Unveiling Social Media Content Related to ADHD Treatment: Machine Learning Study Using X's Posts over 15 Years

Background: Public discourse on social media plays an increasingly influential role in shaping health-related perceptions and behaviours. Individuals share experiences, concerns, and opinions beyond clinical settings around different issues. X (formerly Twitter) provides a unique lens through which to examine how different treatments are perceived, used, and debated across diverse communities over time. Objective: The study aims to (a) identify the types of ADHD medications mentioned in posts, depending on language and user type; (b) evaluate the popularity of content related to these medications, considering language and user type; (c) analyse temporal changes in the frequency of mentions between 2006 and 2022; and (d) examine the distribution of tweets across different content categories. By addressing these objectives, this study provides insights into public perceptions of ADHD medications, which may help healthcare professionals better understand online discussions and improve their communication with patients, facilitating more informed treatment decisions. Methods: An observational study was conducted analysing 254,952 tweets in Spanish and English about ADHD medications from January 2006 to December 2022. Content analysis combined inductive and deductive approaches to develop a categorisation codebook. BERTWEET and BETO models were used for machine learning classification of English and Spanish tweets, respectively. Descriptive statistical analysis was performed. Results: Overall, stimulant medications were posted more frequently and received higher engagement than non-stimulant medications. Methylphenidate, dextroamphetamine, and atomoxetine were the most commonly mentioned medications, especially by patients, who emerged as the most active users among the English tweets. Regarding medical content, tweets in English contained more than twice the number of mentions of inappropriate use compared to those in Spanish. There was a high content of online medication requests and offers in both languages. Conclusions: In this study, conducted on X, discussions on ADHD medications highlighted concerns about misuse, adherence, and trivialisation, with clear differences between English and Spanish tweets regarding focus and type of user participation. These findings suggest that monitoring social media can provide early signals about emerging trends, helping clinicians address misconceptions during consultations and informing public health strategies aimed at the safer and more responsible use of ADHD medications.