Evaluating Public Sentiment on Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder Compared With Other Mental Health Disorders From Posts on X (Formerly Known as Twitter): Longitudinal Analysis.

Abstract

Background: Neurodevelopmental disorders, especially attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), have seen a marked rise in public attention, yet research on public opinion remains limited. Social media analysis offers real-time, unfiltered insights into public perceptions, enabling empirical examination of public attitudes and opinions.

Objective: This study aimed to assess the evolution of public opinion on ADHD and ASD between 2009 and 2023 by analyzing posts from X (formerly known as Twitter; X Corp), comparing perceptions across English and Spanish languages and against other mental health conditions.

Methods: Posts mentioning keywords related to ADHD and ASD and control conditions (eg, depression, anxiety, insomnia, bipolar disorder, schizophrenia, suicide, and substance use disorders) were collected from X between 2009 and 2023. The dataset included posts in both English and Spanish. Machine learning algorithms were then applied to classify post content into predefined categories, including volume of posts, engagement, personal experiences, trivialization, perceived causes, and perceived treatability. Parametric and nonparametric tests were used to assess for differences by language. Descriptive statistics were presented using tables and graphical representations.

Results: A total of 852,990 posts were analyzed, including 511,510 (59.97%) in English and 341,480 (40.03%) in Spanish. Overall, post volume on mental health conditions increased across the study period. In English, posts about ADHD (97,084/511,510, 18.98%) and ASD (74,619/511,510, 14.59%) were among the most frequent, while of the 341,480 Spanish posts, there were 49,475 (14.49%) ASD posts, significantly outnumbering ADHD posts (n=18,223, 5.34%; chi-square test P<.001). Engagement analysis indicated a notable increase in likes and reposts per post over time, particularly after 2019, with ADHD-related posts in English experiencing peak engagement during the COVID-19 pandemic. However, ASD posts had comparatively lower engagement across languages. Posts sharing personal experiences were more polarized in Spanish, with higher proportions of negative and positive experiences compared with English posts. Trivialization of mental illnesses was less common in Spanish posts than in English posts, particularly for ADHD (17,053/18,223, 93.59%; chi-square test P<.001) and ASD (41,933/49,475, 84.73%; chi-square test P<.001). User-perceived causes included multifactorial factors, biological or genetic factors, substance use, psychological susceptibility, acute psychosocial stressors, and COVID-19. Perceived treatability varied by language but consistently included high perceived incurability, limited improvement despite professional help, and low perceived self-manageability except for anxiety.

Conclusions: Analysis of social media discourse showed that ADHD attracted higher post volumes, particularly during the COVID-19 pandemic, often described with multifactorial causes including substance use and genetics. ASD consistently received lower engagement. Both language groups showed low trivialization, awareness of the chronicity of the illness, and limited support for the self-management of mental health conditions. These findings underscore social media's value for capturing direct public perceptions to guide future educational and intervention efforts.