ABSTRACT
Objectives
The prevalence of autism spectrum disorder (ASD) is increasing globally, presenting substantial challenges to affected individuals and their caregivers. Concurrently, there are no established diagnostic biomarkers for ASD, making awareness essential for timely and accurate diagnosis. Prior research highlighted that analyzing Google search queries offers a valuable method for assessing real-time global trends and public interest in health conditions. Accordingly, this study aims to measure public interest in autism by analyzing Google Trends data from April 2014 to April 2024 in Türkiye.
Materials and Methods
Google Trends, an online service that tracks the frequency of search queries on the internet, was employed to analyze web activity from April 2014 through April 2024 in Türkiye.
Results
Throughout the observation period from April 2014 to April 2024, a significant rise in relative search volume (RSV) for autism was noted. An analysis of monthly search queries across all years identified April as the month with the highest RSV peak for autism, attributable to autism awareness events such as World Autism Awareness Day. However, this trend was transient and did not encompass the entire year.
Conclusion
The findings reveal an increase in internet interest in autism in Türkiye. They also highlight the potential impact of autism awareness events on the rise of internet interest. Enacting policies that enhance awareness of autism among the general population is essential. Crucially, these initiatives should be implemented throughout the entire year and not be limited to specific times.
Introduction
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition defined by two primary characteristics: deficits in social communication and the presence of restricted or repetitive behaviors and interests.1The global prevalence of ASD has been rising, with current estimates suggesting that approximately 1 in 31 children are diagnosed with the disorder.2 This upward trend is likely due to modifications in diagnostic criteria, enhancements in screening and diagnostic technologies, and heightened public awareness.3 Notably, there are no established diagnostic biomarkers for ASD,4 making awareness essential for timely and accurate diagnosis.
The awareness of ASD among the general population varies depending on several factors. While females are more likely to be aware of autism,5, 6 the link between age and ASD awareness is inconsistent.6, 7Additionally, higher educational status, internet usage, more frequent contact with individuals with autism, having a family member with autism, and not belonging to an ethnic minority are linked to greater awareness of autism.7, 8Nevertheless, prior research indicates that the level of autism awareness within the general population falls short of global expectations. In Türkiye, as in many other countries, there are notable gaps in understanding specific characteristics and symptoms of ASD within the general population.9
Increasing public awareness is crucial for promoting inclusivity, reducing discrimination, and enabling individuals with autism to attain fulfilling lives. Nonetheless, ongoing misconceptions and stigma resulting from limited understanding still affect individuals on the spectrum and their caregivers.10-12In response to this issue, global initiatives have been launched to ensure timely access to high-quality, culturally relevant health and social care, allowing those impacted to fully exercise their human rights.13 Additionally, countries have developed specific autism policies at national and regional levels, shaped by community needs. Accordingly, in 2016, Türkiye launched the “National Action Plan for Individuals with ASDs.” This plan has prioritized enhancing awareness of ASD in society and improving collaboration between institutions to ensure ongoing health, education, and support services for individuals with ASD.14However, there is not enough data to evaluate how these initiatives affect autism awareness among the general population in Türkiye.
The Current Study
The advent of the internet has significantly altered the landscape of information acquisition, establishing itself as a crucial platform for knowledge dissemination. It facilitates efficient searching and understanding of a wide array of topics, including health-related information. Within this framework, Google (Alphabet Inc.) dominates the market, holding shares of 89.08% in North America, 91.91% in Europe, 95.41% in South America, and 97.53% in Africa.15 Consequently, analyzing Google search queries offers a valuable method for assessing real-time global trends and public interest in health conditions.16 Accordingly, this study investigates whether the marked increase in ASD prevalence correlates with the growing public interest in ASD within Türkiye by utilizing data from Google Trends.
Materials and Methods
Google Trends, an online service that monitors the frequency of search queries on the internet, was utilized to analyze web activity from April 2014 to April 2024 in Türkiye. This tool quantifies the percentage of searches for specified user-defined terms relative to the total searches conducted on Google. It computes a relative search volume (RSV), which is derived by normalizing the query share of a term for a designated location and time frame against the highest query share of that term during the observed period. The values range from 0 to 100. Each data point in the graphical output from Google Trends is scaled relative to the highest point, conventionally set at 100.17,18
Statistical Analysis
Statistical analyses were conducted using SPSS version 29.0 (IBM Corp., Armonk, NY, USA) and R version 3.5.0 (R Foundation for Statistical Computing, Vienna, Austria), incorporating the “nlme” and “forecast” libraries. Continuous variables were reported as means±standard deviations. A repeated measures analysis was conducted to evaluate changes in measurements over the specified time interval. Correlation analyses employed seasonal decomposition of time series by locally estimated scatterplot smoothing, which decomposes the time series into seasonal components, a trend, and irregular components. We established a generalized least squares model that accounts for autocorrelation among residuals to further determine the significance of trends over time after adjusting for seasonal effects. The residuals’ correlation structure was determined by automatically selecting the parameters of the AutoRegressive Integrated Moving Average Model, guided by Akaike’s information criterion.16 A p-value of less than 0.05 was considered statistically significant.
Results
A trend analysis, adjusted for seasonal variations, identified a pronounced escalation in RSV for autism during the monitoring period from April 2014 through April 2024 (b=1.55±0.62, p=0.014) (Figure 1). Moreover, a detailed examination highlighted a significant peak in RSV for autism in September 2019. Concurrently, the analysis indicated that the mean RSV for autism in 2019 (39.25±25.61) surpassed that of other years (Figure 2). Table 1 shows the mean RSVs by year for autism.
Subsequently, the average monthly values for each year under review were computed. An assessment of monthly search queries over the entire period identified April as the month exhibiting the highest RSV peak for autism, recorded at 38.89±8.57 (Figure 3). Table 2 presents the mean RSVs by month for autism.
Discussion
This study investigated public interest in autism by analyzing Google Trends data from April 2014 to April 2024 in Türkiye. The analysis revealed a significant increase in the frequency of search queries related to autism over this decade. Prior research has demonstrated that analyzing Google search queries can serve as an effective tool for monitoring real-time global trends and public awareness of diseases.19, 20Accordingly, the results indicate a heightened public interest in autism within Türkiye, corroborating previous studies. Indeed, Bayın Donar21 indicated that the term “autism” had the greatest rise in RSV among disease concepts, with a significant increase of 372% from 2008 to 2018. However, previous research has shown that public awareness of ASD remains below the desired level in Türkiye. For instance, Rakap et al.9 has shown that awareness of ASD is still insufficient among individuals without family members or relatives affected by autism. Neng et al.22indicated that nearly 10% of mothers applying to a family health center were unaware of autism. Furthermore, studies have indicated that not only the general population but also healthcare professionals lack adequate knowledge and awareness about ASD in Türkiye.23, 24
The delayed diagnosis of children with ASD can indirectly indicate a lack of awareness in Türkiye. Indeed, Kul et al.25 reported that the mean age at diagnosis for children with ASD was 36.76 months. Similarly, Kilicaslan and Tufan26 found that the median age at diagnosis for ASD was 36 months, and Bodur et al.27 noted that only 20.1% of children with ASD were diagnosed before the age of two years. The clinical progression of ASD is closely linked to early diagnosis.28 It is imperative that individuals possess the necessary knowledge and skills to identify signs of autism in children. Therefore, enhancing the knowledge and awareness of the public regarding autism is crucial.
The findings also revealed that April, as the month with the highest RSV for autism, is potentially attributable to autism awareness events. World Autism Awareness Day (WAAD), established by the United Nations General Assembly in 2007, is celebrated annually on 2 April. This global event is dedicated to raising awareness about autism and promoting the acceptance and inclusion of individuals with ASD in society. Organizations and communities worldwide engage in various events, campaigns, and initiatives to educate the public about autism and advocate for the rights and well-being of individuals with ASD. For example, blue, associated with calmness and acceptance, is the primary color designated for autism, and people are encouraged to wear blue to support autism awareness.29 Additionally, Türkiye initiated the “National Action Plan for Individuals with ASDs” in 2016. In this context, a campaign was initiated featuring the slogan “Notice–Accept–Walk with Us.” On April 2, messages were disseminated through social media platforms, alongside public service announcements and radio broadcasts. Correspondence with the Turkish Football, Basketball, and Volleyball Federations facilitated athletes competing under a banner displaying the slogan. Furthermore, the Bosphorus bridges and selected historical and public buildings were illuminated in blue to promote autism awareness.30 Ahmed et al.31 demonstrated an observable increase in the volume of tweets and positive sentiment during WAAD, indicating the effectiveness of WAAD in raising awareness on Twitter. Additionally, a recent study has shown an annually repeating pattern, with a peak in the frequency of search queries related to autism in April, Autism Awareness Month.32 This pattern has been consistent between 2008 and 2021, and following the conclusion of Autism Awareness Month, public interest in autism, as measured by Google searches, declined.32 Supporting this, Figure 1 clearly demonstrates that RSV for autism consistently peaked in April, but this increase was not sustained over time. Consequently, there is typically an increase in internet interest in autism during April, likely due to various autism awareness activities. However, this heightened interest is generally short-lived.
The study identified a peak in RSV for autism in September 2019. This observation correlates temporally with the premiere of the Turkish television series “Mucize Doktor” (2019-2021), which portrays a physician with ASD, and garnered substantial viewership and market share during its initial episodes. It is reasonable to suggest that “Mucize Doktor” may have contributed to heightened internet interest in autism during this period. This is supported by Özkent,33 who has shown that episodes of another Turkish series, “Kırmızı Oda,” which depicted various mental illnesses, such as paranoid personality disorder, panic disorder, and major depression, caused significant spikes in internet searches immediately following their broadcasts. These findings illustrate that television series can function both as sources of entertainment and as potential educational platforms concerning medical issues.34 However, it is critical to recognize that such portrayals often diverge from actual medical practice and could foster unrealistic expectations about patient care.35
Study Limitations
This study offers important insights into public interest in autism within Türkiye. Nevertheless, several limitations warrant mention. Google Trends data are indicative of relative search interest and may be influenced by concurrent increases in searches for other topics, such as politics or general news. Additionally, the demographic characteristics of the individuals performing these searches remain unidentified. Moreover, while the application of Google Trends in research is on the rise, Google does not disclose detailed methodologies for data compilation.16
Conclusion
The prevalence of ASD is increasing globally, presenting substantial challenges to affected individuals and their families. Prompt and accurate diagnosis is vital for effective management of ASD symptoms. Therefore, enhancing autism awareness among the public and healthcare professionals is imperative. Strategies to achieve this include conducting autism awareness campaigns and integrating discussions of autism into television narratives and public service announcements. Crucially, these initiatives should be carried out throughout the entire year and not be limited to specific times.
