creative child case study

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

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

Description of Assignment

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

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

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

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

Qualitative and Quantitative Observation Tips

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

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

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

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

Qualitative Observations

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

Quantitative Observations

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

Remaining Objective 

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

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

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

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

Qualitative and Quantitative Artifact Collection and Review Tips

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

Potential Qualitative Artifacts 

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

Potential Quantitative Artifacts 

• Checklist 
• Rating Scales
• Product Teacher-led activities 

Examples of Components of the Case Study

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

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

Narrative Tips

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

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

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

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

Biggest Mistakes Students Make on this Assignment

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

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

What is creativity? For some, the answer lies in artistic expression, while for others, creativity is reflected by innovative applications of maths and sciences. Business Dictionary defines creativity as the “mental characteristic that allows a person to think outside of the box, which results in innovative or different approaches to a particular task.”

And creativity is not just found in the arts. Creative people can practice their talents in a wide variety of venues—including science, technology, design, mathematics, engineering, popular culture, as well as fine arts, and crafts.

Is creativity born in you or can it be nurtured and developed in everyone? The truth is, everyone has individual gifts that can be fostered into creative expression or practical application. The secret lies in identifying these gifts, and finding ways to develop and channel them.

Are Some People Naturally More Creative?

You’ve probably heard someone referred to as “naturally creative,” but are some people really born with a propensity to creativity? Research shows that this is indeed the case. In fact, a recent study using MRIs and psychological testing, showed that some people do have a larger capacity for creative thinking and application than others.

The reason for this lies in the fact that creativity is the result of a complex interplay between controlled and spontaneous thinking, and studies show that some people have a higher capability for spontaneous, original thought. For example, in one of the tests, participants were shown common objects and asked for creative ideas in using them. When a sock was shown, one person suggested it be used as a foot warmer, while another suggested that it could be turned into a water filtration system—a significantly more creative idea.

Nevertheless, psychologists also agree that every child has the potential for creativity , because everyone is born with an imagination—and imagination is the spark that lights the creative fire. And learning to be a creative child is important because creativity not only helps children develop new ways to express themselves; it also helps children (as well as adults) come up with new ways to solve problems and meet challenges .

How Parents Can Foster Creativity

Here are some inventive ways that you can raise a creative child:

• Utilize creative playtime: This can include starting a story and having each child add to it, or inviting children to come up with their own stories. Activities such as creating puppets and putting on puppet shows, inventing new gadgets, crafting, painting, or any type of artistic expression will also help nurture individual creativity.

• Allow your children to pursue their passions: Whether they love inventing science projects , playing music , or composing poetry , encourage this passion wholeheartedly, and offer support and tools (such as books, chemistry sets, music lessons, etc.) that can help them develop their interests.

• Don’t impose your opinions on your children’s tastes: If your child loves something that you don’t, such as a movie, a fashion style, or a type of music, don’t criticize or try to impose your own taste. Instead, accept that your child is an individual who will form independent tastes from yours, and encourage this.

• Help your child explore the world: Expose your child to new and exciting places and experiences. This can include interactive museums , exotic ethnic restaurants, nature centers, theatrical presentations, and music concerts. Many a dancer was inspired by that first trip to the ballet, while many a great scientist first developed a love of science from childhood trips to a museum.

By nurturing your child’s existing talents and trying to help your child discover new interests, you can light a spark of creativity that can grow into a lifelong passion. Likewise, by encouraging your child to develop imaginative modes of expression and independent interests, you can help your child meet the challenges of life with greater wisdom and understanding.

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• v.11(2); 2016 Apr

Comparison of Creativity between Children with and without Attention Deficit Hyperactivity Disorder: A Case-Control Study

Banafsheh aliabadi.

1. Department of Psychiatry, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2. Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Rozita Davari-Ashtiani

Mojgan khademi, fariba arabgol.

The aim of this study was to compare creativity in children with and without attention deficit hyperactivity disorder.

This was an analytic and descriptive study. Participants were 33 children aged 7–12 years selected from a child and adolescent psychiatric clinic at Imam Hossein hospital (Tehran, Iran), who were diagnosed with ADHD by a child and adolescent psychiatrist. They met the DSM-IV diagnostic criteria for ADHD and had no comorbidity according to K-SADS (Kiddi-Scadule for Affective disorders and Schizophrenia). They were requested not to take any medication. They took the Figural TTCT (Torrance Test of Creativity Thinking) and Raven Intelligence test after using medication. Thirty-three age and sex-matched children selected from the regional schools were recruited for the control group. They did not have any psychiatric disorders according to K-SADS. The Figural TTCT and Raven Intelligence test were conducted for the controls as well.

No statistically significant difference was found in the intelligence score and the mean±SD of the total score of creativity between children with ADHD (125.2 ± 42.6) and the control group (130.6 ± 47.5) (P value = 0.49). Children with ADHD had worse function in fluency and flexibility items and were not different in originality and elaboration items.

Conclusion:

The creativity of children with ADHD is not different from that of the control group.

Attention deficit hyperactivity disorder is one of the most prevalent childhood psychiatric disorders ( 1 ), and its diagnosis is growing among children and adolescences ( 2 ). Although ADHD may negatively affect academic achievement, employment performance and social relationships, there are some children with ADHD who are very creative and successful in adulthood. Gifts and ADHD may cover each other ( 3 , 4 ). Some authors believe that studies of children with ADHD often focus on the problems, diagnosis, and treatment; but rarely consider the symptoms as characteristics similar to creativity ( 5 ). There are some similarities between creative individuals and those with ADHD: Distractibility and inattentiveness, which is associated with creativity ( 6 ); Oversensitivity; restlessness and hyperactivity; inability in time management; dangerous activities; impulsivity and impatience, especially in daily activities; uncontrollable behavior and acting on emotions; day dreaming; mixed laterality and anomalies in cerebral dominance; more spontaneous ideation; higher levels of sensation seeking behavior ( 4 , 7 ).There are some reports of superiority of children with ADHD in some domains of creativity. For instance, they were better problem-solvers and more creative with unusual ideas in response to stimulating video games ( 8 ). In cooperative tasks, the group with children with ADHD were more successful in problem solving ( 9 ). In one study, a group of 34 children with ADHD were tested for creativity, using the figural form of the Torrance Tests of Creative Thinking and found that although the group performed at about the mean on the TTCT, 32% of the children scored above the 90th percentile, and half above the 70th percentile ( 7 ). However, a significant limitation of this study was that the author had no control over whether the children with ADHD were medicated during testing or not. Since there is the possibility of inverse relationship between creativity and concentration, some believe that when people use stimulants to improve cognitive performance, their creative ability may decrease. One study investigated this topic and found no effect ( 10 ), while other researchers reported improving creativity ( 11 , 12 ), and also another study showed decreasing divergent thinking ( 13 ). Another important limitation was that there were a large number of very intelligent children in the ADHD group; six of the 11 children with ADHD who scored above the 90th percentile on TTCT had also been selected for a gifted scholars program.

Assessing the impairment in function for diagnosis of ADHD is very important as in a study about 40% of the highly creative children were diagnosed with ADHD according to rating scales but the diagnosis was not confirmed by semi-structured clinical interview as they were not significantly impaired by the symptoms they displayed ( 14 ).

On the other hand, some studies showed no difference in creative ability among the ADHD group and the control group ( 15 – 18 ) and even some studies reported worse creative function in ADHD group ( 10 , 19 and 20 ).

The researchers have noted the importance of approaching education from a strength-based perspective rather than focusing on remediating weaknesses ( 21 , 22 ). It is helpful to consider the abilities of these children and promote their achievement through enhancing organization with treatment and better implication of these strengths. A creative child, who can learn to organize his activities, complete his projects and pay attention to details, has a more chance for excellence.

Considering the methodological problems of the previous studies like a highly intelligent sample, uncontrolled medication and unconfirmed ADHD diagnosis, the higher creative ability of children with ADHD is still a question. In this study, we tried to compare creativity in children with and without ADHD considering the limitation of past studies.

Materials and Method

Participants: Thirty-three children aged 7–12 years, diagnosed with ADHD by a child and adolescent psychiatrist, were selected from a child and adolescent psychiatric clinic at Imam Hossein hospital (Tehran, Iran).They also met the DSM-IV TR diagnostic criteria for ADHD and had no comorbidity according to KSADS (Kiddi-Scadule for Affective disorders and Schizophrenia). Thirty-three age and sex- matched children were selected from the regional schools for the control group. The controls did not have any psychiatric disorders according to K-SADS.

Instruments: The Figural TTCT (Torrance Test of Creativity Thinking) and Raven Intelligence test, whose reliability in Iran has been confirmed ( 23 ), were conducted for both groups. TTCT is the most widely used test of its kind since it only requires the examinee to reflect upon their life experiences ( 24 ). Thinking creatively with pictures is appropriate for all levels, kindergarten age through adulthood. The test- retest method for the TTCT test in Iran showed the reliability coefficient of 0.8 ( 25 ). The test takes 30 minutes and involves three tasks of drawing unusual and creative pictures. In first task, the child should use a yellow bean shaped paper to demonstrate the idea of a story in his or her mind and choose a title for it. The second task includes 10 incomplete pictures and the child should make the most unusual picture from each. In the third task, which involves a number of circles, the child should make as many pictures as he or she can.

Creativity is assessed by four components including: Fluency, flexibility, originality and elaboration. Task 1 is scored for originality, which means how rare and creative is the idea, and for elaboration, which shows how the examinee could explain the idea with details. Task 2 and 3 are scored for fluency, which is the number of meaningful ideas of each task, and flexibility, which shows how the subjects of ideas are different.

Children with ADHD did the TTCT without receiving stimulants, but they received it before the IQ test. Children with IQ score of less than 90 were excluded from the study. Written consent was obtained from each participant.

Statistical Analysis: To compare the IQ of the two groups, t-test was used and the creativity items between the two groups were compared by Mann-Whitney test with 0.05 significance level, using SPSS 19.

The mean age of children in both groups was 9±2 and there were 9 girls and 24 boys in each group.

Results are presented in the table 1 . Based on the results of the t-test, there was no statistically significant difference in the IQ of the two groups. Creativity was assessed in four items: Originality, fluency, flexibility and elaboration, using Mann-Whitney test. The difference of the total scores of creativity in children with and without ADHD was not statistically significant. The scores of the fluency and the flexibility items were significantly better in the group without ADHD ( figure 1 ). Moreover, no statistically significant difference was found between the two groups in terms of elaboration and originality items.

Comparison of IQ and Creativity Items between Children with and without ADHD

Creativity results in children with and without ADHD

In this study, the total score of creativity was not different between the two groups but children with ADHD had worse function in fluency and flexibility items. The same results were observed in other studies ( 10 , 20 ). Some studies reported less creativity of children with ADHD during free play and performance of nonverbal, figural creativity tasks ( 10 , 20 ) and in other studies they were not different or worse in object usage (ideational fluency), verbal fluency, and design fluency (5-Points Test) ( 19 , 26 ).

A number of studies showed no difference in creativity in children with and without ADHD ( 15 – 18 , 27 ). For instance, creativity and language, general science, and mathematics were compared between ADHD and control group and no difference was found. However, a serious methodological limitation of this study was that the ADHD diagnosis was done solely on the basis of teacher’s ratings of hyperactivity on a DSM-IV evaluation form ( 18 ).

Considering the lower function of children with ADHD in other cognitive tasks such as naming speed, information processing speed and reaction time ( 14 ), lower function in creative task could have been predictable too. On the other hand, if they were more creative than the normal population, this ability should have had a positive effect in their life, but usually people with ADHD have many problems in their education and occupation. In fact, adults with ADHD are less likely to achieve educational (and occupational) level which is predicted based on their IQ ( 28 – 30 ). For example, although 84% of the ADHD-diagnosed adults were statistically expected to be college graduates, only 50% reached this level of education ( 28 ).

In a study on 32 children, children with ADHD showed better analysis for problem solving and more creative and unusual ideas ( 31 ), but ADHD diagnosis was only based on teacher’s report and the continuum of the symptoms in other situations were not evaluated. Another limitation was that the IQ of the sample was all above 115, so they were not representative of community sample of children with ADHD.

A same result was found on thirty-seven 10–17 years old students.The ADHD group with equal IQ had better creative tasks but worse working memory.

However, the sample was selected from a gifted student camp and was not representative of usual students with ADHD, and the ADHD diagnosis was done by self-report test and not professionally confirmed ( 32 ).

In our study, the IQ of children with ADHD was not statistically different from the control group and this finding was similar to that of other studies ( 1 , 33 ). The relationship between IQ and creativity was investigated in some studies, but the results were contradictory and inconclusive. Some suggest that creativity and IQ are correlated until an IQ of 120 ( 34 ). Furthermore, it has been stated in the literature that creativity does not need high IQ, and high intelligence does not bring creativity ( 35 ). In our study, IQ was assessed by Raven test and was only used for screening and not for examining the relationship of IQ and creativity. This study was carried on normal range of IQ to implicate the result on the usual population of children with ADHD, while the higher creativity in other studies could be the result of high intelligence and not the ADHD symptoms.

The similarities between ADHD and creative people cannot be a reason to expect creativity in people with ADHD. In fact, in some occasions, ADHD and creativity may overlap and this calls for caution against misdiagnosis ( 1 ). In some studies, the diagnosis of ADHD was not accurate and was based on the report of the teachers or students ( 19 , 31 ); However, in our study, the diagnosis was done by a psychiatrist and was confirmed by KSADs.

Limitations

One limitation in this study was that the sample was from the known cases of ADHD in the clinic. Clinic-referred samples of children with ADHD are more likely to have co-occurring disabilities and lower IQ ( 36 ). In particular, these students with co-occurring disabilities are three to seven times more likely than their typical peers to be retained, suspended/ expelled from school, or receive special education services ( 37 ). In addition, we did not define ADHD severity and subtypes, and the results might change in mild forms and in different subtypes of ADHD.

In our study, creativity was assessed without using medication, and this may have led to less attention and motivation for task completion, but due to the unknown effect of the stimulants on creativity, the abstinence of medication was necessary to prevent their effect on the results.

Our results showed that creativity of children with ADHD was not different from that of the control group or was worse in some areas. Although some ADHD individuals are successful, their success may have not caused by ADHD.

Acknowledgement

This study was a part of Banafsheh Aliabadi’s post graduate dissertation. The study was supported by a grant from Behavioral Sciences Research Center affiliated in Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Conflict of interest

There is no conflict of interest in this study.

9 Creative Case Study Presentation Examples & Templates

Learn from proven case study presentation examples and best practices how to get creative, stand out, engage your audience, excite action, and drive results.

9 minute read

helped business professionals at:

Short answer

What makes a good case study presentation?

A good case study presentation has an engaging story, a clear structure, real data, visual aids, client testimonials, and a strong call to action. It informs and inspires, making the audience believe they can achieve similar results.

Dull case studies can cost you clients.

A boring case study presentation doesn't just risk putting your audience to sleep—it can actuallyl ead to lost sales and missed opportunities.

When your case study fails to inspire, it's your bottom line that suffers.

Interactive elements are the secret sauce for successful case study presentations.

They not only increase reader engagement by 22% but also lead to a whopping 41% more decks being read fully , proving that the winning deck is not a monologue but a conversation that involves the reader.

Let me show you shape your case studies into compelling narratives that hook your audience and drive revenue.

Let’s go!

How to create a case study presentation that drives results?

Crafting a case study presentation that truly drives results is about more than just data—it's about storytelling, engagement, and leading your audience down the sales funnel.

Here's how you can do it:

Tell a story: Each case study should follow a narrative arc. Start with the problem, introduce your solution, and showcase the results. Make it compelling and relatable.

Leverage data: Hard numbers build credibility. Use them to highlight your successes and reinforce your points.

Use visuals: Images, infographics, and videos can enhance engagement, making complex information more digestible and memorable.

Add interactive elements: Make your presentation a two-way journey. Tools like tabs and live data calculators can increase time spent on your deck by 22% and the number of full reads by 41% .

Finish with a strong call-to-action: Every good story needs a conclusion. Encourage your audience to take the next step in their buyer journey with a clear, persuasive call-to-action.

Visual representation of what a case study presentation should do:

How to write an engaging case study presentation?

Creating an engaging case study presentation involves strategic storytelling, understanding your audience, and sparking action.

In this guide, I'll cover the essentials to help you write a compelling narrative that drives results.

What is the best format for a business case study presentation?

4 best format types for a business case study presentation:

• Problem-solution case study
• Before-and-after case study
• Success story case study
• Interview style case study

Each style has unique strengths, so pick one that aligns best with your story and audience. For a deeper dive into these formats, check out our detailed blog post on case study format types .

What to include in a case study presentation?

An effective case study presentation contains 7 key elements:

• Introduction
• Company overview
• The problem/challenge
• Your solution
• Customer quotes/testimonials

To learn more about what should go in each of these sections, check out our post on what is a case study .

How to motivate readers to take action?

Based on BJ Fogg's behavior model , successful motivation involves 3 components:

This is all about highlighting the benefits. Paint a vivid picture of the transformative results achieved using your solution.

Use compelling data and emotive testimonials to amplify the desire for similar outcomes, therefore boosting your audience's motivation.

This refers to making the desired action easy to perform. Show how straightforward it is to implement your solution.

Use clear language, break down complex ideas, and reinforce the message that success is not just possible, but also readily achievable with your offering.

This is your powerful call-to-action (CTA), the spark that nudges your audience to take the next step. Ensure your CTA is clear, direct, and tied into the compelling narrative you've built.

It should leave your audience with no doubt about what to do next and why they should do it.

Here’s how you can do it with Storydoc:

How to adapt your presentation for your specific audience?

Every audience is different, and a successful case study presentation speaks directly to its audience's needs, concerns, and desires.

Understanding your audience is crucial. This involves researching their pain points, their industry jargon, their ambitions, and their fears.

Then, tailor your presentation accordingly. Highlight how your solution addresses their specific problems. Use language and examples they're familiar with. Show them how your product or service can help them reach their goals.

A case study presentation that's tailor-made for its audience is not just a presentation—it's a conversation that resonates, engages, and convinces.

How to design a great case study presentation?

A powerful case study presentation is not only about the story you weave—it's about the visual journey you create.

Let's navigate through the design strategies that can transform your case study presentation into a gripping narrative.

Add interactive elements

Static design has long been the traditional route for case study presentations—linear, unchanging, a one-size-fits-all solution.

However, this has been a losing approach for a while now. Static content is killing engagement, but interactive design will bring it back to life.

It invites your audience into an evolving, immersive experience, transforming them from passive onlookers into active participants.

Which of these presentations would you prefer to read?

Use narrated content design (scrollytelling)

Scrollytelling combines the best of scrolling and storytelling. This innovative approach offers an interactive narrated journey controlled with a simple scroll.

It lets you break down complex content into manageable chunks and empowers your audience to control their reading pace.

To make this content experience available to everyone, our founder, Itai Amoza, collaborated with visualization scientist Prof. Steven Franconeri to incorporate scrollytelling into Storydoc.

This collaboration led to specialized storytelling slides that simplify content and enhance engagement (which you can find and use in Storydoc).

Here’s an example of Storydoc scrollytelling:

Bring your case study to life with multimedia

Multimedia brings a dynamic dimension to your presentation. Video testimonials lend authenticity and human connection. Podcast interviews add depth and diversity, while live graphs offer a visually captivating way to represent data.

Each media type contributes to a richer, more immersive narrative that keeps your audience engaged from beginning to end. You can upload your own interactive elements or check stock image sites like Shutterstock, Adobe Stock, iStock, and many more. For example, Icons8, one of the largest hubs for icons, illustrations, and photos, offers both static and animated options for almost all its graphics, whether you need profile icons to represent different user personas or data report illustrations to show your findings.

Prioritize mobile-friendly design

In an increasingly mobile world, design must adapt. Avoid traditional, non-responsive formats like PPT, PDF, and Word.

Opt for a mobile-optimized design that guarantees your presentation is always at its best, regardless of the device.

As a significant chunk of case studies are opened on mobile, this ensures wider accessibility and improved user experience , demonstrating respect for your audience's viewing preferences.

Here’s what a traditional static presentation looks like as opposed to a responsive deck:

Streamline the design process

Creating a case study presentation usually involves wrestling with an AI website builder .

It's a dance that often needs several partners - designers to make it look good, developers to make it work smoothly, and plenty of time to bring it all together.

Building, changing, and personalizing your case study can feel like you're climbing a mountain when all you need is to cross a hill.

By switching to Storydoc’s interactive case study creator , you won’t need a tech guru or a design whizz, just your own creativity.

You’ll be able to create a customized, interactive presentation for tailored use in sales prospecting or wherever you need it without the headache of mobilizing your entire team.

Storydoc will automatically adjust any change to your presentation layout, so you can’t break the design even if you tried.

Case study presentation examples that engage readers

Let’s take a deep dive into some standout case studies.

These examples go beyond just sharing information – they're all about captivating and inspiring readers. So, let’s jump in and uncover the secret behind what makes them so effective.

What makes this deck great:

• A video on the cover slide will cause 32% more people to interact with your case study .
• The running numbers slide allows you to present the key results your solution delivered in an easily digestible way.
• The ability to include 2 smart CTAs gives readers the choice between learning more about your solution and booking a meeting with you directly.

Light mode case study

• The ‘read more’ button is perfect if you want to present a longer case without overloading readers with walls of text.
• The timeline slide lets you present your solution in the form of a compelling narrative.
• A combination of text-based and visual slides allows you to add context to the main insights.

Marketing case study

• Tiered slides are perfect for presenting multiple features of your solution, particularly if they’re relevant to several use cases.
• Easily customizable slides allow you to personalize your case study to specific prospects’ needs and pain points.
• The ability to embed videos makes it possible to show your solution in action instead of trying to describe it purely with words.

UX case study

• Various data visualization components let you present hard data in a way that’s easier to understand and follow.
• The option to hide text under a 'Read more' button is great if you want to include research findings or present a longer case study.
• Content segmented using tabs , which is perfect if you want to describe different user research methodologies without overwhelming your audience.

Business case study

• Library of data visualization elements to choose from comes in handy for more data-heavy case studies.
• Ready-to-use graphics and images which can easily be replaced using our AI assistant or your own files.
• Information on the average reading time in the cover reduces bounce rate by 24% .

Modern case study

• Dynamic variables let you personalize your deck at scale in just a few clicks.
• Logo placeholder that can easily be replaced with your prospect's logo for an added personal touch.
• Several text placeholders that can be tweaked to perfection with the help of our AI assistant to truly drive your message home.

Real estate case study

• Plenty of image placeholders that can be easily edited in a couple of clicks to let you show photos of your most important listings.
• Data visualization components can be used to present real estate comps or the value of your listings for a specific time period.
• Interactive slides guide your readers through a captivating storyline, which is key in a highly-visual industry like real estate .

Medical case study

• Image and video placeholders are perfect for presenting your solution without relying on complex medical terminology.
• The ability to hide text under an accordion allows you to include research or clinical trial findings without overwhelming prospects with too much information.
• Clean interactive design stands out in a sea of old-school medical case studies, making your deck more memorable for prospective clients.

Dark mode case study

• The timeline slide is ideal for guiding readers through an attention-grabbing storyline or explaining complex processes.
• Dynamic layout with multiple image and video placeholders that can be replaced in a few clicks to best reflect the nature of your business.
• Testimonial slides that can easily be customized with quotes by your past customers to legitimize your solution in the eyes of prospects.

Grab a case study presentation template

Creating an effective case study presentation is not just about gathering data and organizing it in a document. You need to weave a narrative, create an impact, and most importantly, engage your reader.

So, why start from zero when interactive case study templates can take you halfway up?

Instead of wrestling with words and designs, pick a template that best suits your needs, and watch your data transform into an engaging and inspiring story.

Hi, I'm Dominika, Content Specialist at Storydoc. As a creative professional with experience in fashion, I'm here to show you how to amplify your brand message through the power of storytelling and eye-catching visuals.

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Case Studies and Scenarios

Case studies.

Each case study describes the real experience of a Registered Early Childhood Educator. Each one profiles a professional dilemma, incorporates participants with multiple perspectives and explores ethical complexities. Case studies may be used as a source for reflection and dialogue about RECE practice within the framework of the Code of Ethics and Standards of Practice​.

Scenarios are snapshots of experiences in the professional practice of a Registered Early Childhood Educator. Each scenario includes a series of questions meant to help RECEs reflect on the situation.

Case Study 1: Sara’s Confusing Behaviour

Case study 2: getting bumps and taking lumps, case study 3: no qualified staff, case study 4: denton’s birthday cupcakes, case study 5: new kid on the block, case study 6: new responsibilities and challenges, case study 7: valuing inclusivity and privacy, case study 8: balancing supervisory responsibilities, case study 9: once we were friends, ​​​​scenarios​​, communication and collaboration.

Barbara, an RECE, is working as a supply staff at various centres across the city. During her week at a centre where she helps out in two different rooms each day, she finds that her experience in the school-age program isn’t as straightforward as when she was in the toddler room. Barbara feels completely lost in this program.

Do You Really Know Who Your Friends Are?

Joe is an RECE at an elementary school and works with children between the ages of nine and 12 years old. One afternoon, he finds a group of children huddled around the computer giggling and whispering. Joe quickly discovers they’re going through his party photos on Facebook as one of the children’s parents recently added him as a friend.

Conflicting Approaches

Amina, an experienced RECE, has recently started a new position with a child care centre. She’s assigned to work in the infant room with two colleagues who have worked in the room together for ten years. As Amina settles into her new role, she is taken aback by some of the child care approaches taken by her colleagues.

What to do about Lisa?

Shane, an experienced supervisor at a child care centre, receives a complaint about an RECE who had roughly handled a child earlier that day. The interaction had been witnessed by a parent who confronted the RECE. After some words were exchanged, the RECE left in tears.

Duty to Report

Zoë works as an RECE in a drop-in program at a family support centre. She has a great rapport for a family over a 10-month period and beings to notice a change in the mom and child. One day, as the child is getting dressed to go home for the day, she notices something alarming and brings it to the attention of her supervisor.

Posting on Social Media

Allie, an RECE who has worked at the same child care centre for the last three years, recently started a private social media group to collaborate and discuss programming ideas. As the group takes a negative turn with rude and offensive comments, it’s brought to her supervisor’s attention.

What happened in the Kolkata rape case that triggered doctors’ protests?

Activists and doctors in India demand better safeguarding of women and medical professionals after a trainee medic was raped and murdered in Kolkata.

Activists and doctors across India continued to protest on Wednesday to demand justice for a female doctor, who was raped and murdered while on duty in a hospital in the eastern city of Kolkata.

Feminist groups rallied on the streets in protests titled “Reclaim the Night” in Kolkata overnight on Wednesday – on the eve of India’s independence day – in solidarity with the victim, demanding the principal of RG Kar Medical College resign. Some feminist protesters also marched well beyond Kolkata, including in the capital Delhi.

Keep reading

Doctors across india protest rape and murder of medic in kolkata, india supreme court to monitor investigations into manipur sexual violence, goals not guns: how a girls football team in india’s manipur beats violence, four arrested after spanish blogger on india motorcycle tour gangraped.

While the protests were largely peaceful, a small mob of men stormed the medical college and vandalised property. This group was dispersed by the police.

This comes after two days of nationwide protests by doctors following the incident at RG Kar Medical College in West Bengal’s capital city. “Sit-in demonstrations and agitation in the hospital campus will continue,” one of the protesting doctors, identified as Dr Mridul, told Al Jazeera.

Services in some medical centres were halted indefinitely, and marches and vigils shed light on issues of sexual violence, as well as doctors’ safety in the world’s most populous nation.

What happened to the doctor in Kolkata?

A 31-year-old trainee doctor’s dead body, bearing multiple injuries, was found on August 9 in a government teaching hospital in Kolkata.

The parents of the victim were initially told “by hospital authorities that their daughter had committed suicide,” lawyer and women’s rights activist Vrinda Grover told Al Jazeera. But an autopsy confirmed that the victim was raped and killed.

Grover has appeared for victims in sexual violence cases in India in the past, including Bilkis Bano , a Muslim woman who was gang-raped during the 2002 Gujarat riots, and Soni Sori, a tribal activist based in Chhattisgarh state.

Thousands of doctors marched in Kolkata on Monday, demanding better security measures and justice for the victim.

On Tuesday, the Kolkata High Court transferred the case to the Central Bureau of Investigation (CBI).

The Federation of Resident Doctors Association (FORDA) called for a nationwide halting of elective services in hospitals starting on Monday. Elective services are medical treatments that can be deferred or are not deemed medically necessary.

On Tuesday, FORDA announced on its X account that it is calling off the strike after Health Minister Jagat Prakash Nadda accepted protest demands.

One of these demands was solidifying the Central Protection Act, intended to be a central law to protect medical professionals from violence, which was proposed in the parliament’s lower house in 2022, but has not yet been enacted.

FORDA said that the ministry would begin working on the Act within 15 days of the news release, and that a written statement from the ministry was expected to be released soon.

Press release regarding call off of strike. In our fight for the sad incident at R G Kar, the demands raised by us have been met in full by the @OfficeofJPNadda , with concrete steps in place, and not just verbal assurances. Central Healthcare Protection Act ratification… pic.twitter.com/OXdSZgM1Jc — FORDA INDIA (@FordaIndia) August 13, 2024

Why are some Indian doctors continuing to protest?

However, other doctors’ federations and hospitals have said they will not back down on the strike until a concrete solution is found, including a central law to curb attacks on doctors.

Those continuing to strike included the Federation of All India Medical Associations (FAIMA), Delhi-based All India Institute Of Medical Sciences (AIIMS) and Indira Gandhi Hospital, local media reported.

Ragunandan Dixit, the general secretary of the AIIMS Resident Doctors’ Association, said that the indefinite strike will continue until their demands are met, including a written guarantee of the implementation of the Central Protection Act.

Medical professionals in India want a central law that makes violence against doctors a non-bailable, punishable offence, in hopes that it deters such violent crimes against doctors in the future.

Those continuing to protest also call for the dismissal of the principal of the college, who was transferred. “We’re demanding his termination, not just transfer,” Dr Abdul Waqim Khan, a protesting doctor told ANI news agency. “We’re also demanding a death penalty for the criminal,” he added.

“Calling off the strike now would mean that female resident doctors might never receive justice,” Dr Dhruv Chauhan, member of the National Council of the Indian Medical Association’s Junior Doctors’ Network told local news agency Press Trust of India (PTI).

Which states in India saw doctors’ protests?

While the protests started in West Bengal’s Kolkata on Monday, they spread across the country on Tuesday.

The capital New Delhi, union territory Chandigarh, Uttar Pradesh capital Lucknow and city Prayagraj, Bihar capital Patna and southern state Goa also saw doctors’ protests.

Who is the suspect in the Kolkata rape case?

Local media reported that the police arrested suspect Sanjoy Roy, a civic volunteer who would visit the hospital often. He has unrestricted access to the ward and the police found compelling evidence against him.

The parents of the victim told the court that they suspect that it was a case of gang rape, local media reported.

Why is sexual violence on the rise in India?

Sexual violence is rampant in India, where 90 rapes were reported on average every day in 2022.

Laws against sexual violence were made stricter following a rape case in 2012, when a 22-year-old physiotherapy intern was brutally gang-raped and murdered on a bus in Delhi. Four men were hanged for the gang rape, which had triggered a nationwide protests.

But despite new laws in place, “the graph of sexual violence in India continues to spiral unabated,” said Grover.

She added that in her experience at most workplaces, scant attention is paid to diligent and rigorous enforcement of the laws.

“It is regrettable that government and institutions respond only after the woman has already suffered sexual assault and often succumbed to death in the incident,” she added, saying preventive measures are not taken.

In many rape cases in India, perpetrators have not been held accountable. In 2002, Bano was raped by 11 men, who were sentenced to life imprisonment. In 2022, the government of Prime Minister Narendra Modi authorised the release of the men, who were greeted with applause and garlands upon their release.

However, their remission was overruled and the Supreme Court sent the rapists back to jail after public outcry.

Grover believes that the death penalty will not deter rapists until India addresses the deeply entrenched problem of sexual violence. “For any change, India as a society will have to confront and challenge, patriarchy, discrimination and inequality that is embedded in our homes, families, cultural practices, social norms and religious traditions”.

What makes this case particularly prominent is that it happened in Kolkata, Sandip Roy, a freelance contributor to NPR, told Al Jazeera. “Kolkata actually prided itself for a long time on being really low in the case of violence against women and being relatively safe for women.”

A National Crime Records Bureau (NCRB) report said that Kolkata had the lowest number of rape cases in 2021 among 19 metropolitan cities, with 11 cases in the whole year. In comparison, New Delhi was reported to have recorded 1, 226 cases that year.

Prime Minister Modi’s governing Bharatiya Janata Party (BJP) has called for dismissing the government in West Bengal, where Kolkata is located, led by Mamata Banerjee of All India Trinamool Congress (AITC). Banerjee’s party is part of the opposition alliance.

Rahul Gandhi, the leader of the opposition in parliament, also called for justice for the victim.

“The attempt to save the accused instead of providing justice to the victim raises serious questions on the hospital and the local administration,” he posted on X on Wednesday.

Roy spoke about the politicisation of the case since an opposition party governs West Bengal. “The local government’s opposition will try to make this an issue of women’s safety in the state,” he said.

Have doctors in India protested before?

Roy explained to Al Jazeera that this case is an overlap of two kinds of violence, the violence against a woman, as well as violence against “an overworked medical professional”.

Doctors in India do not have sufficient workplace security, and attacks on doctors have started protests in India before.

In 2019, two junior doctors were physically assaulted in Kolkata’s Nil Ratan Sircar Medical College and Hospital (NRSMCH) by a mob of people after a 75-year-old patient passed away in the hospital.

Those attacks set off doctors’ protests in Kolkata, and senior doctors in West Bengal offered to resign from their positions to express solidarity with the junior doctors who were attacked.

More than 75 percent of Indian doctors have faced some form of violence, according to a survey by the Indian Medical Association in 2015.

What happens next?

The case will now be handled by the CBI, which sent a team to the hospital premises to inspect the crime scene on Wednesday morning, local media reported.

According to Indian law, the investigation into a case of rape or gang rape is to be completed within two months from the date of lodging of the First Information Report (police complaint), according to Grover, the lawyer.

The highest court in West Bengal, which transferred the case from the local police to the CBI on Tuesday, has directed the central investigating agency to file periodic status reports regarding the progress of the investigation.

The FIR was filed on August 9, which means the investigation is expected to be completed by October 9.

Bengal women will create history with a night long protest in various major locations in the state for at 11.55pm on 14th of August’24,the night that’ll mark our 78th year as an independent country. The campaign, 'Women, Reclaim the Night: The Night is Ours', is aimed at seeking… pic.twitter.com/Si9fd6YGNb — purpleready (@epicnephrin_e) August 13, 2024

District of Columbia

Gay d.c. gym owner delays decision on plea offer in child porn case.

Michael Everts pleaded not guilty in April following 2023 arrest

At the request of a federal prosecutor and the attorney representing D.C. gay gym owner Michael Everts, who was arrested Nov. 29, 2023, on a charge of distributing child pornography, a judge on Aug. 15 agreed for the third time to give Everts more time to decide whether to accept an offer by prosecutors to plead guilty to a lower charge.

U.S. District Court Judge Tanya S. Chutkan scheduled a status hearing for the case on Oct. 23, when Everts is expected to disclose whether he will accept the plea offer or go on trial.

Everts has been held in jail since the time of his arrest. He pleaded not guilty to the charge at an April 4 arraignment hearing. At that time Judge Chutkan agreed to the first request by Everts’s attorney and the prosecutor to give Everts more time to consider a plea offer by prosecutors.

The judge scheduled a hearing for June 10 at which time Everts was expected to disclose through his attorney whether he had accepted or turned down the plea offer, the details of which have not been publicly disclosed. But the hearing set for June 10 was also later postponed until Aug. 15 after Everts’s attorney informed the judge that Everts needed yet more time to decide on the plea offer.

At the Aug. 15 hearing Judge Chutkan ordered the hearing to be temporarily closed to the public, requiring a Washington Blade reporter to leave the courtroom for about 10 minutes before being allowed to return. A reason was not given for the decision to temporarily close the hearing. Chutkan announced at the time it was reopened that she had scheduled another status hearing for the Everts case for Oct. 23.

 Assistant U.S. Attorney Paulette Pagan, the lead prosecutor in the case, told the Blade after the hearing the continuation of the case until October was supported by both prosecutors and the defense and was made to give Everts more time to consider the plea offer.

Everts is the owner and until the time of his arrest was the lead operator of the FIT Personal Training gym located at 1633 Q St., N.W. near Dupont Circle.

Court records show that Everts’s arrest last November came after a joint D.C. police-FBI investigation that prosecutors say determined that Everts allegedly distributed images of underage boys engaging in sexual acts to an undercover D.C. police detective posing in an online gay hookup site as someone interested in underage boys for sex.

Charging documents also show that the investigation began after information was obtained by police from an unnamed source indicating that Everts was exchanging messages on a gay sex hookup site expressing interest in exchanging images of underage boys for sexual gratification. Although Everts has pleaded not guilty to the charge against him, the public court records do not include documents from Everts’s attorneys that dispute any of the specific allegations in the charging documents.

The charge of distribution of child pornography carries a mandatory minimum sentence of five years in prison upon conviction and a possible maximum sentence of 20 years in prison. Aside from a prison sentence an individual convicted of this offense must register as a sex offender for life. 

Two prominent D.C. churches join National Trans Visibility March

Recall efforts targeting two d.c. council members fail.

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Annual event set to take place Aug. 24

D.C.’s National City Christian Church and United Church of Christ announced on Aug. 14 that they will provide supportive religious services to participants in this year’s National Trans Visibility March scheduled to take place in D.C. on Saturday, Aug. 24 along with a full weekend of related events.

In a joint statement, the two churches announced their plans for the march include an Empowerment Service on Friday, Aug. 23, at 11 a.m. at the National City Christian Church located at 5 Thomas Circle, N.W. The statement says the service will “expand on the theme of this year’s march and be delivered under the message of “Illuminate, Educate, & Advocate: United in Faith and Purpose.”  

The statement says faith leaders will also lead a prayer and hold a press conference in front of National City Christian Church at 5 Thomas Circle on Aug. 24 at 11 a.m. before the start of the march. “Then, in a show of solidarity, they will march together to the Human Rights Campaign headquarters where thousands of LGBTQ+ individuals and allies will be waiting to start the journey to Dupont Circle,” according to the statement.

It was referring to plans by organizers of the trans march to hold a rally outside the HRC building at 17th Street and Rhode Island Ave., N.W. at 1 p.m. on Aug. 24 before the start of the march at that same location at 1:30 p.m. A post-march rally was scheduled to take place in Dupont Circle, where the march will end, at 2:30 p.m.

“In a time when the rights and dignity of transgender individuals are under threat, this Empowerment worship service serves as a beacon of hope and unity,” Rev. Carmarion Anderson-Harvey of National City Christian Church said in the statement. “It is a powerful reminder of our shared commitment to justice, equality, and love for everyone, regardless of gender identity.”

On its website the National Trans Visibility March describes itself as an organization “advocating for the visibility, equality and protection of all Transgender, Gender Nonconforming and Non-Binary (TGNCNB)  people across the United States.” It says it mobilizes each year “hundreds of thousands” across the country to “march the streets and online to reaffirm that Trans rights are human rights and call for the abolition of anti-LGBTQ+ laws.”

Among the events associated with the D.C. march are three workshops, one Aug. 22 and two on Aug. 23 at the HRC headquarters.

A schedule of the evens associated with the D.C. march, which take place from Aug. 22-Aug. 24, can be accessed at nationaltransvisibilitymarch.org .

Activists disagree over extent of support for plan targeting Allen, Nadeau

The D.C. Board of Elections confirmed this week that the campaign to recall D.C. Council member Charles Allen (D-Ward 6) failed to obtain the required 6,427 petition signatures needed to place the Allen recall on the November election ballot in time for an Aug. 12 deadline.

And the chairperson of the campaign to recall Council member Brianne Nadeau (D-Ward 1), Diana Alvarez, told the Washington Blade on Tuesday in a telephone interview that she and her campaign team do not believe they will be able to collect the required number of 5,448 petition signatures in time for their Oct. 1 deadline.

“We unfortunately have not collected the number of signatures we hoped for, and at this point I don’t think we will be able to collect all of them,” she said. “So, it’s been a challenge, you know, especially with everyone having their own personal lives going on. Many of us are small business owners.”

Under the D.C. election law, organizers of recall campaigns are given 180 days from the time they officially file papers for the recall  to obtain the required number of signatures.

News that the effort to recall Allen had failed and that the effort to recall Nadeau was on its way to failing drew attention to a sharp disagreement among LGBTQ activists over the extent of support for or opposition to the two recall campaigns within the D.C. LGBTQ community.

Many of the city’s LGBTQ Democratic Party activists, led by the Capital Stonewall Democrats, the city’s largest local LGBTQ political group, have argued that the LGBTQ community overwhelmingly opposed the two recall campaigns in part on grounds that Allen and Nadeau have been longtime strong supporters of the LGBTQ community and have championed LGBTQ supportive legislation before the D.C. Council.

But LGBTQ community supporters of the recall campaigns, including Ward 1 gay Democratic activist and Advisory Neighborhood Commissioner Jamie Sycamore, have argued that the “rank-and-file” members of the LGBTQ community support the recall efforts for the same reason as their straight counterparts. Sycamore and other LGBTQ recall backers say they blame Nadeau and Allen for the alarming rise in violent crime in the city in 2023 due to their support for policies to defund the police department and put in place lenient sentencing rules for those convicted of committing violent crimes, including carjackings and armed robberies.

Sycamore said he officially withdrew as a member of the Nadeau recall campaign in June after becoming convinced that the other leaders of the campaign failed to do the “legwork” needed to gather the required number of petition signatures. But he told the Blade this week that he still supports the recall of Nadeau and Allen on grounds that their actions on the Council have led to a public safety crisis in the city that impacts LGBTQ residents as well as everyone else.

David Perruzza, owner of the Adams Morgan gay bar Pitchers and its attached lesbian bar League Her Own, said he too supports the recall of Nadeau because of what he calls her “refusal” to properly address crime in Ward 1 where his bars are located.

“I think every LGBT person I know is supporting it,” he said of the Nadeau recall campaign. “The crime is terrible and people aren’t going out as much because of the crime,” which he said is hurting businesses in Ward 1, including nightlife businesses like his.

Michael Haresign, president of the Capital Stonewall Democrats, disputes Sycamore’s argument, saying he believes the large majority of LGBTQ D.C. residents agree with Nadeau and Allen and their supporters that the two lawmakers should not be blamed for the rise in crime. Both Allen and Nadeau have argued that public safety is their highest priority, and they have pushed for legislation to curtail crime by, among other things, addressing the root cause of crime such as mental health issues and substance abuse to prevent crime before it happens.

Haresign points out that Capital Stonewall Democrats urged its members and others in the LGBTQ community not to sign the petitions being circulated for the two recall campaigns. He noted the organization endorsed Allen and Nadeau in their most recent primary election campaigns in 2022 because of their strong support for the LGBTQ community.

He also points out that he believes members of the LGBTQ community, like their straight allies, think a recall effort is appropriate for ethical violations by elected officials such as violating a law but is not appropriate for a disagreement over public policy issues.

In noting that the recall efforts have failed, Haresign added, “I think it shows there really wasn’t that much of a push for any recall efforts from the community. It was sort of a few people with bones to pick with the Council members who were pushing these recalls forward. But the community at large wasn’t really lining up to sign the petitions.”

Among those who disagree with Haresign is Andrew Minik, president of the D.C. chapter of the national LGBTQ GOP group Log Cabin Republicans.

“I absolutely support both of the recall efforts,” Minik told the Blade at the start of the recall campaigns in March. “In our D.C. Chapter of Log Cabin, we have members in all eight wards of D.C.,” he said. “You do not need to go very far to ask any of our members if he or she has been a victim of crime themselves or just knowing someone who has,” according to Minik. “People like Charles Allen and Brianne Nadeau are uniquely responsible for the conditions that have allowed crime to spiral out of control here.” 

D.C. gay Democratic activists John Klenert of Ward 2 and David Meadows of Ward 8 said many in the LGBTQ community have joined or given financial support to the official Allen and Nadeau campaigns opposing the recall efforts.

“I oppose these recall efforts,” Meadows said. “The recall people raise some good issues, but you have to weigh the good over the bad,” he said, adding that Allen’s and Nadeau’s positive actions far outweigh the crime-related allegations made by supporters of the recalls, which Allen and Nadeau have said are mostly mischaracterizations of their actual positions and actions.  

On Aug. 12, the day the Board of Elections announced the Allen recall campaign had failed to obtain the required number of petition signatures from registered voters in Ward 6, the campaign announced that although it obtained 5,500 signatures instead of the required number of 6,427, it was asking the election board to place the recall measure on the ballot anyway.

In a statement, the campaign said the reason it wasn’t able to obtain the needed signatures was because the Board of Elections violated a D.C. law that requires the board to provide a mobile app to help gather signatures in addition to gathering signatures on paper petitions. Board of Elections Executive Director Monica Holman Evans said the mobile petition app was discontinued in 2022 when a third-party vendor stopped providing it, according to a report by the Washington Post

But Evans told the Post that use of the app would not have made a difference in the Allen recall campaign’s ability to gather signatures because petition circulators would have had to approach each potential signer of the petition while holding an iPad instead of a paper petition, with the two taking the same amount of time.

Whitman-Walker to hold East of the River Fall Festival on Aug. 17

Congress Heights event to provide back-to-school supplies, entertainment

Whitman-Walker, which describes itself as a leader in LGBTQ+ health care and comprehensive health care for “everyone else,” announced it will hold its largest ever annual East of the River Fall Festival on Saturday, Aug. 17, at the Sycamore & Oak food court and entertainment center in the city’s Congress Heights neighborhood.

The announcement says the event, which will take place between 2-6 p.m., will include live entertainment, including Go-Go music performances, a poetry performance, free food and drinks, and free backpacks and school supplies for the first 500 kids to arrive and claim them.

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• Case report
• Open access
• Published: 11 September 2017

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

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

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

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

Case presentation

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

Conclusions

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

Peer Review reports

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Abbreviations

Attention-Deficit/Hyperactivity Disorder

Disruptive Mood Dysregulation Disorder

Disinhibited Social Engagement Disorder

Post-Traumatic Stress Disorder

Reactive Attachment disorder

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

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

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• Published: 15 August 2024

Functional cure induced by tenofovir alafenamide plus peginterferon-alpha-2b in young children with chronic hepatitis B: a case series study

• Qing-Lei Zeng 1 ,
• Ru-Yue Chen 1 ,
• Xue-Yan Lv 1 ,
• Shuo Huang 1 ,
• Wei-Zhe Li 1 ,
• Ya-Jie Pan 1 ,
• Fu-Sheng Wang 2 &
• Zu-Jiang Yu 1  

BMC Infectious Diseases volume  24 , Article number:  830 ( 2024 ) Cite this article

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Background and Aims

Data on the safety and effectiveness of tenofovir alafenamide (TAF) plus peginterferon-alpha (Peg-IFN-α) in children with chronic hepatitis B (CHB) are lacking. The current study aimed to present the characteristics of four pediatric CHB patients who obtained a functional cure by using TAF and Peg-IFN-α.

In this case series study initiated in May 2019, ten children who had no clinical symptoms or signs received response-guided (HBV DNA undetectable, hepatitis B e antigen [HBeAg] loss or seroconversion, and hepatitis B surface antigen [HBsAg] loss or seroconversion) and functional cure-targeted (HBsAg loss or seroconversion) TAF (25 mg/d, orally) plus Peg-IFN-α-2b (180 µg/1.73m 2 , subcutaneously, once weekly) in combination (9/10) or sequential (1/10) therapy. The safety and effectiveness of these treatments were monitored.

As of April 2024, four out of ten children obtained a functional cure after a mean of 31.5 months of treatment, and the other six children are still undergoing treatment. These four cured children, aged 2, 4, 8, and 6 years, were all HBeAg-positive and had alanine aminotransferase levels of 80, 47, 114, and 40 U/L; HBV DNA levels of 71200000, 93000000, 8220, and 96700000 IU/mL; and HBsAg levels of 39442.8, 15431.2, 22, and 33013.1 IU/mL, respectively. During treatment, all the children (10/10) experienced mild or moderate adverse events, including flu-like symptoms, anorexia, fatigue, and cytopenia. Notably, growth retardation (8/10) was the most significant adverse event; and it occurred in three cured children (3/4) treated with combination therapy and was present to a low degree in the other cured child (1/4) treated with sequential therapy. Fortunately, all three cured children recovered to or exceeded the normal growth levels at 9 months posttreatment.

Conclusions

TAF plus Peg-IFN-α-2b therapy is potentially safe and effective for pediatric CHB patients, which may provide important insights for future clinical practice and study designs targeting functional cures for children with CHB.

Peer Review reports

Introduction

Chronic hepatitis B virus (HBV) infection is a global public health burden that affects 257.5 million individuals worldwide [ 1 ]. Although perinatal transmission has significantly decreased since the implementation of maternal antiviral prophylaxis and infant vaccination [ 2 , 3 ], almost 2 million new infections have occurred annually through perinatal and horizontal transmission in children aged 5 years or younger [ 4 ].

There is an unmet need in real-life clinical practice. On the one hand, many children continue to be at risk of progressive liver disease due to active hepatitis [ 5 ]; however, less attention has been given to this topic, and limited antiviral options have been approved for younger children with chronic hepatitis B (CHB). Moreover, most hepatologists have adopted a conservative attitude toward antiviral treatment for CHB children [ 4 , 6 ], which has resulted in few concerns about functional cures. On the other hand, discrimination against chronic HBV infection is severe in China [ 7 ], and most families are eager to cure their children in an easy way so as not to interfere with their schooling and work.

In this case series study, we report four functionally cured CHB children treated with two first-line antivirals, tenofovir alafenamide (TAF, which theoretically does not need dosage adjustment because of its favorable safety profile and similar high genetic barrier to resistance compared with tenofovir disoproxil fumarate [TDF]) plus peginterferon-alpha-2b (Peg-IFN-α-2b, the only available Peg-IFN-α in our hospital and even in most areas of China), which has not been evaluated or reported previously in young CHB children.

Patients and methods

From May 2019 to August 2023, a total of 10 children (all of whom were less than 8 years old) visited and were diagnosed with treatment-naïve and asymptomatic hepatitis B e antigen (HBeAg)-positive CHB in our center; moreover, their parents strongly demanded a functional cure and could not accept the cumbersome oral antiviral drug (entecavir and TDF) dosing adjustments or frequent regular interferon injections. As of April 2024, four children aged 2, 4, 8, and 6 years who were enrolled from May 2019 to November 2021 and treated with TAF plus Peg-IFN-α-2b have achieved functional cure. Here, we mainly report the management process of four cured children.

Clinical procedures

After careful discussion by the expert group and approval by the Medical Management Department of the hospital, we decided to administer response-guided and functional cure-targeted TAF (25 mg/d, orally, once daily) plus Peg-IFN-α-2b (180 µg/1.73 m 2 , subcutaneously, once weekly) therapy to the 10 children. In detail, children with strong immune clearance features (high [abnormal] alanine aminotransferase [ALT] levels with or without relatively low levels of virological markers, i.e., HBV DNA, HBeAg, and hepatitis B surface antigen [HBsAg]) received initial combination therapy, and children with weak immune clearance features (low [normal] ALT levels with or without relatively high levels of virological markers [HBV DNA, HBeAg, and HBsAg]) received TAF monotherapy first and then received Peg-IFN-α-2b add-on therapy sequentially at specific time points in the future.

Definition of functional cure

The definition of a functional cure for CHB is seroclearance of HBsAg, i.e., loss of detectable serum HBsAg by the assays as described as following with or without seroconversion to hepatitis B surface antibody (HBsAb) [ 8 ]. Certainly, before or simultaneously with the seroclearance of HBsAg, HBV DNA and HBeAg should also become undetectable or undergo seroclearance.

Definition of response-guided treatment

Commonly, there are three virologic steps for the functional cure of HBeAg-positive CHB, i.e., undetectable HBV DNA, HBeAg loss or seroconversion, and HBsAg loss or seroconversion, although these steps may not occurr sequentially. Therefore, response-guided therapy and functional cure-targeted treatment are aimed at these three steps. In fact, prior to the start of this study, we did not specifically define this response-guided therapy quantitatively. Generally, on the basis of good adherence and tolerance, if a child’s HBV DNA level continues to decrease to an undetectable level, treatment will continue to achieve this goal. Similarly, if a child’s HBeAg continues to decrease to a negative level, treatment will continue to achieve this goal. Again, if a child’s HBsAg continues to decrease to a negative level, treatment will continue to achieve this goal. In contrast, if a child’s HBV DNA, HBeAg, or HBsAg do not exhibit an obvious decrease at two follow-up timepoints with an interval of 3 months, combination therapy will be discontinued, or only TAF will be retained to continue monotherapy.

Management of the side effects of hemocytopenia

During treatment, when the neutrophil count is ≤ 0.75 × 10 9 /L, the platelet count is < 50 × 10 9 /L, and/or the ALT level is > 5 times the upper limit of normal (ULN, 40 U/L), the interferon dose should be reduced; 1 to 2 weeks later, these parameters should be retested; if recovery occurs, increase to the original dose. When the neutrophil count is ≤ 0.5 × 10 9 /L, the platelet count is < 25 × 10 9 /L, and/or the ALT concentration is > 10 ULN, interferon should be suspended [ 6 ]. For patients with significantly decreased blood cell counts, granulocyte colony-stimulating factor or granulocyte macrophage colony-stimulating factor may be used; additionally, for patients with significantly increased ALT levels, hepatoprotective drugs (glutathione tablets) may be used [ 6 ].

Laboratory assessments and growth evaluations

Serum HBV markers were tested by using the Abbott ARCHITECT Alinity i Reagent Kit (Abbott Ireland Diagnostics Division, Finisklin Bussiness Park, Sligo, Ireland), with a lower limit of quantification [LLOQ] of 0.05 IU/mL for HBsAg (< 0.05 IU/mL indicating a negative result or HBsAg loss), a normal range of 0–10 mIU/mL for HBsAb (> 10 mIU/mL indicating a positive result), and a normal range of 0–0.18 IU/mL for HBeAg (< 0.18 IU/mL indicating a negative result or HBeAg loss). The serum HBV DNA levels (the LLOQ was 10 IU/mL) were measured by using an Abbott Real Time HBV Assay (Abbott Molecular Inc., Des Plaines, IL, USA). The upper limit of normal for ALT was defined as 40 U/L [ 9 ]. The growth conditions (weight and height) were referred to as “Height and weight standardized growth charts for Chinese children and adolescents aged 0 to 18 years” [ 10 ].

Baseline characteristics

Table 1 presents the detailed characteristics of the four cured children before treatment initiation. The baseline characteristics of the other six children who were still undergoing treatment and follow-up testing are presented in Table  2 . The four cured children, aged 2, 4, 8, and 6 years, were infected with HBV through mother-to-child transmission, were asymptomatic and HBeAg-positive, and had alanine aminotransferase levels of 80, 47, 114, and 40 U/L, HBV DNA levels of 71200,000, 93000,000, 8220, and 96700000 IU/mL, and HBsAg levels of 39442.8, 15431.2, 22, and 33013.1 IU/mL, respectively. Three children (Nos. 1–3, Table  1 ) with strong immune clearance features received initial TAF plus Peg-IFN-α-2b combination therapy, and one child (No. 4, Table  1 ) with weak immune clearance features received TAF and Peg-IFN-α-2b sequential therapy.

Effectiveness

As of April 2024, four out of ten children obtained a functional cure after a mean of 31.5 months of treatment (ranging from 18 to 42 months), and the detailed viral dynamics are presented in Fig.  1 . HBV DNA was undetectable in three children (Nos. 1–3) after 3 to 6 months of TAF and Peg-IFN-α-2b combination therapy. Notably, child No. 1 received TAF monotherapy for 15 to 24 months due to the infeasibility of regular follow-up due to the coronavirus disease 2019 (COVID-19) lockdown in his hometown. Unfortunately, child No. 4 was not able to undergo regular monitoring during the first 21 months of TAF monotherapy because of the COVID-19 lockdown in his hometown, and undetectable HBV DNA and HBeAg seroconversion were both detected at 21 months of treatment (Fig.  1 ). Moreover, HBeAg seroclearance was detected in the other three children (Nos. 1–3) after 24, 18, and 30 months of TAF and Peg-IFN-α-2b combination therapy; however, persistent HBeAg seroconversion was detected only in child No. 2 (Fig.  1 ). For the functional cure, it is interesting that child No. 3 had the lowest level of HBsAg (22 IU/mL) but the longest treatment duration. Notably, HBsAg seroconversion occurred in children Nos. 1, 2, and 3, with HBsAb levels of 991.1, 53.5, and 29.4 mIU/mL, respectively, at posttreatment month 9, and child No. 4 did not achieve HBsAg seroconversion but maintained the HBsAg seroclearance at posttreatment month 9.

Hepatitis B viral dynamics during treatment and follow-up. Abbreviations: F/U, follow-up; HBeAb, hepatitis B e antibody; HBeAg, hepatitis B e antigen; HBsAb, hepatitis B surface antibody; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; TAF, tenofovir alafenamide

Safety profiles

During treatment, all four cured children experienced mild or moderate adverse events, including flu-like symptoms, anorexia, and fatigue (Table  3 ), and laboratory abnormalities, including elevated ALT levels (Fig.  2 ), neutropenia (Fig.  3 ), and thrombopenia (Fig.  4 ). However, none of the children presented elevated total bilirubin or abnormal thyroid function parameters. Notably, children Nos.1–3, who received long-term initial combination therapy, exhibited growth retardation, and child No. 4, who received sequential therapy (only one year of Peg-IFN-α-2b treatment), was less affected by growth retardation (Figs. 5 and 6 ).

Changes in alanine aminotransferase levels during treatment and follow-up

Changes in neutrophil count during treatment and follow-up

Changes in platelet count during treatment and follow-up

Children’s body weight at baseline, functional cure, and 9 months posttreatment. Abbreviations: m, months; PostTx, posttreatment; y, years

Children’s height at baseline, functional cure, and 9 months posttreatment. Abbreviations: m, months; PostTx, posttreatment; y, years

Infants’ growth during posttreatment follow-up

Interestingly, by 9 months post-treatment, all three cured children were catching up with or even exceeding the expected growth parameters (Figs. 5 and 6 ). Unexpectedly, child No. 3 grew 17 cm after 9 months of drug withdrawal (Fig.  6 ). Notably, although child No. 4, who received sequential therapy, had normal growth parameters during treatment, the baseline gap between the actual and expected growth parameters was obviously larger than that at treatment discontinuation, indicating that only one year of Peg-IFN-α-2b add-on treatment may still slightly influence a child’s growth (Figs. 5 and 6 ).

Many studies have reported the safety and efficacy (effectiveness) of Peg-IFN-α therapy in CHB children [ 4 , 11 , 12 , 13 , 14 , 15 , 16 ]; however, data on the use of Peg-IFN-α plus TAF combination therapy are limited or even lacking. This study is the first to demonstrate the generally favorable safety and effectiveness of TAF plus Peg-IFN-α-2b combination therapy in children with CHB, and reversible growth retardation is the most significant adverse event. These findings may provide important insight for future clinical practice and study designs targeting functional cures for children with CHB.

The functional cure rate of CHB in children is obviously different from that in adults. A previous study indicated that sequential combination treatment with lamivudine and interferon can lead to remarkable HBsAg loss in children with chronic HBV infection and immune-tolerant characteristics [ 17 ]. Recently, a randomized trial revealed that peg-interferon and TDF combination therapy followed by protocolized TDF withdrawal led to earlier but not greater HBsAg clearance [ 18 ]. Our recent study showed that, compared with those aged 7 years and older, children aged between 1 and 7 years with active CHB can attain a high rate of functional cure through antiviral therapy (nucleos[t]ide analog monotherapy or combination therapy with regular interferon-α), which suggests that early antiviral treatment is beneficial for children with CHB [ 19 ].

Currently, the first-line anti-HBV drugs used include entecavir, TDF, TAF, and interferon [ 6 ]. Previous studies have indicated that TAF is noninferior to TDF in adult CHB patients and has improved bone and renal effects [ 20 , 21 ]. Furthermore, our previous studies demonstrated the favorable safety and effectiveness of short-term TAF therapy to prevent mother-to-child transmission in pregnant women with chronic HBV infection and high HBV DNA levels and long-term TAF therapy to treat pregnant women with active CHB [ 2 , 3 ]. However, data on the safety and effectiveness of TAF in CHB patients (especially those younger than 6 years) are lacking, as are data on TAF and interferon combination therapy.

Notably, entecavir and TDF require dose adjustment for children, and regular interferon necessitates frequent injection, which results in strong rejection by parents. The TAF concentration is less than 1/10 of the TDF concentration and has a high genetic resistance barrier similar to that of TDF [ 22 , 23 ]. Moreover, a previous study indicated that antiviral monotherapy with Peg-IFN α-2a in children with CHB is well tolerated and effective [ 24 ]. Currently, Peg-IFN-α-2b (PegBeron) is the only available Peg-IFN-α in China [ 25 ]. Therefore, after providing written informed consent, the expert group decided to administer the TAF plus Peg-IFN-α-2b combination or sequential therapy to meet their parents’ needs.

During long-term treatment, growth retardation was the most significant adverse event. We speculate that this is mainly caused by long-term Peg-IFN-α-2b injection rather than TAF. Fortunately, this adverse event was reversible after 9 months of treatment discontinuation. Notably, the reversible nature of the growth retardation that occurred in children Nos. 1–3 was impressive, especially for child No. 3. During the 9 months posttreatment, child No. 3’s growth was so remarkable that his family, neighbors, teachers, and physicians were all astonished. These findings may greatly alleviate concerns in future clinical practice and research.

Initial combination and sequential therapies are two common treatment strategies for functional cure. In this study, Child No. 4, who received sequential therapy (shorter Peg-IFN-α-2b treatment duration), exhibited less Peg-IFN-α-2b–induced growth retardation, which may provide critical insight into management strategy selection or study design for the future treatment of CHB. Therefore, TAF monotherapy can be used first to achieve the first goal of undetectable HBV DNA. TAF monotherapy or TAF plus Peg-IFN-α-2b combination therapy can then be selected based on the decreasing trend in HBeAg to achieve the second goal of HBeAg loss or seroconversion. Finally, TAF plus Peg-IFN-α-2b combination therapy or even Peg-IFN-α-2b monotherapy can eventually be selected based on the decreasing trend in HBsAg to achieve the final goal of HBsAg loss or seroconversion.

Currently, the achievement of a functional cure in children with CHB does not have a fixed mode or standard of care. Response-guided and functional cure-targeted therapy may be an important mode of treatment, as mentioned above. This means that the treatment plan needs to be adjusted according to the response during treatment, and whether the drug should be stopped if “a standard or prespecified course is completed and there is an obvious response but no functional cure” has become a problem worth considering. In this study, we reported only four children who were cured; the other six children who responded favorably to treatment have not yet been cured, and it is not even possible to predict whether or when they will be cured in the future. Therefore, on the basis of safety, "determining the functional cure goal without determining a clear course of treatment" has become an important strategy for the functional cure of CHB patients in China, including children, which can also be interpreted as a “response-guided and functional cure-targeted strategy”, as described in the Methods section of this study.

In conclusion, although this study had a small sample size, the findings clearly demonstrated the potential for a functional cure of children with CHB treated with TAF plus Peg-IFN-α-2b, as well as the reversibility of growth retardation, which may provide important clues and may change clinical practice or thinking in the future.

Availability of data and materials

Availability of data and materials. All data generated or analyzed during this study are included in this published article.

Abbreviations

Alanine aminotransferase

• Chronic hepatitis B

Hepatitis B e antigen

Hepatitis B surface antigen

Hepatitis B virus

Lower limit of quantification

Peginterferon-alpha-2b

• Tenofovir alafenamide

Tenofovir disoproxil fumarate

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Acknowledgements

The authors sincerely thank the children and their families for their cooperation in the on‐treatment and follow‐up evaluations.

National Natural Science Foundation of China (82270629, 82100177); Henan Provincial Science Fund for Distinguished Young Scholars, China (232300421011); Health Science and Technology Innovation Fund for Distinguished Young Scholars, Health Commission of Henan Province, China (YXKC2020024), Program for Science & Technology Innovation Talents in Universities of Henan Province, China (24HASTIT064); Funding for Scientific Research and Innovation Team of The First Affiliated Hospital of Zhengzhou University, China (QNCXTD2023014), and Young and Middle-aged Academic Leaders of Health Commission of Henan Province, China (HNSWJW-2023029). The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.

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Qing-Lei Zeng, Ru-Yue Chen, Xue-Yan Lv, Shuo Huang, Wei-Zhe Li, Ya-Jie Pan & Zu-Jiang Yu

Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China

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Q.L.Z., F.S.W., and Z.J.Y. contributed to the conception and design of this study. Q.L.Z., R.Y.C., X.Y.L., and Y.J. P. contributed to the data collection and interpretation. S.H. and W.Z.L. contributed to the statistical analysis. Q.-L. Z. contributed to the drafting and revision of this manuscript. F.S.W. and Z.J.Y. contributed to the critical revision of the manuscript for important intellectual content. All authors approved the final version of this manuscript. The corresponding authors attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

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Zeng, QL., Chen, RY., Lv, XY. et al. Functional cure induced by tenofovir alafenamide plus peginterferon-alpha-2b in young children with chronic hepatitis B: a case series study. BMC Infect Dis 24 , 830 (2024). https://doi.org/10.1186/s12879-024-09723-0

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WEATHER ALERT

99 advisories in effect for 23 regions in the area

First case of polio confirmed in a 10-month-old child in gaza, palestinian health officials say.

Associated Press

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FILE - Palestinians displaced by the Israeli air and ground offensive on the Gaza Strip walk next a dark streak of sewage flowing into the streets of the southern town of Khan Younis, Gaza Strip, Thursday, July 4, 2024. Health authorities and aid agencies are racing to avert an outbreak of polio in the Gaza Strip after the virus was detected in the territory's wastewater and three cases with a suspected polio symptom have been reported. (AP Photo/Jehad Alshrafi, File)

RAMALLAH – Palestinian health officials on Friday reported the first case of polio in an unvaccinated 10-month-old child in the Gaza city of Deir al-Balah, the first case in years in the coastal enclave that has been engulfed in the Israel-Hamas war since Oct. 7.

After discovering the child's symptoms, tests were conducted in Jordan’s capital of Amman and the case was confirmed to be polio, the health officials said.

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The potentially fatal, paralyzing disease mostly strikes children under the age of 5 and typically spreads through contaminated water. Pakistan and Afghanistan are the only countries where the spread of polio has never been stopped.

The World Health Organization did not immediately respond to requests to confirm the case. However, U.N. health and children’s agencies have called for seven-day pauses in the fighting , starting at the end of August, to vaccinate 640,000 Palestinian children against polio.

They said the polio virus had been discovered in wastewater in two major cities last month in Gaza, which has been polio-free for the last 25 years, according to the United Nations.

The humanitarian community has warned of the re-emergence of polio since the latest war erupted when Hamas attacked Israel on Oct. 7, killing around 1,200 people and taking more than 250 hostage. Israel’s devastating retaliatory offensive has killed more than 40,000 people in Gaza in the 10-month-long conflict and created a dire humanitarian situation, which health officials say has created a public health emergency.

In July, WHO said a variant of type 2 was discovered in wastewater samples from southern Khan Younis and central Deir al-Balah, linked to a variant of the polio virus last detected in Egypt last year.

While WHO did not confirm the polio case, it said earlier on Friday that three children in Gaza were found with acute flaccid paralysis — the onset of weakness or paralysis with reduced muscle tone, a common symptom of polio.

The children's stool samples have been sent for testing to the Jordan National Polio Laboratory, the agency said.

More than 1.6 million doses of the polio vaccine are expected to arrive in Gaza by the end of August, WHO said, in time for the vaccination campaigns which would have to be conducted in two rounds. Children under 10 will be given two drops of the oral vaccine against type 2 of the polio virus.

Health officials in Gaza warned they would not be able to stop the spread of polio and treat people without an urgent cease-fire in place. The stark warning came as international mediators expressed hope that a cease-fire deal is within reach.

Two days of talks had wrapped up in Qatar on Friday, the mediators said, adding that they plan to reconvene in Cairo next week to seal an agreement to stop the fighting.

The mediators have spent months trying to hammer out a three-phase plan in which Hamas would release the hostages in exchange for a lasting cease-fire, the withdrawal of Israeli forces from Gaza and the release of Palestinians imprisoned by Israel.

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Ukraine war latest: Zelenskyy reveals aim of Kursk invasion; Ukraine blows hole in another Russian bridge

Ukrainian President Volodymyr Zelensky says the military incursion into Russia's Kursk region aims to create a buffer zone - the first time he has clearly stated the aim of the operation.

Sunday 18 August 2024 23:11, UK

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Volodymyr Zelenskyy has said the operation in Kursk aims to create a buffer zone.

It's the first time the Ukrainian president has clearly stated the aim of the incursion into Russian territory, which was launched on 6 August. 

He has previously said the operation is to protect communities in the bordering Sumy region from constant shelling. 

"It is now our primary task in defensive operations overall - to destroy as much Russian war potential as possible and conduct maximum counteroffensive actions," he has just said in his nightly address. 

"This includes creating a buffer zone on the aggressor's territory - our operation in the Kursk region."

During the address he also repeated calls to Kyiv's allies to speed up deliveries of military aid - singling out the UK, as well as the US and France.

Ukraine is "still inflicting losses" on Russia, President Volodymyr Zelenskyy has said in his nightly address.

He claimed Ukraine's operation in Russia's Kursk region is damaging "the Russian army, state, their defence industy and their economy".

Mr Zelenskyy posted a video showing a growing cloud from a bridge explosion, with one of its sections destroyed.

He also thanked his soldiers stationed over the Russian border and asked his Ukraine's allies to speed up the delivery of promised military aid.

"Regarding deliveries from our partners - need acceleration, we ask very much. War has no holidays," he warned.

Yesterday, the German government was forced to deny rumours it is planning to halve its military aid to Ukraine in 2025.

A crater was left in the Kyiv region in the aftermath of a Russian missile attack.

Images show locals looking on at the destruction left by the strike, in a seemingly rural area.

Parts of the missile remained scattered across the ground.

This comes after Russia launched its third ballistic missile attack on Kyiv this morning (see 07:35 post).

Preliminary data showed all missiles were destroyed on their approach to the city, the military administration of the Ukrainian capital said. 

Two people have been killed in a Ukrainian shelling of Donetsk, according to the Russian-installed mayor.

A man and a woman were said to have been killed on Sunday, local mayor Alexei Kulemzin said.

Sky News has not been able to independently verify his claim.

It would continue Kyiv's push into Russian territory and their newfound aggression in the face of Russia's invasion.

This comes after, earlier in the day, Russian forces were said to have taken control of the village of Svyrydonivka, in the same region, according to TASS state news agency.

Chechnya President Ramzan Kadyrov has invited Elon Musk to Russia after being filmed behind the wheel of one of Tesla's Cybertrucks mounted with a machine gun.

Kadyrov, sanctioned by the US after being linked to numerous human rights violations, said he "literally fell in love" with the car and would donate it to Russian forces fighting in the invasion of Ukraine.

The president, who rules over Chechnya, a republic within the Russian Federation, claimed he received the truck from Musk, although this was not independently confirmed.

Messages left with Tesla by AP seeking comment were not immediately returned.

"It's not for nothing that they call this a cyberbeast. I'm sure that this beast will bring plenty of benefits to our troops."

Inviting Musk to Chechnya, Kadyrov said: "I don't think the Russian foreign ministry would mind such a trip.

"And, of course, we're waiting for your new developments that will help us finish our special military operation." 

Russian officials often refer to its invasion as a "special military operation".

More than 3,000 people were evacuated in 24 hours between Friday and Saturday from areas in Russia's Kursk region, according to local authorities.

Russia says the Ukrainian incursion has led to the evacuation of more than 120,000 civilians in total.

More than 10,000 Kursk residents were staying at temporary accommodation centres across the country, the Russian Emergency Ministry said.

Kyiv's offensive came as a shock to Yan Furtsev, an activist and member of the local opposition party Yabloko.

"No one expected that this kind of conflict was even possible in the Kursk region. 

"That is why there is such confusion and panic, because citizens are arriving [from frontline areas] and they're scared, very scared."

Russia has denied any talks were taking place with Kyiv about halting strikes on energy targets before Ukraine's Kursk offensive.

The Washington Post reported yesterday the incursion derailed indirect talks on civilian infrastructure facilities, with delegations set to be sent to Qatar.

The agreement would have amounted to a partial ceasefire, the Post said.

But Russian foreign ministry spokesperson Maria Zakharova refuted the report: "No one broke anything off because there was nothing to break off.

"There have been no direct or indirect negotiations between Russia and the Kyiv regime on the safety of civilian critical infrastructure facilities." 

Ukraine's government did not immediately respond to a Reuters request for comment. 

Ukraine has dismissed Belarusian border tension claims as false.

President Aleksandr Lukashenko was just trying to "appease" Russia when he said he was sending a third of the Belarusian army to the Ukrainian border, said Andrii Demchenko, spokesperson for the State Border Guard Service of Ukraine.

"We have not seen an increase in the equipment or manpower of Belarusian units near our border," he said.

"The situation on the border with the Republic of Belarus remains unchanged. 

"As you can see, Lukashenko's rhetoric is consistent, exacerbating the situation at regular intervals to appease the terrorist country."

We can now bring you video of the Ukrainian strike on the second bridge in Kursk this week.

A plume of smoke can be seen erupting from the construction in footage  published by the Ukrainian air force.

The attacks on bridges crossing the river Seym, one in Zvannoe and the other in Glushkovo, are thought to be attempts to hamper Russian attempts to resupply its troops in the region.

We've had more details from Belarusian President Alexander Lukashenko on his movement of troops to the Ukrainian border.

Minsk has deployed nearly a third of its armed forces along the entire border, the Belta state news agency reported.

The exact number of soldiers was not specified, but Belarus' professional army consists of 48,000 and around 12,000 state border troops, according to the 2022 International Institute for Strategic Studies' Military Balance.

The president claimed Ukraine had stationed more than 120,000 troops at its border with Belarus.

"Seeing their aggressive policy, we have introduced there and placed in certain points - in case of war, they would be defence - our military along the entire border," Belta cited Mr Lukashenko as saying in an interview with Russian state television.

Yesterday, Kyiv said it had seen no signs of a Belarusian troop build-up at the border.

Belarusian defence minister Viktor Khrenin said on Friday there was a high probability of an armed provocation from Ukraine and that the situation at their shared border "remains tense". 

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• Projects / U of I Child and Youth Study Center

U of I Child and Youth Study Center

The University of Idaho Child & Youth Study Center provides a broad range of psychological assessment and counseling services for children and youth in the Palouse region.

Contact the Child and Youth Study Center at 208-885-6191.