someone you love, has ADHD? Here I  share my personal experience of just what it’s really like to grow up with attention deficit hyperactivity disorder.

(Want to read a list of symptoms? Read our comprehensive Guide to ADHD ).

ADHD – A Case Study

“It’s like she lives in a bubble of her own making”, read the note one teacher sent home to my parents. But as usual, my habit of not being present was just attributed to shyness and intelligence. Like many kids with ADHD , I was exceedingly bright.

The new research on ADHD now recognises that many girls go undiagnosed because instead of hyperactivity, they are prone more to the major symptom of inattention. They are dreamy and always ‘clocking out’. That was me.

Although to be fair, I did have hyperactivity too. I’d get overexcited, or as my mother would say, ‘she’s on the ceiling again’. After I’d crash and need a nap. My mother felt it was chocolate and treats that caused i,t so I was not allowed any.

I had a lot of stressful experiences because of my ADHD that I now realise other kids probably didn’t. For example, I had to pull my first all-nighter aged only eight. We knew we had a science project to do all year. And I procrastinated and then did the entire thing in the 24 hours before it was due, crying from the stress. But I still won second place.

Surviving adolescence with ADHD

By adolescence my ADHD was in full force, but it was just attributed to ‘ being a teen ‘. High school was in Canad.a (My father, who I’ll get back to, was always moving us. I went to eight different schools in total.)

I was inevitably late for my first class every day. I struggled to remember my schedule, was often losing things, and would get in trouble for chatting in class. Simply as I was too distracted to see that the teacher was talking again. Again, because I was smart and had good grades, teachers overlooked a lot of my behaviour.

By: Richard Smith

Socially I can see my ADHD was a problem. I would join teams then drop out. And became known for changing my social groups ‘like she changes her clothes’, I overheard someone say. The comment stung.

I now see this was the ADHD symptom of impulsivity . It was the same issue that had me rip a portrait into pieces in the middle of art class when I couldn’t quite get the face right. I was incredibly embarrassed to see my teacher and fellow students staring at me, the pieces of my artwork on the floor.

Over focus, putting too much energy on the wrong thing, was also big issue. I would spend hours making the perfect cover for an assignment. Then have to do the assignment itself frantically at the last moment.

A ‘special exception’ is made

I got sent to the principal’s office for skipping a lot of classes. I explained that I was bored out of my mind. They could see something was different with me, I see that now. The said I was ‘too smart’ and needed an exception. I could go to class when I wanted as long as I maintained high grades. Now this makes me sad. I often think, what if they had of realised then I had ADHD? How would my life be different? My intelligence was a curse really, it meant I kept not getting help.

Can ADHD ruin your life? Put it this way. I forgot to choose my classes in time for my final year of high school, and the ones I needed to graduate were full. I was so upset I dropped out of school for a month and looked for a job. But I knew it was the wrong thing to do, so then frantically found another high school to take me. But I had to travel two hours a day to get there and back, and spend my last year at a school where I knew nobody.

University life with adult ADHD

University was a shock. I just couldn’t focus on anything, and I had no idea how to be organised and study. The teachers didn’t know me, so were far from forgiving with my poor timekeeping and tendency to talk loudly out of turn.

I had to maintain straight As to keep my scholarship and there was an art class I took as an elective. The teacher obviously didn’t like me, despite my art being better than most.  And gave me a B+ instead of an A, even though I scored high on all my assignments. It meant the rest of university I had to work two jobs to get by, which just made me even more of a scattered mess.

ADHD and dating

By: martinak15

In university I also started dating. This is one area where I think people need to talk about the damaging effects of ADHD more. I would rush into things before I knew someone then panic.

My tendency of talking in circles, or of wandering off mid-conversation, often had dates tell me they “couldn’t keep up with me”. Then there was the time I really liked someone and found out later he had no idea I was interested. I guess my distracted nature gave the entirely wrong sign.

Just like high school, I briefly dropped out of university, bored. Before begging my way back in at the last moment and finishing my degree. By the time I graduated, I was depressed.

I now realised there was something wrong with me, but just blamed myself for my inability to focus and be organised.

Finally getting the diagnosis of Adult ADHD

I began to drink and go out a lot, I suppose to bolster my falling self-esteem. It was at a party that I met a woman who spilled her soul to me, admitting she was seeing a psychiatrist for depression . I was fascinated. Could this help me? I’d never thought to try. She said she’d give me the number. I of course delayed calling for several weeks, but bumped into the woman again and felt pressured to go through with it.

And that was how I ended up sitting in a psychiatrist’s office across from a rather glamorous and aloof blonde doctor, expecting to be given antidepressants. Instead I was told I had ADHD and was offered a prescription for Ritalin . I walked out in a daze. I knew what ADHD was, but in my mind it equated to hyperactive children, not a 23 year-old like me. The way this woman diagnosed me in one hour flat left me feeling misunderstood and judged, too. I threw out the prescription, cancelled the next appointment, and didn’t talk about the experience to anyone.

Of course my life continued to be a mess. I kept messing up big opportunities by being impulsive. Like having a coveted big acting break, but instead hopping a plane and leaving the country when offered a last minute job teaching in Japan. My life was fun, but I was scattered, stressed, and lonely, and the depression kept returning.

Trying therapy when you have Adult ADHD

By: Banalities

At 28, feeling really awful about my inability to stay in a relationship, I again took a therapy referral from a friend.

This psychotherapist specialised in CBT ( cognitive behavioural therapy ). A slight man with little John Lennon glasses and a pink Ralph Lauren shirt in a soulless office with imitation expressionist art, I was sure it wouldn’t work and wanted to run out screaming.

I told him I had been diagnosed as ADHD but was sure it was a mistake. He ran me through a series of questionnaires and confirmed I did have it. But he said he was optimistic CBT would help.

My friend pushed me to try four sessions before quitting, promising me four was a magic number somehow. And oddly, she was right. Something clicked on the fourth session. I walked out liking him better and feeling hopeful I could make changes in my life.

This was the therapist that taught me about mindfulness meditation . It turned out he’d gone to Berkeley back in the day, and he was a lot cooler than his bad outfits. Near the end of my four months working with him I even went to a one-week meditation retreat, excited by how much calmer and focussed the meditation made me.

I continued the mindfulness meditation, and kept using what I had learned from the CBT process about questioning my thoughts before taking action. It really helped with my impulsivity and I had a few good years after that.

What other forms of therapy did I try?

I also tried   psychodynamic psychotherapy . Friends had great results from it, but I would say that in some ways (and now I’ve read research to prove it) that was not the best choice for someone with ADHD. I started to overanalyse myself ,and my self-esteem , which people say therapy usually helps, got worse.

I do feel CBT is really a good choice for ADHD, as it helps reorganise the brain. Or nowadays I’d try a therapist who specialises in ADHD clients and see what they have to offer.

Life when you have Adult ADHD

I think that just accepting I had ADHD was the most helpful. It meant I could be more patient with myself, and focus on learning new ways of doing things that make living with ADHD easier . I am a huge fan, for example, of using a timer, as I have absolutely no sense of time and it helped me realise what can and can’t be done in an hour.

As for telling my family, I avoided it for years. I have an older sister who is very cynical and always making fun of my ideas about myself. To my surprise , when I did tell her about my diagnosis, she said she had thought so, and that it was hardly a surprise given our father. My father is a good example that ADHD often has a genetic component. He never sits down, never finishes a conversation. Alongside all those moves he put us through, he also burned his way through many jobs and is now on his fourth wife.

Did I try medication?

Yes. But not until an older adult. I was living in France at the time where the only option was was methlyphenidate. I tried both long release Concerta and just instant release Ritalin.

And it was awful, it did not work at all for me, no matter how I took it. It gave me bad headaches, severe insomnia, but what was the worst was that I was so dulled down I felt stupid. Yes, I’d sit oddly still for hours. But I’d get done in 4 hours what I could do in one hour unmedicated. So I stopped using any of it. I also then tried modafinil, it was the same thing. I felt spacey, stupid, slow, tired, and had brutal headaches.

Instead, now I make sure I keep up a regular routine of exercise, eat healthy, and take things like fish oils, which I feel help.

Would I wish to not have attention deficit disorder?

Of course being hard on oneself is another ADHD attribute, and when I remember that I try to shift my focus to see all I have achieved. I’ve travelled extensively, I run my own business, I was the first person I know to be a ‘digital nomad’, as I am always way ahead of the curve… I am doing ok.

And in some ways, I would not want to exchange the good sides of ADHD as I don’t know who I’d be without them. Like  the way I can think fast and under pressure, see multiple perspectives all at once, be incredibly creative, etc.

If you feel you might have ADHD, it’s best not to self diagnose. Talk to your GP or book an assessment with a psychiatrist who specialises in Adult ADHD .

I found this article very interesting thank you!

I just wonder how you managed to get mindfulness to work for you with impulsivity? Whenever I have tried it I either get too bored or unmotivated to do it, or I forget to do it when it really matters!

Hi Lauren, there are several things to try here. One is a support system. Join a group of others who you have to check in with, or have a mediation buddy who you check in with, or use an app that shares results with other users. Sometimes just knowing there is an audience can make even the most distracted amongst us more likely to perform. A timer is pretty essential too. And then there is the simple idea that you make it a non negotiable. You decide you will have a mindfulness practise, come what may. When you judge it as boring, you recognise that thought, let it go, and stay where you are, meditating, until that timer goes off. When you don’t want to do it, you again recognise this is just a thought, and that you have the choice to do it anyway. Brushing your teeth is pretty boring too, but we’d guess you’ve made that a non negotiable… see meditating as that important. the point is to do it every day if possible, so that it isn’t a case of doing it when it matters/doesn’t matter but an ingrained habit. With time you’ll see palpable results, and then you’ll probably want to keep it up, but until then, do it anyway. If there are days that are bad days and you miss it, then you don’t judge yourself. You just start again the next day. Best, HT.

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• Knowledge Base

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Research bias

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

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Home / Guides / Citation Guides / How to Cite Sources / How to Cite a Case Study in APA, MLA, or Chicago

How to Cite a Case Study in APA, MLA, or Chicago

When citing a case study, the format in MLA and APA is similar to that of a report, and in Chicago style, it is similar to that of a book. For all three citation styles, you will need the name of the author(s), the title of the case study, the year it was published, the publishing organization/publisher, and URL (if applicable). The templates and examples below will demonstrate how to cite a case study in MLA, APA, and Chicago styles.

Author Last Name, Author First Name.  Title of Case Study . Edition (if applicable), volume number (if applicable), Publisher, year of publication, URL without http:// or https:// (if applicable).

Hill, Linda A., et al. HCL Technologies (A). Rev. edition, Harvard Business School, 2008, www.hbs.edu/faculty/Pages/item.aspx?num=34784.

In-text Citation:

(Author Last Name(s) page #)

(Hill et al. 8)

Author Last Name, Author Initial. (Publication Year). Title of Case Study (Case # if applicable). Publishing Organization. URL

Hill, L., Khanna, T., & Stecker, E. (2008). HCL Technologies (A) (Case 408-004). Harvard Business School. https://www.hbs.edu/faculty/Pages/item.aspx?num=34784

(Author Last Name, Publication Year)

(Hill et al., 2008)

Notes-bibliography style

Author Last Name, First Name.  Title of the Case Study . Publishing City: Publishing Organization, Publication Year. URL.

Hill, Linda A., Tarun Khanna, and Emily Stecker. HCL Technologies (A).  Boston: Harvard Business School, 2008. https://www.hbs.edu/faculty/Pages/item.aspx?num=34784.

1. Author First Name Last Name, Title of the Case Study (Publishing City: Publishing Organization, Publication Year), URL.

1. Linda A. Hill, Tarun Khanna, and Emily Stecker, HCL Technologies (A) ( Boston: Harvard Business School, 2008), https://www.hbs.edu/faculty/Pages/item.aspx?num=34784.

Author-date style

Author Last Name, First Name. Publication Year. Title of the Case Study . Publishing City: Publishing Organization. URL.

Hill, Linda A., Tarun Khanna, and Emily Stecker. 2008. HCL Technologies (A).  Boston: Harvard Business School. https://www.hbs.edu/faculty/Pages/item.aspx?num=34784.

In-text citation: 

(Author Last Name Publication Date)

(Holl, Khanna, and Stecker 2008)

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How to write a case study — examples, templates, and tools

It’s a marketer’s job to communicate the effectiveness of a product or service to potential and current customers to convince them to buy and keep business moving. One of the best methods for doing this is to share success stories that are relatable to prospects and customers based on their pain points, experiences, and overall needs.

That’s where case studies come in. Case studies are an essential part of a content marketing plan. These in-depth stories of customer experiences are some of the most effective at demonstrating the value of a product or service. Yet many marketers don’t use them, whether because of their regimented formats or the process of customer involvement and approval.

A case study is a powerful tool for showcasing your hard work and the success your customer achieved. But writing a great case study can be difficult if you’ve never done it before or if it’s been a while. This guide will show you how to write an effective case study and provide real-world examples and templates that will keep readers engaged and support your business.

In this article, you’ll learn:

What is a case study?

How to write a case study, case study templates, case study examples, case study tools.

A case study is the detailed story of a customer’s experience with a product or service that demonstrates their success and often includes measurable outcomes. Case studies are used in a range of fields and for various reasons, from business to academic research. They’re especially impactful in marketing as brands work to convince and convert consumers with relatable, real-world stories of actual customer experiences.

The best case studies tell the story of a customer’s success, including the steps they took, the results they achieved, and the support they received from a brand along the way. To write a great case study, you need to:

• Celebrate the customer and make them — not a product or service — the star of the story.
• Craft the story with specific audiences or target segments in mind so that the story of one customer will be viewed as relatable and actionable for another customer.
• Write copy that is easy to read and engaging so that readers will gain the insights and messages intended.
• Follow a standardized format that includes all of the essentials a potential customer would find interesting and useful.
• Support all of the claims for success made in the story with data in the forms of hard numbers and customer statements.

Case studies are a type of review but more in depth, aiming to show — rather than just tell — the positive experiences that customers have with a brand. Notably, 89% of consumers read reviews before deciding to buy, and 79% view case study content as part of their purchasing process. When it comes to B2B sales, 52% of buyers rank case studies as an important part of their evaluation process.

Telling a brand story through the experience of a tried-and-true customer matters. The story is relatable to potential new customers as they imagine themselves in the shoes of the company or individual featured in the case study. Showcasing previous customers can help new ones see themselves engaging with your brand in the ways that are most meaningful to them.

Besides sharing the perspective of another customer, case studies stand out from other content marketing forms because they are based on evidence. Whether pulling from client testimonials or data-driven results, case studies tend to have more impact on new business because the story contains information that is both objective (data) and subjective (customer experience) — and the brand doesn’t sound too self-promotional.

Case studies are unique in that there’s a fairly standardized format for telling a customer’s story. But that doesn’t mean there isn’t room for creativity. It’s all about making sure that teams are clear on the goals for the case study — along with strategies for supporting content and channels — and understanding how the story fits within the framework of the company’s overall marketing goals.

Here are the basic steps to writing a good case study.

1. Identify your goal

Start by defining exactly who your case study will be designed to help. Case studies are about specific instances where a company works with a customer to achieve a goal. Identify which customers are likely to have these goals, as well as other needs the story should cover to appeal to them.

The answer is often found in one of the buyer personas that have been constructed as part of your larger marketing strategy. This can include anything from new leads generated by the marketing team to long-term customers that are being pressed for cross-sell opportunities. In all of these cases, demonstrating value through a relatable customer success story can be part of the solution to conversion.

2. Choose your client or subject

Who you highlight matters. Case studies tie brands together that might otherwise not cross paths. A writer will want to ensure that the highlighted customer aligns with their own company’s brand identity and offerings. Look for a customer with positive name recognition who has had great success with a product or service and is willing to be an advocate.

The client should also match up with the identified target audience. Whichever company or individual is selected should be a reflection of other potential customers who can see themselves in similar circumstances, having the same problems and possible solutions.

Some of the most compelling case studies feature customers who:

• Switch from one product or service to another while naming competitors that missed the mark.
• Experience measurable results that are relatable to others in a specific industry.
• Represent well-known brands and recognizable names that are likely to compel action.
• Advocate for a product or service as a champion and are well-versed in its advantages.

Whoever or whatever customer is selected, marketers must ensure they have the permission of the company involved before getting started. Some brands have strict review and approval procedures for any official marketing or promotional materials that include their name. Acquiring those approvals in advance will prevent any miscommunication or wasted effort if there is an issue with their legal or compliance teams.

3. Conduct research and compile data

Substantiating the claims made in a case study — either by the marketing team or customers themselves — adds validity to the story. To do this, include data and feedback from the client that defines what success looks like. This can be anything from demonstrating return on investment (ROI) to a specific metric the customer was striving to improve. Case studies should prove how an outcome was achieved and show tangible results that indicate to the customer that your solution is the right one.

This step could also include customer interviews. Make sure that the people being interviewed are key stakeholders in the purchase decision or deployment and use of the product or service that is being highlighted. Content writers should work off a set list of questions prepared in advance. It can be helpful to share these with the interviewees beforehand so they have time to consider and craft their responses. One of the best interview tactics to keep in mind is to ask questions where yes and no are not natural answers. This way, your subject will provide more open-ended responses that produce more meaningful content.

4. Choose the right format

There are a number of different ways to format a case study. Depending on what you hope to achieve, one style will be better than another. However, there are some common elements to include, such as:

• An engaging headline
• A subject and customer introduction
• The unique challenge or challenges the customer faced
• The solution the customer used to solve the problem
• The results achieved
• Data and statistics to back up claims of success
• A strong call to action (CTA) to engage with the vendor

It’s also important to note that while case studies are traditionally written as stories, they don’t have to be in a written format. Some companies choose to get more creative with their case studies and produce multimedia content, depending on their audience and objectives. Case study formats can include traditional print stories, interactive web or social content, data-heavy infographics, professionally shot videos, podcasts, and more.

5. Write your case study

We’ll go into more detail later about how exactly to write a case study, including templates and examples. Generally speaking, though, there are a few things to keep in mind when writing your case study.

• Be clear and concise. Readers want to get to the point of the story quickly and easily, and they’ll be looking to see themselves reflected in the story right from the start.
• Provide a big picture. Always make sure to explain who the client is, their goals, and how they achieved success in a short introduction to engage the reader.
• Construct a clear narrative. Stick to the story from the perspective of the customer and what they needed to solve instead of just listing product features or benefits.
• Leverage graphics. Incorporating infographics, charts, and sidebars can be a more engaging and eye-catching way to share key statistics and data in readable ways.
• Offer the right amount of detail. Most case studies are one or two pages with clear sections that a reader can skim to find the information most important to them.
• Include data to support claims. Show real results — both facts and figures and customer quotes — to demonstrate credibility and prove the solution works.

6. Promote your story

Marketers have a number of options for distribution of a freshly minted case study. Many brands choose to publish case studies on their website and post them on social media. This can help support SEO and organic content strategies while also boosting company credibility and trust as visitors see that other businesses have used the product or service.

Marketers are always looking for quality content they can use for lead generation. Consider offering a case study as gated content behind a form on a landing page or as an offer in an email message. One great way to do this is to summarize the content and tease the full story available for download after the user takes an action.

Sales teams can also leverage case studies, so be sure they are aware that the assets exist once they’re published. Especially when it comes to larger B2B sales, companies often ask for examples of similar customer challenges that have been solved.

Now that you’ve learned a bit about case studies and what they should include, you may be wondering how to start creating great customer story content. Here are a couple of templates you can use to structure your case study.

Template 1 — Challenge-solution-result format

• Start with an engaging title. This should be fewer than 70 characters long for SEO best practices. One of the best ways to approach the title is to include the customer’s name and a hint at the challenge they overcame in the end.
• Create an introduction. Lead with an explanation as to who the customer is, the need they had, and the opportunity they found with a specific product or solution. Writers can also suggest the success the customer experienced with the solution they chose.
• Present the challenge. This should be several paragraphs long and explain the problem the customer faced and the issues they were trying to solve. Details should tie into the company’s products and services naturally. This section needs to be the most relatable to the reader so they can picture themselves in a similar situation.
• Share the solution. Explain which product or service offered was the ideal fit for the customer and why. Feel free to delve into their experience setting up, purchasing, and onboarding the solution.
• Explain the results. Demonstrate the impact of the solution they chose by backing up their positive experience with data. Fill in with customer quotes and tangible, measurable results that show the effect of their choice.
• Ask for action. Include a CTA at the end of the case study that invites readers to reach out for more information, try a demo, or learn more — to nurture them further in the marketing pipeline. What you ask of the reader should tie directly into the goals that were established for the case study in the first place.

Template 2 — Data-driven format

• Start with an engaging title. Be sure to include a statistic or data point in the first 70 characters. Again, it’s best to include the customer’s name as part of the title.
• Create an overview. Share the customer’s background and a short version of the challenge they faced. Present the reason a particular product or service was chosen, and feel free to include quotes from the customer about their selection process.
• Present data point 1. Isolate the first metric that the customer used to define success and explain how the product or solution helped to achieve this goal. Provide data points and quotes to substantiate the claim that success was achieved.
• Present data point 2. Isolate the second metric that the customer used to define success and explain what the product or solution did to achieve this goal. Provide data points and quotes to substantiate the claim that success was achieved.
• Present data point 3. Isolate the final metric that the customer used to define success and explain what the product or solution did to achieve this goal. Provide data points and quotes to substantiate the claim that success was achieved.
• Summarize the results. Reiterate the fact that the customer was able to achieve success thanks to a specific product or service. Include quotes and statements that reflect customer satisfaction and suggest they plan to continue using the solution.
• Ask for action. Include a CTA at the end of the case study that asks readers to reach out for more information, try a demo, or learn more — to further nurture them in the marketing pipeline. Again, remember that this is where marketers can look to convert their content into action with the customer.

While templates are helpful, seeing a case study in action can also be a great way to learn. Here are some examples of how Adobe customers have experienced success.

Juniper Networks

One example is the Adobe and Juniper Networks case study , which puts the reader in the customer’s shoes. The beginning of the story quickly orients the reader so that they know exactly who the article is about and what they were trying to achieve. Solutions are outlined in a way that shows Adobe Experience Manager is the best choice and a natural fit for the customer. Along the way, quotes from the client are incorporated to help add validity to the statements. The results in the case study are conveyed with clear evidence of scale and volume using tangible data.

The story of Lenovo’s journey with Adobe is one that spans years of planning, implementation, and rollout. The Lenovo case study does a great job of consolidating all of this into a relatable journey that other enterprise organizations can see themselves taking, despite the project size. This case study also features descriptive headers and compelling visual elements that engage the reader and strengthen the content.

Tata Consulting

When it comes to using data to show customer results, this case study does an excellent job of conveying details and numbers in an easy-to-digest manner. Bullet points at the start break up the content while also helping the reader understand exactly what the case study will be about. Tata Consulting used Adobe to deliver elevated, engaging content experiences for a large telecommunications client of its own — an objective that’s relatable for a lot of companies.

Case studies are a vital tool for any marketing team as they enable you to demonstrate the value of your company’s products and services to others. They help marketers do their job and add credibility to a brand trying to promote its solutions by using the experiences and stories of real customers.

When you’re ready to get started with a case study:

• Think about a few goals you’d like to accomplish with your content.
• Make a list of successful clients that would be strong candidates for a case study.
• Reach out to the client to get their approval and conduct an interview.
• Gather the data to present an engaging and effective customer story.

Adobe can help

There are several Adobe products that can help you craft compelling case studies. Adobe Experience Platform helps you collect data and deliver great customer experiences across every channel. Once you’ve created your case studies, Experience Platform will help you deliver the right information to the right customer at the right time for maximum impact.

To learn more, watch the Adobe Experience Platform story .

Keep in mind that the best case studies are backed by data. That’s where Adobe Real-Time Customer Data Platform and Adobe Analytics come into play. With Real-Time CDP, you can gather the data you need to build a great case study and target specific customers to deliver the content to the right audience at the perfect moment.

Watch the Real-Time CDP overview video to learn more.

Finally, Adobe Analytics turns real-time data into real-time insights. It helps your business collect and synthesize data from multiple platforms to make more informed decisions and create the best case study possible.

Request a demo to learn more about Adobe Analytics.

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Home » Case Study – Methods, Examples and Guide

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.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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4 Reasons Why There's Never Been a Better Time to Write Case Studies By Casey Hibbard

In 2000, I was a freshly minted case study writer.

I'd written a few of these fun, well-paying projects, and was hooked.

I was interviewing my clients' happy customers and crafting compelling stories. Sign me up for more!

In the pre-LinkedIn era, I began frequenting face-to-face networking events to find clients.

But when I enthusiastically told people that I write case studies … blank stares followed.

Back then, it was the rare marketer who had heard of customer case studies — mostly limited to savvy technology companies.

I had to explain WHAT case studies were, WHY they were valuable, and then SELL prospects on working with me. It became exhausting.

The good news for writers is, things are vastly different today.

Customer case studies, aka success stories, have become an indispensable marketing tool. Hundreds of thousands of businesses create them. And if they don't yet, most know they should.

Here are four reasons why there's never been a better time to be a case study writer …

Reason #1: Social Proof Rules the Day

People have always relied on "social proof," or word-of-mouth, to make decisions.

Maybe your friend recommends a babysitter or restaurant. With that endorsement, you feel more confident making the same decision.

But in the past 20 years, social proof has become more formalized and part of companies' marketing budgets.

From buying blenders to hotels to software, we've come to rely on the experiences of others to help make decisions. Consider the power of reviews on Amazon, TripAdvisor, and Yelp.

Think about the last major purchase you made. Chances are, someone else's experience influenced your decision.

But beyond online review sites, countless businesses now actively create customer case studies to give buyers more peace of mind in their decisions. Because the more expensive, complex, or risky the purchase is, the more proof buyers need.

What better way than a compelling customer story to show that a company delivers on its promises?

Buyers agree. When the research firm Forrester asked Business-to-Business (B2B) buyers about the type of content that helps them make purchase decisions, over 70% said "real customer or peer stories."

Reason #2: Companies Can't Find Enough Good Case Study Writers

So many organizations now create case studies that marketers just can't find enough skilled help. Trust me.

Nearly every week, a new prospect contacts me about creating case studies. But I can't take on all the requests that come in.

The market needs more qualified case study writers.

Companies want someone experienced in the ins and outs of this unique kind of writing …

Someone who can learn their solutions quickly … Ask the right questions in interviews … Craft a compelling story with measurable results … Match the story to the client's goals and key messages … And guide them through the process until they have a completed story ready for use.

It's not hard, but it does take specific know-how and the "human" touch.

Reason #3: Written Case Studies Still Reign

Writers frequently ask me whether video testimonials are replacing written case studies. After all, marketing and social media are rife with video.

While customer stories lend themselves well to video, the price tag and logistics seriously limit its use.

Consider this: Chances are, the vendor and customer are in two totally different places. That requires flying a video crew to the customer's site, bringing the customer to the vendor's location, or finding a quality video team based in the customer's location — for every story.

None of this is easy, or cheap. That's one of the reasons why written customer stories still outpace video testimonials.

Second, not everyone prefers video. In fact, one survey found only about 30% of buyers actually prefer video over written. A possible explanation: written stories are skimmable and consumed at the buyer's own pace, while video is not.

I see this with my own clients. Even those who produce customer videos still develop written stories about those same customers.

Reason #4: Nearly Any Type of Business Can Benefit

In the early days of my freelance career, customer case studies were mostly a make-or-break marketing tool for tech companies attempting to stand out in a very competitive start-up environment.

But those technology trailblazers set the precedent for the rest of the business world, and now TONS of businesses market with written customer stories — from business services providers to consumer companies.

Spend a few minutes searching online for "customer case studies" or "customer success stories" and you'll see what I mean.

Up will pop page upon page of hits. At the top, you'll see big names like Microsoft and Cisco. But keep going and you'll find all types and sizes of businesses.

These are just the ones that come up in a search. There are countless others behind-the-scenes that already produce case studies, or know they need to.

Those could be coaches, consultants, health providers, financial advisors, architects, building contractors, educational providers, and many more. Check out the AWAI website and you'll find dozens of member success stories .

Because just about ANY organization could benefit from marketing with customer stories.

So there you have it. There's never been a better time to add case studies to your menu of writing services.

But beyond all that, it's an especially rewarding and fun form of writing for those who enjoy storytelling. And who doesn't?

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Historical parallels between Trump ballot case, RI's Dorr Rebellion | Opinion

Erik Chaput and Russell DeSimone are the co-creators of the Dorr Rebellion Project website.

The study of our nation’s past — from just a few years ago to as far back as the Reconstruction era — continues to shape the contours of American politics. For teachers tasked with engaging the next generation of voters, there are interesting historical parallels from a recent Supreme Court case to one over a century and a half ago stemming from the 1842 Dorr Rebellion in Rhode Island .

In December 2023, the Colorado high court ruled that because former President Donald Trump had, in their understanding, directly aided an insurrection on Jan. 6, 2021, he was ineligible to run for office under Section 3 of the 14th Amendment. Trump appealed. In its ruling on March 4 in Trump v. Anderson, the U.S. Supreme Court put the former president back on the ballot.

Despite the urging of a who’s who list of American historians who wrote amicus curiae briefs outlining the original understanding of Section 3, the court charted a path to preserve the democratic order in a presidential election year. They did not explore connections between the insurrection on Jan. 6 and the Civil War.

More: Maine just barred Trump from the ballot. Will RI's secretary of state follow suit?

A study of Rhode Island’s mini (and bloodless) civil war in 1842 will also help students explore complicated questions relating to the Supreme Court and democracy. For Providence attorney Thomas W. Dorr, the state’s failure to usher in a modern constitution, along with its neglect of voting reform measures, justified forceful action.

In mid-May 1842, Dorr, believing himself to be the duly elected governor, took drastic steps to take control, including an attempt to seize the state arsenal by force of arms. Unlike the insurrection on Jan. 6, however, Dorr and his allies caused no damage to state property nor was anyone killed − though a great deal of that was due to dumb luck.

In June 1844, Dorr was tried and convicted of treason. The Supreme Court eventually weighed in, though not on Dorr’s appeal, but rather on a trespass case stemming from an overzealous militia during the short-lived rebellion.

Luther v. Borden (1849) raised significant issues, ones that Dorr helped to manage early on from his jail cell. These included the possibility of whether or not the Supreme Court could decide between the legality of Dorr’s government and the sitting government that put down his brief insurrection. If the justices retroactively ruled that Dorr was right and his opponents wrong, then the state, which finally adopted a new constitution in 1843, would have been thrown into chaos.

The Luther case was argued in 1848, but the court waited until after the presidential election to hand down its ruling. Dorr wanted the Supreme Court to use the guarantee of the republican government clause in Article IV, Section 4 to justify his actions. Instead, the court, while acknowledging the “unfortunate political differences” in the state, said the guarantee was established by the sitting government sending representatives to Congress and the actions of President John Tyler at the time.

More: 'A dangerous time in America': Political scholar looks at national, world politics

The long-term impact of the ruling was that the guarantee clause became wholly nonjusticiable, something akin to what the court said a few weeks ago about Section 3 of the 14th Amendment. In Luther, the court, while certainly acknowledging the state’s antiquated political culture, did not get at the myriad of ways reform efforts had been squashed in Rhode Island.

On March 4, the Supreme Court refused to discuss the elephant in the room of whether Jan. 6 constituted an insurrection and whether or not a former president played a role. The ruling hinged on whether or not Section 3 required Congress to act first to disqualify a federal candidate before a state could act. The recent past was not discussed.

The issue of the people’s sovereignty continues to arise in moments of intense disagreement. Key participants will continue to frame their words and deeds within the ideology of democracy, exploiting ambiguities, and making the role of the teacher so vital as they set out to help students navigate this turbulent political landscape.

Dinosaur study challenges Bergmann's rule

When you throw dinosaurs into the mix, sometimes you find that a rule simply isn't.

A new study led by scientists at the University of Alaska Fairbanks and the University of Reading calls into question Bergmann's rule, an 1800s-era scientific principle stating that animals in high-latitude, cooler climates tend to be larger than close relatives living in warmer climates.

The fossil record shows otherwise.

"Our study shows that the evolution of diverse body sizes in dinosaurs and mammals cannot be reduced to simply being a function of latitude or temperature," said Lauren Wilson, a UAF graduate student and a lead author of a paper published today in the journal Nature Communications. "We found that Bergmann's rule is only applicable to a subset of homeothermic animals (those that maintain stable body temperatures), and only when you consider temperature, ignoring all other climatic variables. This suggests that Bergmann's 'rule' is really the exception rather than the rule."

The study started as a simple question Wilson discussed with her undergraduate advisor: Does Bergmann's rule apply to dinosaurs?

After evaluating hundreds of data points gleaned from the fossil record, the answer seemed a solid "no."

The dataset included the northernmost dinosaurs known to scientists, those in Alaska's Prince Creek Formation. They experienced freezing temperatures and snowfall. Despite this, the researchers found no notable increase in body size for any of the Arctic dinosaurs.

Next the researchers tried the same evaluation with modern mammals and birds, the descendants of prehistoric mammals and dinosaurs. The results were largely the same: Latitude was not a predictor of body size in modern bird and mammal species. There was a small relationship between the body size of modern birds and temperature, but the same was not the case for prehistoric birds.

The researchers say the study is a good example of how scientists can and should use the fossil record to test current-day scientific rules and hypotheses.

"The fossil record provides a window into completely different ecosystems and climate conditions, allowing us to assess the applicability of these ecological rules in a whole new way," said Jacob Gardner, a postdoctoral researcher at the University of Reading and the other lead author of the paper.

Scientific rules should apply to fossil organisms in the same way they do modern organisms, said Pat Druckenmiller, director of the University of Alaska Museum of the North and one of the co-authors of the paper.

"You can't understand modern ecosystems if you ignore their evolutionary roots," he said. "You have to look to the past to understand how things became what they are today."

• Evolutionary Biology
• Global Warming
• Paleontology
• Early Mammals
• Little Ice Age
• Circle of latitude
• Hereford (cattle)
• Ocean current

Story Source:

Materials provided by University of Alaska Fairbanks . Note: Content may be edited for style and length.

Journal Reference :

• Lauren N. Wilson, Jacob D. Gardner, John P. Wilson, Alex Farnsworth, Zackary R. Perry, Patrick S. Druckenmiller, Gregory M. Erickson, Chris L. Organ. Global latitudinal gradients and the evolution of body size in dinosaurs and mammals . Nature Communications , 2024; 15 (1) DOI: 10.1038/s41467-024-46843-2

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