Quality and reliability of YouTube videos on attention deficit hyperactivity disorder: A cross-sectional study

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is among the most frequent disorders within child and adolescent psychiatry, with a prevalence of >5%. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), and the International Classification of Diseases, editions 10 and 11 (ICD-10/11) continue to define ADHD as per behavioural criteria, based on observation and informant reports.¹ ADHD is an early-onset clinical condition characterized by attention difficulties, hyperactivity, and impulsivity. It can persist across the lifespan, influencing the evolutionary course and facilitating the rise of psychiatric comorbid conditions.²

Social media platforms like ‘YouTube’ or ‘Google’ are easily accessible to all and have gained immense popularity in the past, owing to the provision of an online environment for doctors and medical health providers to display their knowledge and treatment options. It also helps patients gain extensive knowledge regarding their health and seek medical attention.

The top countries searching for ADHD-related content on YouTube are the USA, the UK, Canada, and Australia.³ We evaluated the quality and reliability of information shared on YouTube about ADHD.

METHODS

This cross-sectional study was conducted in April 2023 to assess the quality and reliability of the information provided by YouTube videos on ADHD. Each of the seven authors was assigned one of the following keywords: ‘ADHD,’ ‘ADHD symptoms,’ ‘ADHD treatment,’ ‘ADHD cause,’ ‘ADHD medications,’ ‘Attention deficit hyperkinetic disorder,’ and ‘ADHD patient.’ To meet the inclusion criteria, videos had to be relevant to ADHD, in English or Hindi, at least 1 minute long, and not exceed 20 minutes. The top 10 videos, meeting the inclusion criteria, were considered. Videos that did not fulfil these criteria were excluded. These conditions were selected keeping in mind the behaviour of the general population towards YouTube videos. Videos <1 minute convey little information, and those >20 minutes do not hold the attention of the viewer. Although several videos are available on YouTube, viewers may not watch all, but only the top ones visible to them after typing in a search word. Hence, the top 10 videos appearing after typing the keyword in the search bar were considered.

Those that fulfilled the inclusion criteria were documented with their upload date, duration, number of likes and comments, and source (for instance, a health organization or an individual diagnosed with ADHD). Information on ADHD’s symptoms, causes, investigations, prevention, treatments, mortality rate, and rehabilitation options was noted, including any personal experience or promotional content. Videos were deemed suitable for patients, doctors, or both. Finally, the video power index (VPI), Global Quality Scale (GQS), and Reliability (DISCERN) score were calculated. VPI used the formula ([likes count]/[dislikes count+likes count]×100) to rank the videos’ popularity. GQS scored the videos from 1 (poor quality) to 5 (excellent quality) to determine their quality and usefulness for patients. The DISCERN questionnaire consisted of five questions about the video’s clarity, validity, and bias. One point was given for ‘yes’ while zero points were given for ‘no’, and the points were summed to give the reliability score.⁴ Results were initially recorded on Google Sheets and transferred to Microsoft Excel. Quality of videos was compared for varying sources of the videos. Statistical analysis was performed using the Statistical Package for the Social Sciences software.

RESULTS

A total of 70 videos meeting the inclusion criteria were evaluated. Table 1 shows the characteristics of the 70 YouTube videos analysed. The number of views, likes, dislikes, and comments have been mentioned. Amongst them, 85.1% of videos were uploaded >1 year ago, while only 14.9% were uploaded >1 month to <1 year ago; 43.3% of the videos were uploaded under the ‘other’ category, 31.3% by doctors/hospitals, and 10.4% by news channels.

Table 2 shows information about ‘disease’ in the YouTube videos. Of the 70 videos, 86.6% described symptoms, 73.1% had information on treatment, 34.3% had information on investigations, and 58.2% covered cause/aetiology. No videos had information about prevention/vaccination.

Table 3 shows a comparison of GQS, reliability score, and VPI based on the type of uploader. All the videos were found to have an average GQS score of 4. The videos with the highest VPI scores were uploaded by patients. The videos with the lowest VPI scores were uploaded by doctors/hospitals. All videos were found to have a reliability score of 4, regardless of the type of uploader.

DISCUSSION

The GQS in our study was 4 for all types of providers. This finding may be due to the accurate information on attention-deficit/hyperactivity disorder (ADHD) provided to patients by doctors or healthcare organizations. It can also be attributed to the accessibility of articles on the topic of ADHD. In a related study by Ward, 120 videos were investigated using different search terms such as ‘ADHD’, ‘Attention-deficit/hyperactivity disorder’, ‘Attention deficit disorder’, ‘Ritalin’, ‘Concerta’, and ‘Adderall’.⁵ This indicates that Ward’s study primarily focused on assessing the quality of the information provided in YouTube videos, whereas our study concentrates on the type of information available more comprehensively.

Furthermore, Kang et al. conducted a study highlighting the most common issues addressed in YouTube videos related to ADHD, namely symptoms, children, and treatment.⁶ Our study aligns with their findings, as 86.5% of the videos in our study addressed symptoms and 73.1% provided information on treatment. Similarly, Kang et al. noted that most videos were created by non-medical professionals, which is similar to our study.⁶ Only 31.3% of the videos were uploaded by doctors/hospitals, while 7.5% were by healthcare organizations. These results suggest that a major portion of the relevant ADHD-related videos on YouTube originate from non-professional sources.

A similar study by Hornung et al. had a GQS of 2.3.⁷ The reliability score was also 4 for all the providers. There was no difference in GQS and reliability scores. The VPI was first described by Erdem and Karaca, and used to assess the power of the video based on the number of views and likes.⁸ The VPI of our study (532.22) is the highest for videos by patients. Commercial and patient-based videos were the most popular groups with higher VPI and saw ratios similar to the study by Celik et al.⁹ Our study does not show a significant difference in VPI among providers.

Our study has several limitations. The small sample size is a drawback. Another restriction is the scoring system’s inter-observer variability. Assigning 7 observers makes it possible for each one to assign different scores depending on their perceived accuracy of a certain component of the video. Despite ‘DISCERN’ scoring being the standard scoring system, some scoring variations exist due to observer perceptions. YouTube search results vary by location. Similarly, we exclusively considered YouTube videos and ignored other sites that patients could visit to learn more about ADHD. We only included English and Hindi YouTube videos, which make up a small part of all the ADHD videos.

Verified information pertaining to the medical domain should be uploaded on social media platforms by responsible individuals, particularly healthcare professionals and reputable healthcare organizations. It is imperative to ensure that such information is not only easily comprehensible but also upholds high GQS and reliability scores. By delivering readily accessible content that maintains a superior standard of quality and dependability, the dissemination of accurate knowledge becomes more efficient and beneficial for the general population and viewers. It is of utmost importance to include a clear statement within the video, urging patients to consult a qualified medical practitioner for any inquiries related to diagnosis, treatment, or other medical concerns. This precautionary measure highlights the potential risks associated with self-diagnosis, thereby emphasizing the importance of seeking professional medical guidance for optimal healthcare outcomes.