Community Ment Health J (2017) 53:445–451
DOI 10.1007/s10597-016-0015-5
BRIEf REpORT
Attention Deficit Hyperactivity Disorder on YouTube: Framing,
Anchoring, and Objectification in Social Media
Seok Kang1 · Jae-Sik Ha2 · Teresa Velasco3
Received: 18 March 2015 / Accepted: 19 May 2016 / Published online: 26 May 2016
© Springer Science+Business Media New York 2016
Abstract  This study investigated videos about Attention
Deficit Hyperactivity Disorder (ADHD) on YouTube in
terms of issues, sources, and episodic–thematic aspects. A
total of 685 videos uploaded onto YouTube between 2006
and 2014 were content analyzed. Results demonstrated
that the top three key issues about ADHD were symptom,
child, and treatment. Doctor, patient, and supporter were
the three most interviewed sources. Videos from the public
sector including the government, company representative,
and public organizations were relatively rare compared to
other sources suggesting the potential for a greater role for
the government and public sector contributions to YouTube
to provide credible information relevant to public aware-
ness, campaigns, and policy announcements. Meanwhile,
many personal videos in the episodic frame advocated
social solutions. This result implies that YouTube videos
about health information from the private sectors have the
potential to affect change at the social level.
Seok Kang
seok.kang@utsa.edu
Jae-Sik Ha
angelha71@gmail.com
Teresa Velasco
byb013@my.utsa.edu
1
Department of Communication, University of Texas at San
Antonio, One UTSA Circle, San Antonio, TX
78249-0643, USA
2
Communication Department, University of Illinois at
Springfield, One University Plaza, MS UHB 3010,
Springfield, IL 62703, USA
3 Yahoo. The rapid growth and accessibility of YouTube
Department of Communication, University of Texas at San
Antonio, One UTSA Circle, San Antonio, TX
78249-0643, USA
Keywords  ADHD · YouTube · Information framing ·
Episodic aspects · Thematic aspects
The media have been the audience’s paramount source of
information about health (Atkin et al. 2008). The public is
informed or misinformed about health covered by the media,
which can impact personal attitudes, experiences, and social
policies (Slopen et al. 2007). Particularly, a stigmatizing
depiction of individuals with disabilities by the media can
elicit negative perceptions, stereotypes, and concerns from
these individuals’ family about discrimination (Angermeyer
and Matschinger 1996; Domino 1983; Thorton and Wahl
1996). The depiction can also influence policy making in
public sectors (Siperstein 2003).
A well-known disability that has received limited research
attention in media coverage is Attention Deficit Hyperactiv-
ity Disorder (ADHD). ADHD is one of the most common
childhood mental disorders and is characterized as sustained
inattention, hyperactivity, and impulsivity (Anderson et al.
2012). While considerable research attention has been given
to the media’s coverage of mental disorders, only a few
studies have been conducted on ADHD (e.g., Day and Page
1986; Wahl 2000; Wahl et al. 2002). The studies mainly
investigated the coverage of ADHD by traditional media
such as newspapers and magazines.
In the Internet era, however, audiences view and read
health information on websites, social media, and mobile
phones. One of the most widely accessed new media chan-
nels is YouTube. According to ComScore (2015), YouTube
is the number one video website with over 150  million
unique viewers per month, followed by Facebook and
as a new multimedia channel calls for research attention,
because audiences can view YouTube videos about ADHD
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and may identify problems and solutions. YouTube videos
can eventually influence audiences’ perceptions or attitudes
toward ADHD. In this study, we analyze how YouTube vid-
eos frame or represent ADHD. In turn, the ways YouTube
videos anchor or objectify ADHD in a certain direction are
examined in (a) issues about ADHD; (b) interview sources;
(c) different aspects of ADHD videos; and (d) how issues,
sources, and aspects interact with one another.
Health Information Framing and Representation
in the Media
Information framing occurs when the media select certain
aspects of an agenda as salient attributes and frame the
aspects in a certain way (Entman 1993). Information fram-
ing is defined as the main idea for organizing the reality and
providing meanings to an unfolding strip of information
attributes, weaving a connection among them (Nelson et al.
1997). For example, the study by Imison and Schweinsberg
(2013) found that medical tourism was framed as a “benefit”
rather than a “risk.”
Research on the news media addresses that informa-
tion framing can be represented as three categories: issues,
sources, and aspects (Cho 2006). First, content categories
represent issue items covered in the media, which can deter-
mine the attribute structure of the agenda. Second, voices
of people and actors (sources) constitute an important part
of the information, which reflects the framing of an agenda.
Third, different angles of aspects can explain the degree of
emphasis on the coverage. These three elements are indi-
cators of how an agenda is structured and represented (de
Rosa 1987; Durham 2007; Iyengar 1990).
Two concepts related to framing, particularly dealing
with mental health, are anchoring and objectification. The
two concepts are drawn from social representations theory.
Social representations refer to the collection of common
knowledge that people share as common-sense theories
about the social world (Flick 1998). Anchoring accounts
for the process of reducing and transforming unfamiliar
agendas into ordinary categories and images (Schmitz et al.
2003). Objectification translates abstract concepts to con-
crete images, weaving the phenomenon into the common
knowledge of the social group (Augoustinos and Walker
1995).
Social representation theory is effective in examining
social processes of health information through which col-
lective knowledge about mental health becomes embedded
across different public groups. In fact, social representations
theory has been used to describe the diffusion of psychoana-
lytic constructs into familiar belief and language (Mosco-
vici 1976). For instance, a study using social representations
theory for mental illness found that people identify mental
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Community Ment Health J (2017) 53:445–451
illness as the deviant, psychologically impaired, or magical/
fantastical (de Rosa 1987). The news media likely anchor
mental illness from an unfamiliar idea to a familiar one by
translating (objectifying) it. Negative objectifications were
prevalent in describing persons with mental illness (Cover-
dale et al. 2002). Those with mental illness were seen as
distant and different from normality (Zani 1995). As such,
the media may have socially represented ADHD through
anchoring and objectification on YouTube.
Health Information Framing on YouTube
YouTube is a website or social application that both pro-
fessional videographers and amateur users can post videos
for public attention worldwide (VanderKnyff et al. 2015).
On YouTube, news, TV programs, commercials, movies,
sporting events, and user-generated-content (UGC) are
viewed every day (Yoo and Kim 2012). Researchers have
suggested that YouTube has an impact on viewers’ attitudes
and behaviors on health topics. Kim et al. (2010) analyzed
200 smoking fetish videos on YouTube and concluded that
videos glamorizing smoking behaviors with sexual appeals
could entice adolescent smoking. Keelan et al. (2007) found
that 32 % of YouTube videos about immunization were pre-
sented negatively by emphasizing the risk of immunization.
Although research is still thin, scholars have begun to exam-
ine health disorders covered in YouTube videos. Yoo and
Kim (2012), in their analysis of YouTube videos about obe-
sity, found that the prevailing emphasis was put on weight-
based teasing and stereotypical eating behaviors.
With a focus on ADHD, the current study poses four
research questions and one hypothesis examining various
issues, interview sources, aspects, and interactions among
the framing components presented on YouTube.
●● RQ1: What issues in ADHD have been highlighted on
YouTube over time?
●● RQ2: What sources in ADHD have been highlighted on
YouTube over time?
●● H1: YouTube videos about ADHD are likely to stress
episodic frames about ADHD more than thematic ones
over time.
●● RQ3: How do issues about ADHD covered on YouTube
relate to episodic–thematic aspects?
●● RQ4: How do sources about ADHD covered on You-
Tube relate to episodic–thematic aspects?
Regarding RQ1, issues about a mental health topic can
socially represent the characteristics of news framing (de
Rosa 1987). Schmitz et al. (2003) analyzed U.S. newspa-
pers about ADHD between the years of 1987 and 1997.
The issues covered in the newspapers were “genetic con-
dition,” “stressors,” “deviance,” and “gender, particularly
Community Ment Health J (2017) 53:445–451
boys.” Studies about mental disorders found “diagnosis,”
“intervention,” “symptom,” “therapy,” (Clarke 2008; Sig-
man 2007; Speers and Lewis 2004; Spittler 2009), “educa-
tion” (e.g., correction of misconception, training), “personal
story,” and “personality” (Douwe 2009) as primary issues.
Celebrities with ADHD such as Michael Phelps received
large media attention for their personal success and achieve-
ments (Goodin 2013).
Pertaining to RQ2, as the media emphasize elite sources
such as opinion leaders or experts, certain aspects are framed
and socially represented in the directions (Durham 2007;
Jha 2007). News reports about health information often
rely on medical doctors, researchers, and medical research
results (Logan 1991). Lloyd and Norris (1999) found that
the media are highly reliant on two major sources—parents
and experts—while covering ADHD. As Cho (2006) claims,
most sources about health information are doctors rather
than patients. This one-sided news source may provide the
audience with biased or insufficient views on ADHD.
As to H1, media framing of issues and sources has been
socially represented either episodically or thematically
(Iyengar 1991). The episodic frame refers to a personal
event or story in which an individual is involved. The the-
matic frame is concerned with background information of
ideas at the social level (Iyengar 1990). The episodic frame
emphasizes personal responsibility in the topic. Meanwhile,
the thematic frame covers the people who have the power
to control the problem and solution at the social level (e.g.,
government, congress). Therefore, by stressing either the
episodic or thematic frame, the audience understands and
identifies the aspects of a health topic depending on the
responsibility attributed to either individuals or society.
Horton-Salway (2011) found that newspaper coverage of
ADHD was focused on ineffectual and neglectful parent-
ing, which emphasized personal responsibility. In addition
to parenting, a large portion of the ADHD news tends to be
framed as episodic, emphasizing individual responsibility
of the disorder from a “risky” point of view (Slopen et al.
2007). However, social responsibility such as the govern-
ment’s policies or solutions about ADHD was minimally
emphasized (MacKenzie et al. 2008).
As asked in RQ3 and RQ4, identifying the interactions
among issues, sources, and aspects of ADHD can indicate
what issues are related to sources and aspects. Kang et al.
(2010) discovered that the episodic frame of Alzheimer’s
disease in TV news in the US was positively related to the
government’s enactment of affirmative policies on Alzheim-
er’s disease, implying that voices at the personal level might
have influenced the government’s policy change. Similarly,
Spence’s (2010) study on the coverage of HIV/AIDS sug-
gests that episodically framed coverage in U.S. newspapers
stimulated the public’s positive attitudes toward regressive
policy solutions about the disease. On the other hand, the
447
thematic coverage of a breast cancer vaccine influenced the
subsidy policy of the government on the cancer (Cho 2006).
As such, revealing the relationships may provide productive
suggestions or solutions on ADHD.
Method
Sampling Procedure
Data collection followed several sequential steps to accom-
modate the characteristics of YouTube videos, because video
uploading and removal take place on an ongoing basis. This
study used two keywords: Attention Deficit Hyperactivity
Disorder and ADHD. As of February 10, 2014, a search
using the keyword, Attention Deficit Hyperactivity Disor-
der, yielded 18,400 videos. On February 18 of 2014, the
use of keyword ADHD resulted in 492,000 videos. The two
searches were filtered by “view count” in order to sort out
the videos that received high viewer attention. The current
setting of YouTube only provides the first 30 pages of vid-
eos with 20 videos on each page, totaling 600 videos.
Two trained coders took charge of each keyword and
refined the videos in the 30 pages by removing redundant
or minimally related videos about ADHD. As a result, the
search of Attention Deficit Hyperactivity Disorder finally
produced 513 videos. The search of ADHD resulted in 348
videos. The two coders combined the results and reviewed
if any videos overlapped between the two lists. The purifica-
tion attempt found 54 redundant videos. Therefore, the final
number of videos for the analysis was 807. All YouTube
URLs were recorded for the coders to visit for data encod-
ing. Based on the web URLs, the analysis was conducted in
March through July of 2014. During the coding period, the
coders found 122 videos to be unavailable. By removing the
cases, the final number of videos for analysis was 685.
Coding Categories
This study used a whole video clip as the unit of analysis
for the content categories, including types of media format,
issues, sources, and episodic–thematic frames. Each video
clip includes visual, audio, and text presentation. Items of
these categories were coded as one for presence and zero for
absence. The constant comparative method was applied to
the coding process (Cho 2006). Categories of media types,
issues, sources, and episodic–thematic frames were drawn
from previous research. If a new category was found during
the coding procedure by comparison, the new category was
added to the coding.
First, the types of media format were categorized into
(a) TV news coverage, (b) public service announcement
(PSA), (c) excerpt from TV documentary, (d) excerpt from
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TV entertainment, (e) user-generated content (UGC), (f)
podcast, and (g) others (e.g., advertisement) (Yoo and Kim
2012). Examples of PSA encompass videos by government
agencies or nonprofit organizations. The UGC format was
coded when a video was a viewer-created amateur one,
such as first person narrative, third person narrative, skit,
or home video. Podcast videos were those made for Inter-
net broadcasting, which viewers could download through
syndication.
Second, in order to identify types of issues, all issues that
appeared in a video in order to identify the type of issues
were coded. As such, multiple issues were possibly found in
one video. This study used content categories employed in
previous research on mental disorders (Douwe 2009; Speers
and Lewis 2004). The coded issues are (a) drug, (b) boy, (c)
girl, (d) adult, (e) child, (f) race, (g) treatment, (h) fact, (i)
risk, (j) cause, (k) genius, (l) symptom, (m) prevention, (n)
parenting, (o) vaccine, (p) addiction, (q) personal story, (r)
legal case, (s) community, (t) government policy, (u) celeb-
rity, (v) research, (w) accident, (x) therapy, (y) education,
(z) diagnosis, and (aa) other (e.g., donation).
Third, videos about sources were counted when any per-
son was interviewed in either the visual or narrative format.
If the same source appeared several times in the video, it
was coded as one source. Source categories included (a)
doctor, (b) patient, (c) family, (d) supporter, (e) government,
(f) company representative, (g) other (e.g., insurance), and
(h) no source.
Lastly, for episodic and thematic frames, three subcat-
egories were created for each frame. The episodic frame
covers stories as individual causes and solutions (Iyengar
1990; Slopen et al. 2007). On the other hand, the thematic
frame attributes causes and solutions to society. Drawn from
these characteristics, this study coded (a) personal cause, (b)
personal problem, and (c) personal solution as the episodic
frames. The thematic frames consisted of (a) public cause,
(b) public problem, and (c) public solution.
Inter-Coder Reliability
Two trained coders coded the 685 videos. The third coder
took the role of a coding intervener. The third coder ran-
domly selected 10 % of each coder’s data. Then the third
coder conducted the same data coding for the selected vid-
eos. As a result, minor discrepancies were found in coding
ADHD issues. For example, the first coder viewed that a
video showed “symptom” only. The second coder, however,
coded the video as “risk”, “treatment,” and “symptom.” The
third coder also found the video to have multiple issues.
Such discrepancies were resolved through discussions
among the coders. The 10 % of adjusted data were tested for
reliabilities. This study used Cohen’s Kappa for a reliabil-
ity test, which is used for categorical data. The inter-coder
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Community Ment Health J (2017) 53:445–451
reliabilities for the issue(s) were 0.87, the source(s), 0.93,
and episodic/thematic frame(s), 0.83. Crano and Brewer
(2002) suggest that the reliability range from 0.83 to 0.89
indicates a sufficiently acceptable level.
Results
Of the 685 videos analyzed, years of the videos ranged
from 2006 to 2014. The video with the highest viewer-
ship was 2,897,546 (M = 29,379.83, SD = 171,373.65,
Median = 1,131, Mode = 0). The average number of “likes”
of the videos was 89.14 (SD = 365.18, Range = 0–4977,
Median = 4, Mode = 0). The number of “dislikes” ranged
from 0 to 497 (M = 9.49, SD = 35.87, Median = 0, Mode = 0).
This study used crosstab tables to view the distributions of
data over time. A Chi square test in data distributions was
used as a significance test for issues, sources, and aspects.
A Cramer’s V test was implemented to measure correlations
among categorical variables.
RQ1 questioned the proportion of issues in ADHD in
YouTube videos. A total of 3225 issues were identified. The
top three key issues over the years were symptom (10.3 %),
child (10.1 %), and treatment (10.1 %). The ADHD issues
with the least attention were race (0.1 %), followed by legal
case (0.2 %) and vaccine (0.3 %). RQ2 asked if there were
different types of sources in ADHD videos. The top three
sources are doctor (28.8 %), patient (16.5 %), and supporter
(7.5 %). Government and company representative were two
least interviewed sources in the videos.
H1 predicted that there would be more episodic videos
than thematic ones. Among sub-categories, in presenting
ADHD causes, episodic frames were more frequently found
than were thematic frames (episodic: M = 0.29, SD = 0.45;
thematic: M = 0.16, SD = 0.36; t = 6.28, df = 684, p < .001).
However, there were more thematic videos than episodic
ones about ADHD problems (episodic: M = 0.49, SD = 0.50;
thematic: M = 0.56, SD = 0.49; t = −1.98, df = 684, p < .05). In
terms of ADHD solution, there were more thematic solutions
than episodic ones (episodic: M = 0.34, SD = 0.47; thematic:
M = 0.40, SD = 0.49; t = −2.71, df = 684, p < .01). Overall,
the results showed that there was no significant difference
between episodic and thematic frames (paired sample t test,
episodic: M = 0.37, SD = 0.39; thematic: M = 0.37, SD = 0.32;
t = 0.02, df = 684, NS). Therefore, H1 was not supported.
RQ3 inquired if correlations existed between ADHD
issues and episodic/thematic frames. A Cramer’s V test indi-
cated that the videos emphasized both personal and public
solutions in presenting the issues of drug, prevention, com-
munity, government policy, and education. RQ4 questioned
the relationship between sources and episodic/thematic
frames. Patient and family sources about ADHD appeared to
be positively related to both episodic and thematic frames.
Community Ment Health J (2017) 53:445–451
Discussion
This study investigated how ADHD has been framed on
YouTube in terms of issues, sources, and aspects. As the
framing perspective addresses, the results indicate that cer-
tain aspects are emphasized in ADHD videos on YouTube.
Particular issues and sources are anchored and objectified
as social representations in the videos. Episodic/thematic
aspects of ADHD videos on YouTube objectify concrete
images and weaving the frames into the popular belief and
language of the social group (Flick 1998; Moscovici 1976).
As found in RQ1, YouTube videos were generally
focused on “symptom” and “treatment” or “children” in dis-
cussing ADHD. YouTube videos in regards to “treatment”
presented both medicated and non-medicated forms. The
non-medicated forms were addressed in the videos, because
parents and patients experienced negative side effects while
on prescriptions. For example, there were videos about ther-
apy techniques such as breathing exercises, meditation, and
yoga to help decrease a child’s heart rate and blood pressure.
As such, practical components of ADHD treatment were
frequently represented in YouTube videos as issues.
With respect to RQ2, doctor was the most important
source in YouTube videos analyzed followed by patients.
This finding shows that no significant difference exists
between traditional media and YouTube regarding the rev-
erence of credible and authoritative information sources.
These findings might have reflected the general trend that
the news media rely on elite sources, such as experts or
opinion leaders (Durham 2007; Jha 2007). Patients are
likely to share their experiences and feelings to the global
audience in the videos. However, government sources were
hardly covered in the videos. This finding implies that view-
ers are more likely exposed to personal storytelling than
official information from the government. The government
may need to use this channel to deliver credible informa-
tion about ADHD by which the viewers can compare and
contrast diverse information and make a fair judgment on
understanding ADHD.
In spite of the traditional media’s general preference of
episodic frames over thematic frames, there was no signifi-
cant difference in the frequencies of episodic and thematic
frames in YouTube videos about ADHD, which rejected H1.
A large number of TV news and documentary about ADHD
on YouTube presented ADHD as social issues, such as edu-
cation, community, and video games. Meanwhile, videos
produced by individuals advocate for social issues about
ADHD. This interpretation may be supported by the few
government sources (0.1 %), indicating that individuals talk
about ADHD at the social level.
As such, the most prominent media type of YouTube vid-
eos is UGC (61 %), congruent with previous research (Yoo
and Kim 2012). Numerous videos in this media type were
449
produced and interviewed by doctors, health care experts,
social activists, and parents. These YouTube users are also
likely to present ADHD from the societal and educational
perspectives, which claim that children and adults with
ADHD could be better treated when social actions and
responsibilities are combined with individual efforts. None-
theless, since a large portion of thematic aspects is presented
by individual sectors, a credibility issue is likely to appear.
It is possible that the viewers may be misinformed about
ADHD in treatment, prevention, or other emotional coping.
In this sense, thematic aspects covered by the public sector
need to be presented as well to provide the viewers with an
opportunity to impart fair judgment.
Findings for RQ3 and 4 showed that there were more
positive relationships between issues and thematic public
causes than between issues and episodic personal causes.
For example, drug, child, treatment, risk, cause, symptom,
prevention, parenting, addiction, community, accident,
therapy, and education were described as thematic public
causes more frequently than they were portrayed as episodic
personal causes. When individual storytellers present health
issues on YouTube, they tend to employ more thematic
frames than episodic frames (VanderK nyff et al. 2015).
Consistent with other findings, the results suggest that You-
Tube should include more videos from the public sectors in
which diverse views and information are presented.
Given the findings, YouTube videos about ADHD or
other health information can be used as a new channel for
public awareness and involvement. More importantly, You-
Tube could potentially become the public sectors’ participa-
tory media outlet for public attention. As a result, this study
helped identify the status of YouTube videos playing a role
in health information anchoring, storytellers’ objectification
of this channel, and what the community or the government
can or needs to do for ADHD through social representation
(de Rosa 1987).
A concerted effort to make credible information about
ADHD available on YouTube is needed. In this study, the
personal sectors accounted for both episodic and thematic
frames. With credible information, the public sectors, such
as the government, should use YouTube for information
about ADHD more actively in order to provide public solu-
tions. YouTube can be a media outlet for practical param-
eters on health information available to the public.
Conclusion
The current study found that YouTube is a channel that
encompasses both personal and social aspects of ADHD.
Particularly, individuals speak up for public causes and
solutions for ADHD. The present study confirmed that there
are more thematic public solution frames than episodic
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personal solution frames on this media channel, in contrast
to TV news or newspapers found in previous research. In
relation to the findings, a success case of viral philanthropic
social media campaign for Amyotrophic Lateral Sclerosis
(ALS) is a relevant example (Giusti 2014). The viral vid-
eos by individuals (episodic) on YouTube led to the unprec-
edented fundraising amounts for ALS research at the social
level (thematic).
Therefore, YouTube may have become a new media chan-
nel that provides personal storytellers with an opportunity to
voice social responsibilities about health. This media out-
let may play a role in balancing personal and social aspects
of health information. Social media for health information
may invoke the citizens’ heightened awareness, attention,
and engagement with ADHD at both the personal and social
levels. However, the dominance of UGC raises concerns
about information credibility. Objective information about
ADHD from the government and public agencies is called
for in order to offer balanced and reliable points of view to
viewers. ADHD on YouTube in this study can be considered
as just one example of how public health messages regard-
ing illnesses and issues could be communicated to the pub-
lic. With objective and credible information about health,
social media including YouTube may serve as a vehicle to
bring public attention and action to community mental and
general health issues.
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