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Pensar Enfermagem / v.28 n.01 / September 2024

DOI: 10.56732/pensarenf.v28i1.325

Qualitative Original Article

How to cite this article: Gama JLG, Lima HC, Oliveira A, Pereira ND, Harmuch C. Expressions during

World Autism Awareness Week on Twitter. Pensar Enf [Internet]. 2024 Sep; 28(1): 74-81. Available from:

https://doi.org/10.56732/pensarenf.v28i1.325

Expressions during World Autism Awareness Week

on Twitter

Abstract

Introduction

Autism spectrum disorder (ASD) is a condition that influences communication, social

interaction, and behaviors. On social media, we find expressions ranging from information

about ASD to personal accounts and discussions on inclusion.

Objective

To analyze the expressions of the Brazilian population on Twitter regarding autism.

Methods

This study is qualitative, descriptive, and based on document analysis. We collected data on

the social media platform Twitter between April 3, 2023, and April 10, 2023, in Portuguese,

encompassing the hashtags: #diamundialdeconscientizaçãodoautismo

(#worldautismawarenessday) and #autistas (#autisticpeople). We analyzed 279 tweets

using discursive textual analysis, from which two thematic axes emerged.

Results

The results indicate that the inclusion of people with ASD in cultural, sports, and labor

market spaces is seen as crucial for promoting citizenship and social inclusion. However,

challenges persist in implementing public policies, especially in education, health, and

information dissemination, highlighting the need for a more holistic approach and respect

for diversity.

Conclusion

Social media reflects a lack of progress in public policies and legislation to include people

with ASD in various aspects of social life, such as education, health, and work, which are

necessary to promote full citizenship. Despite advances in public policies, significant

challenges remain in implementing these initiatives, requiring greater awareness and respect

for this population.

Keywords

Autistic Disorder; Social Network; Public Policy; Social Inclusion.

José Lucas Grigoleto Gama1

orcid.org/0009-0001-2722-9601

Heloise Carrer de Lima2

orcid.org/0009-0005-4354-5355

Andressa Oliveira3

orcid.org/0009-0007-4897-4911

Natan David Pereira4

orcid.org/0000-0002-7116-0533

Camila Harmuch5

orcid.org/0000-0002-1609-1037

1 Bachelor. Centro Universitário Santa Maria da Glória

(UNISMG), Maringá, Brazil.

2 Bachelor. Centro Universitário Santa Maria da Glória

(UNISMG), Maringá, Brazil.

3 Bachelor. Centro Universitário Santa Maria da Glória

(UNISMG), Maringá, Brazil.

4 PhD. Universidade Estadual de Maringá (UEM),

Maringá, Brazil.

5 PhD. Universidade Estadual de Maringá (UEM),

Maringá, Brazil.

Corresponding author

Natan David Pereira

E-mail: naatan_daviid@hotmail.com

Received: 10.04.2024

Accepted: 29.08.2024

Pensar Enfermagem / v.28 n.01 / September 2024 | 75

DOI: 10.56732/pensarenf.v28i1.325

Qualitative Original Article

Introduction

Autism spectrum disorder (ASD) is a heterogeneous

condition that encompasses a group of complex brain

development disorders, including those previously known

as early childhood autism, childhood autism, Kanner’s

autism, high-functioning autism, atypical autism, pervasive

developmental disorder not otherwise specified, childhood

disintegrative disorder, and Asperger’s syndrome.1 The

condition is characterized by impairments in social

interaction and communication, as well as restricted and

repetitive patterns of behavior, activities, and interests,

primarily affecting the neurological development of

children. Additionally, individuals with ASD may present a

variety of comorbidities, including hyperactivity, sleep

disorders, gastrointestinal problems, and epilepsy.2-3

The literature highlights that people with disabilities or

disorders are generally perceived by society as abnormal,

alienated, unrealistic, dangerous, and incapable, often facing

prejudice and social stigma. This perception contributes to

the lack of appropriate care and attention for individuals

with ASD in various areas, suppressing the exercise of free

citizenship, which is guaranteed to all citizens.4

In the Brazilian context, although there are no specific

studies on the prevalence of ASD, it is estimated that this

condition affects approximately two million Brazilians.5 In

the United States, where there has been significant progress

in standardized assessment resources and tools, the

incidence of ASD is estimated to be 1 in every 50 children.6

Thus, the urgency of substantial investments focusing on

various aspects of the lives of this population is evident,

aiming at their inclusion and the guarantee of fair and equal

rights.

In 2008, the United Nations (UN) declared April 2 as World

Autism Awareness Day to raise awareness among society

and policymakers about the disorder, provide information,

and break down prejudices, recognizing the condition and

supporting actions for improving the quality of life of

individuals with ASD.7

One of the areas affected by ASD that draws the attention

of health managers is social interaction. Relationships

established through the internet have exponentially spread

over time, helping to overcome physical barriers and

enabling communication among social actors anywhere in

the world.8 In general, social media can be used to extract

information about patterns of interpersonal interaction and

opinions, proving to be an important tool for assessing

social expressions that occur in various social movements,

such as World Autism Awareness Week.9

Therefore, identifying and understanding the main

expressions on social media regarding the population with

autism is necessary to demystify the topic, thereby allowing

for the dissemination of information aimed at guiding the

actions of competent authorities and assisting in

implementing inclusive public policies nationwide. Thus,

the study aimed to analyze the Brazilian expressions on

Twitter concerning World Autism Awareness Week.

Methods

We conducted a qualitative, descriptive, and document-

based study. We adopted the Discursive Textual Analysis

(DTA) as the methodological framework, an approach that

integrates elements from traditional content analysis and

discourse analysis, characterized as a self-organized process

of construction and understanding, demonstrating an

interpretative movement of a hermeneutic nature.10

Regarding document-based research, studies using this

methodology primarily utilize documents without analytical

treatment, meaning they have not been previously analyzed

or systematized. In discursive textual analysis, both

description and interpretation are elements of analysis, with

these stages occurring concurrently within the article. From

this perspective, interpretation requires a systematic and

argumentative understanding of the information.10

The study setting was the social media platform Twitter,

which provides a publicly accessible global database,

chosen for its importance as a communication tool

between governmental and non-governmental

organizations and the general population. We conducted

data collection from April 3 to April 10, 2023, considering

that April 2 is recognized as World Autism Awareness Day,

established by the United Nations (UN) and instituted in

Brazil by Law 13,652/2018, marking the beginning of

World Autism Awareness Week.

We considered the following inclusion criteria: tweets

published between March 3 and March 10, 2023 (filtered

using the MAXQDA Plus software), in Brazil, in the

Portuguese language (Brazil), and containing the

intersection of the hashtags

#diamundialdeconscientizaçãodoautismo

(#worldautismawarenessday) [Supplementary Material

No.1] and #autistas (#autisticpeople) [Supplementary

Material No. 2 and Supplementary Material No. 3], with no

profile restrictions. Exclusion criteria included publications

that did not represent the research subject. We selected the

hashtags based on an analysis of Twitter’s trending topics,

which are the most frequently mentioned and trending

topics at the time of the research.

We included all tweets made during the data collection

period that met the selection criteria in the study. People

worldwide have been using Twitter to discuss issues of

great societal interest, such as debates and statements from

government organizations, including direct speeches from

heads of state.11 Therefore, we decided to use tweets

published throughout the national territory, originating

from different regions of Brazil.

We considered the number of likes on tweets as

interactions sharing the original post, signifying agreement

with the content and consent for the publications.12 Based

76 | Pereira, ND.

Qualitative Original Article

on this, we used the number of likes to assess the level of

agreement with the shared information.

We collected data using the “Import Twitter Data”

interface in the MAXQDA Plus 2022 Student software.

The subsequent analysis followed the three phases

suggested by DTA, encompassing unitization,

categorization, and metatexts.

The dataset included information at the tweet level, such as

the author’s account name, Twitter identifier, account

verification status, number of followers at the time of

download, date and time of tweet publication, indication of

the original tweet or retweet, textual content, hashtags, user

mentions, Uniform Resource Locator (URLs), presence of

media (images and/or videos), user location, and languages

used in the publication.

Initially, we compiled a database of 1,411 tweets, which we

refined according to the inclusion and exclusion criteria,

resulting in a final database of 279 tweets. We coded the

data with the MAXQDA software, and in the first stage

proposed by DTA, we assigned 17 meaning units and 275

codings, utilizing the theoretical data saturation technique

and a thorough reading of all tweets in the selected sample.

Subsequently, we conducted the second analysis stage,

constructing four intermediate categories, which we re-

categorized into two final categories, where we discussed

the achieved metatexts. For developing the partial report,

we used the visual tools available in the MAXQDA Plus

2021 Student software, version 20.4.1, which allowed us to

construct the analyzed textual corpus and word cloud,

enabling the visualization of results. To refine the word

cloud, we established a list of exclusion words that did not

influence its presentation [Supplementary Material No.4].

It is important to note that this study involved publications

in an institutional open-access database, so it did not

require approval from the relevant Research Ethics

Committee (REC). However, we emphasize that we

followed all ethical research principles stipulated by

Resolution No. 466/2012 of the National Health Council

and ensured the anonymity of all authors of the analyzed

publications. To guarantee the anonymization of the tweet

authors, we used only the status of the users’ accounts, with

the acronym “V” for verified profiles or “NV” for non-

verified ones and the number of likes each original tweet

received.

Results

We observed that the expressions published on World

Autism Awareness Day covered various themes, including

inclusion, state, government, and information. This

diversity suggests that the population is focused on

inclusion and governmental issues, highlighting the need

for actions that broadly raise awareness about ASD while

considering all associated factors.

Figure 1. Word cloud representing the main hashtags. Source: Authors’ data. Brazil, 2023.

Next, we analyzed and organized the tweets into two

thematic axes: “The importance of social inclusion” and

“The governmental perspective.”

The importance of social inclusion

The appreciation and approval of spaces designed for

people with ASD can indicate a sense of belonging and

concern for their well-being and inclusion in society. This

sentiment is evident in expressions demonstrating efforts in

sports and cultural contexts to promote inclusive practices.

Great initiative by @Corinthians in creating a space for

#autistas. I hope @Gremio and @SCInternacional in Poa [Porto

Alegre] follow this beautiful example. This way, our community can

attend the games. Congratulations to the club from São Paulo for this

wonderful initiative! (NV-0)

This Wednesday morning, we held the workshop “The Art

of Puppetry in an Inclusive Context.” The workshop, aimed at

educators, was part of BPBL’s program for World Autism Awareness

Day (...). (NV-0)

Another possible tool to minimize prejudice and stereotypes

is disseminating information about the disorder and

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DOI: 10.56732/pensarenf.v28i1.325

Qualitative Original Article

executing informative campaigns that can provide greater

visibility to this issue.

With more than 500 people, a walk was held in Guaíba

on World Autism Awareness Day (...). (NV-0)

STRENGTH, GLORY, AND INCLUSION! Our

captain will wear the captain’s armband in honor of World Autism

Awareness Day. (V-0)

Yesterday, we attended a wonderful event at the Latin

America Memorial on World Autism Awareness Day. As a mother

of a child with ASD, I ask for more public policies, information, and

less prejudice. (NV-0)

The expressions regarding including people with ASD in the

job market suggest a need for dialogue and awareness on

this topic. We believe structural changes (including specific

legislation to promote the social inclusion of people with

disabilities) are necessary to improve employment

opportunities.

During World Autism Awareness Week, Crivelli discusses the

inclusion of people with autism in the job market (...). (NV-0)

I suggested a bill to include people with disabilities in the job market.

(NV-0)

Actions aimed at including people with disabilities in the

job market appear to be limited, and when it comes to

people with ASD specifically, they may be virtually

nonexistent. Work can be an excellent tool for exercising

citizenship, and public policies that encourage hiring

individuals with ASD could break down inequalities and

foster greater social inclusion.

The governmental perspective

We observed distinct perceptions in the tweets regarding

the support provided to individuals with ASD. One tweet

criticizes the Unified Health System (SUS) and private

health plans for their lack of involvement in autism

awareness campaigns and the absence of coverage for

treating these individuals, thus reflecting frustration with

the healthcare system. In contrast, another message

reaffirms a commitment to inclusive education,

emphasizing the importance of ensuring that autistic

students have their educational rights respected.

Where are the SUS and other health plans in the World Autism

Awareness Day campaign? Oh, I forgot that neither covers treatment

for autistic people. (NV - 9).

On World Autism Awareness Day, we reaffirm our commitment to

inclusive education, thereby ensuring students’ right to education is

respected. (NV- 0).

Public authorities should expand the responsibility for

developing and implementing informative initiatives about

autism. We can highlight official events organized by

municipal and state departments, focusing on training

professionals to better meet the needs of autistic

individuals.

This week, the city of São Paulo (SP) hosted official events organized

by the municipal and state departments to mark World Autism

Awareness Day. These events included training sessions for

professionals across various fields (...). (NV-0)

The Parliamentary Front of the Caxias Legislature promotes a

meeting with parents of autistic individuals. The action is in honor of

World Autism Awareness Day. (NV-2)

These expressions can be seen as a recognition of the

efforts made in public policies and legislation. However,

challenges seem to persist, particularly concerning

education, law enforcement, and the support provided to

schools, suggesting a lack of genuine commitment to

inclusion.

(...) In Brazil, despite advances in legislation to guarantee rights,

parents still frequently resort to legal action, especially to enroll their

children in school. (NV-7)

I am shocked by the number of councilors [...] who posted on social

media yesterday about World Autism Awareness Day and today

voted in the chamber against school mediators for autistic people and

people with disabilities. Doesn’t this shock you? (NV-3)

Thus, these expressions reveal a recognition of the efforts

in public policies and legislation to include individuals with

ASD, but they also highlight persistent challenges,

especially in education. Improvements in law enforcement

and support for schools are identified as necessary

measures. The tweets emphasized the responsibility of

public authorities in developing informative initiatives

about autism.

The content also allows us to identify that some strategies

are necessary, such as disseminating basic information

about the disorder, expanding knowledge, and

consequently minimizing prejudice and stereotypes.

Therefore, social inclusion actions, active participation, and

educational measures aimed at improving the development

of individuals with ASD are declared essential.

Additionally, we observe a need to address these individuals

comprehensively, respecting the individuality, specificity,

and human needs of people with ASD.

78 | Pereira, ND.

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Discussion

The lack of knowledge or misconceptions about ASD

highlights the importance of disseminating accurate

information to society, particularly to those without direct

contact with this population.13 Awareness campaigns aim

to educate the public, promote discussions, and increase

the visibility of conditions, thereby supporting the

dissemination of scientific and technical advancements and

aiding in early diagnosis.14

Individuals with ASD face a series of social prejudices

compounded by the absence of physical traits that typically

characterize the syndrome. This lack of visible signs often

contributes to these biases, even though everyone is equal

under the law and has the right to freedom, equality, and

security for a healthy life.15 The first step toward addressing

this issue is to ensure social inclusion and provide

opportunities for individuals with ASD to live without

discrimination in welcoming and appropriate

environments.15

Experiences of violence, whether verbal or physical, on the

internet or in other contexts, represent a clear form of

perceived stigmatization.17 In a study involving individuals

with ASD, this variable emerged as a significant predictor

of quality of life, both in general and specific terms.16 These

findings corroborate previous research that identified

stigmatization as a crucial factor in the health of autistic

individuals, explaining the health disparities between

minority and majority groups due to social disadvantages

and associated stigma.17

Given that stigma can be understood as the opposite of

acceptance, lower acceptance of ASD from external

sources is associated with poorer mental health outcomes,

which in turn negatively impact these individuals’ lives.18

Additionally, since a sense of community can moderate the

effects of discrimination and stigma on psychological

distress and well-being, it is important to develop and

implement programs that help autistic individuals

strengthen their sense of community.19

Public policies play a fundamental role in shaping the

practical realities faced by individuals with health

conditions like ASD, influencing both public opinion and

the pathways to identification and treatment of the

condition. Historically, ASD was absent from major federal

policies, particularly during the 1960s and 1970s, a period

marked by significant legislative advances in the rights of

people with disabilities. Examples include the

Rehabilitation Act of 1973, which prohibited

discrimination against individuals with disabilities in federal

programs, and the Education for All Handicapped

Children Act of 1975, which ensured a free and appropriate

public education for all children with disabilities.20

The importance of equal and inclusive education for

autistic children has been consistently reflected in the

formulation of global educational policies, which guarantee

these children’s rights to education. The United Nations

established a fundamental policy to protect and promote

these rights in the Universal Declaration of Human

Rights,21 which asserts that everyone has the fundamental

right to an education to fully develop the human personality

the human personality. Since its ratification, this declaration

has been the foundation for policies, strategies, and human

rights actions in subsequent decades.22

The inclusion of individuals with ASD in subsequent

policies has provided additional protections in the areas of

education and employment. However, research estimated

that 80% of young people with ASD do not receive

adequate transition services during the critical period from

adolescence to adulthood, resulting in various unmet needs

such as employment, schooling, and housing.23

A study revealed a variety of obstacles that individuals with

autism expected to face and indeed encountered. The

findings mentioned difficulties such as filling out job

applications, finding work, and communicating and

interacting with supervisors.24

In Brazil, SUS provides most services for individuals with

ASD, mainly at the levels of Primary Care and Specialized

Care. Among specialized services, the Psychosocial Care

Centers (CAPS) stand out. These open and community-

based services should offer daily care, provide efficient and

personalized clinical care, promote social integration, and

support and oversee mental health care within the primary

care network.25

However, despite these intentions, the ASD population

faces additional obstacles in accessing healthcare and

interacting with professionals in the field, which not only

increases stress but can also discourage or even prevent

timely access to medical care. Often, these individuals seek

help late, presenting with severe problems and high levels

of distress, making it difficult for them to communicate and

process information. Moreover, many try to hide their

autistic traits to avoid social stigma, which can make them

appear to lack typical characteristics of autism.26

Failing to recognize and appropriately address an individual

with ASD can result in a range of adverse impacts for the

individual and the service in question. A negative patient

experience can discourage future help-seeking or lead to

delays until the person’s health deteriorates significantly.27

As the number of diagnoses increases, there is also greater

interest in the social representations of autism and the need

for representation. After all, it is through representation in

society, especially in the media and entertainment, that this

topic is exposed to a larger audience. In recent years, we

have observed how entertainment culture, with its series,

films, and soap operas, has increasingly addressed this

topic.28

Conclusion

Social media platforms serve as significant sources of social

interaction and public expressions. Through analyzing the

expressions of the Brazilian population in tweets about

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autism, we identified a general reference to the limited

progress in public policies and legislation aimed at the

inclusion of individuals with ASD, with persistent

challenges, particularly in education. There is a clear need

for improvements in the enforcement of laws and support

for schools. Additionally, the public sector must take

responsibility for developing and implementing

informative initiatives about ASD, using the dissemination

of information and ongoing public servant training as

strategies to combat prejudice and stereotypes.

This analysis underscores the necessity for a more

comprehensive and effective approach that not only

involves developing and implementing more efficient

policies but also calls for additional research to identify gaps

and develop interventions. Furthermore, the continuous

training of education professionals and the dissemination

of information about ASD are crucial for combating

prejudice and stereotypes, thus promoting a more inclusive

and supportive culture.

Study limitations

This research presents limitations primarily due to its

reliance on Twitter data. The tool used to extract the dataset

is limited to 10,000 tweets per search term and only allows

the import of tweets posted within a seven-day period. This

constraint resulted in a limited scope of publications and

restricted the available period for data collection.

Authors’ Contributions

Gama JLG: Conception and design of the study; Collection

of data; Analysis and interpretation of data; Statistical

analysis; Writing of the manuscript; Critical revision of the

manuscript;

Lima HC: Conception and design of the study; Data

collection; Data analysis and interpretation; Writing of the

manuscript;

Oliveira A: Conception and design of the study; Data

collection; Data analysis and interpretation; Writing of the

manuscript;

Pereira ND: Study conception and design; Data collection;

Data analysis and interpretation; Statistical analysis; Critical

revision of the manuscript;

Harmuch C: Conception and design; Data collection; Data

analysis and interpretation; Statistical analysis; Writing of the

manuscript; Critical revision of the manuscript.

Conflicts of interest and funding

No conflicts of interest were declared by the authors.

Sources of support / Financing

The study was not funded by any funding organisation.

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