Section EditorJennifer P. D'Auria, PhD, RN, CPNPUniversity of North Carolina at Chapel HillSchool of NursingChapel Hill, North CarolinaIn July 2010, entering the term “autism” into the Google search box resulted in more than 19 million hits in 0.21 seconds. Although this is much too general of a search term for such an immense topic, it does provide some measure of the vast amount of information about autism on the World Wide Web (web). The web provides a very accessible mode of information, support, and even friendships for individuals living on the autism spectrum and their families. The purpose of this article will be to provide a broad overview of informational, educational, and support resources about autism on the web. Issues related to quality assessment and tips for searching about autism will be addressed. Jennifer P. D'Auria, PhD, RN, CPNP University of North Carolina at Chapel Hill School of Nursing Chapel Hill, North Carolina Before going any further into this article, I'd like to say a word about the title. Oh, the Places You'll Go! is the title of a very famous poem by Dr. Seuss, 1990Seuss Dr. Oh, the places you'll go!. Random House, New York1990Google Scholar. It would be easy to use such a title to depict all the many places one can go on the web to learn about autism. However, this is the summary provided on the copyright page of the book: “Advice in rhyme for proceeding in life, weathering fear, loneliness, and confusion; and being in charge of your actions.” The title captured many of the life experiences shared on the web by individuals with autism and their families.The web provides a very accessible mode of information, support, and even friendships for individuals living on the autism spectrum and their families.. The web provides a very accessible mode of information, support, and even friendships for individuals living on the autism spectrum and their families. There are many different acronyms, terms, and expressions associated with autism. They include AD (autistic disorder), AS (Asperger's Syndrome or one of the five types of autism), Aspie (affectionate term for a person with Asperger's), ASD (Autism Spectrum Disorder), BMP (Behavior Management Plan), LFA (low-functioning autistic), HFA (high-functioning autistic), CDD (Child Disintegrative Disorder), PPD-NOS (pervasive developmental disorder not otherwise specified), NT (neurotypical), and much more. There is little agreement about a precise definition for autism. It is commonly described as a continuum of neurodevelopmental disorders characterized by qualitative differences and impairments in social communication skills and restricted interests and stereotyped behavior patterns (Dalton, R., et al., 2007Dalton R. Boris N.W. Pervasive developmental disorders and childhood psychosis.in: Kliegman R.M. Behrman R.E. Jenson H.B. Stanton B.F. Nelson textbook of pediatrics. 18th ed. 2007Google Scholar). Autistic Disorder (Classic Autism) is the most well known of the Pervasive Developmental Disorders (PPDs). The PPDs, also known as Autism Spectrum Disorders (ASDs), include Asperger's Disorder, Childhood Disintegrative Disorder, Rett's Disorder, and Pervasive Development Disorder-Not Otherwise Specified. These disorders can impair individuals in different ways ranging from mild to severe. Recently, the American Psychiatric Association released a public draft of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) (Kupfer and Regier, 2010Kupfer, D. J., & Regier, D. A. (2010). DSM-5 Task Force: The future of psychiatric diagnosis. (The American Psychiatric Association). Retrieved from http://www.dsm5.orgGoogle Scholar). The DSM-5 Task Force recommends that Rett's Disorder be removed from the DSM-5 and that the remaining four disorders be officially folded into one diagnostic category, Autism Spectrum Disorder. The rationale for this recommendation will allow for greater uniformity in diagnosis which can then be adapted to the symptoms and features of an individual child (Kupfer and Regier, 2010Kupfer, D. J., & Regier, D. A. (2010). DSM-5 Task Force: The future of psychiatric diagnosis. (The American Psychiatric Association). Retrieved from http://www.dsm5.orgGoogle Scholar). Search engines keep getting better. Google and most other search engines arrange results in hierarchies so that the user can get the “right” results at the top of the search results. Health subsets of the search engine you are using and trustworthy health information sites commonly appear at the top of search results. For example, after running a general search for autism on Google, the search results include a link to Google Health and several trustworthy health information websites—Mayo Clinic, Medline Plus, and WebMD. The health subset of Bing (http://www.bing.com) is integrated into the major search mechanism. After running a search on Bing, click the “Health” tab on the bar at the top of the page to retrieve results from a selected list of credible health websites (e.g., WebMD, Mayo Clinic). Other health subsets that may help users focus their searches on trustworthy sites are AOL Health (http://www.aolhealth.com) and Yahoo! Health (http://health.yahoo.net). It is helpful to remind users to enter the major concept they are interested in as the first term in the search box. By putting autism first in the search phrase, the search engine will recognize this as the most important concept in the search. This is called term order sensitivity (Hearst, 2009Hearst, M. A. (2009). Search user interfaces. (Cambridge University Press). Retrieved from http://searchuserinterfaces.comiGoogle Scholar). When searching for treatments for autism, entering “autism treatment” (use quotation marks) will retrieve a more focused set of results related to autism. The quotations tell the search engine to only look for pages that use your search words in the exact order you typed them and that they be right next to each other in the search listings. As might be anticipated, the user may be overwhelmed even by a more focused search. In July 2010, a Google search for “autism treatment” generated about 1,180,000 results in 0.17 seconds. Many search engines also include technology that provides query suggestions for alternate searches as it is being typed into the search box (Hearst, 2009Hearst, M. A. (2009). Search user interfaces. (Cambridge University Press). Retrieved from http://searchuserinterfaces.comiGoogle Scholar). The search suggestions will display automatically in a drop box below the current search. Search engines also offer users the ability to search for pictures, books, and videos. These links are generally in the left panel of the web page. A word of caution for individuals, families, and health care professionals interested in autism: Not all the videos are educational or positive in nature—some are very disturbing and can easily be found on the web by children and adults with autism and their friends and family. Children with autism are usually visual learners. The value of technology is that it uses visual cues to enhance understanding by combining activities with listening and auditory skills (Wirkus et al., 2009Wirkus, M., Comer, L., Swenson, K., & Weingarten, S. (2009). Assistive technology supports for individuals with autism spectrum disorder. (IDEA grant number 9906-23; Wisconsin Assistive Technology Initiative and the Wisconsin Department of Public Instruction). Retrieved from http://dpi.wi.gov/sped/at-wati-resources.htmlGoogle Scholar). LeSieur is the Chief Executive Officer of a software company that has designed three browsers to promote a more positive and secure online experience for people with autism and other disabilities (People, 2010aPeople C.D. About us. 2010; (Retrieved from)http://www.peoplecd.com/about.htmlGoogle Scholar). He created the ZAC (Zone for Autistic Children) Browser (http://www.zacbrowser.com) for his grandson, Zachery, who has autism (Hughes, 2008Hughes G. Grandfather builds web browser for autistic grandson.USA Today. 2008, June 3; (Retrieved from)http://www.usatoday.com/tech/webguide/internetlife/2008-06-03-grandfather-zac-browser_N.htmGoogle Scholar). It is the first Internet browser designed for young children with autism. The Tweens Browser (http://www.tweensbrowser.com) is designed for children 7 to 12 years of age with autism and other developmental disabilities. Both the ZAC and the Tweens Browsers include a link to “The Autism News” (http://www.autismnews.com) created by LeSieur and People CD. This newsletter provides current new stories and discussion forums for parents and children with autism (People, 2010bPeople C.D. Our web services: The Autism News. 2010; (Retrieved from)http://www.peoplecd.com/about.htmlGoogle Scholar). The PAL (Physical Assistant Logistics) Browser (http://www.palbrowser.com) is assistive technology designed for people (children and adults) with (or without) physical disabilities who do not have reliable hand control. It provides the user with access to visual assistance and touch-screen technology to promote a positive Internet experience. Individuals with autism, parents, and teachers frequently mentioned fun and educational activities on the web for children with autism. Table 1 provides a beginning list of online activities that children with autism and their parents can explore.Table 1Examples of fun and activity websites for kids with autismWebsiteURLAven's Cornerhttp://www.avenscorner.com/numbertrain.aspxFacial Expressionshttp://www.dotolearn.com/games/facialexpressions/face.htmLiteracy Centerhttp://www.literacycenter.net/lessonview_en.phpMouseTrialhttp://www.mousetrial.comPBS Kidshttp://pbskids.orgSensory Worldhttp://www.sensoryworld.orgStarfallhttp://www.starfall.comSesame Streethttp://www.sesamestreet.orgThomas & Friendshttp://www.thomasandfriends.com/usa/Thomas.mvc/HomeTree House—Kidshttp://www.treehouse-kids.com/games/home.htmlThe Wiggles Playgroundhttp://www.wiggletime.com/public/home.aspx Open table in a new tab Reichow et al., 2010Reichow, B., Halpern, J, and Volkmar, F. R. (2010). Presence of quality indicators on autism websites. (Abstract Book of the International Meeting for Autism Research). Retrieved from http://imfar.confex.com/imfar/2010/webprogram/start.htmlGoogle Scholar evaluated the presence of quality indicators on 164 websites about autism. They constructed a quality indicator tool for the study that included eight quality indicators: author's identity, references, no commercial emphasis, no promotion of a cure for autism, updated in the past 6 months, no request for personal information, evidence of a contact or feedback mechanism, and the presence of a medical disclaimer. The majority of the 164 websites contained less than six of these quality indicators for the study. In addition, approximately 20% of the websites promoted products or miracle cures for autism and commonly lacked other quality indicators. Reichow et al., 2010Reichow, B., Halpern, J, and Volkmar, F. R. (2010). Presence of quality indicators on autism websites. (Abstract Book of the International Meeting for Autism Research). Retrieved from http://imfar.confex.com/imfar/2010/webprogram/start.htmlGoogle Scholar did not evaluate the quality of the information about autism on the websites. One quick screen for determining if a website holds to a set of ethical standards regarding the reliability of health information is locating the Health on the Net (HON) Foundation Code of Conduct logo (http://www.hon.ch). Google search results now include the HONcode logo by the link to a website in the search results. Another way to identify sites accredited by HON is to download the HONcode tool bar, which will automatically check whether the website is accredited. Certain domain names can indicate the likelihood that a website is the source of trustworthy health information. Table 2 provides a listing of some helpful websites for families and professionals about autism. Many are federal (.gov), national (.org), or university (.edu) websites. The organizational websites focus primarily on advocacy, while the websites ending in .gov and .edu focus more heavily on current information related to diagnosis, testing, treatment, and research.Table 2Websites about autismWebsiteURLAutism Speaks∗Debate on autism cure: http://www.autismspeaks.org/whatisit/cure_intro.phphttp://www.autismspeaks.orgAutism Science Foundationhttp://www.autismsciencefoundation.orgAutism Society of Americahttp://www.autism-society.orgAutism Research Institute †Discussion of autism recovery: http://www.autism.com/fam_recovery.asphttp://www.autism.comAutismWebhttp://www.autismweb.comCenters for Disease Control and Prevention—ASDshttp://www.cdc.gov/ncbddd/autismFirst Signshttp://www.firstsigns.orgHealing Thresholdshttp://autism.healingthresholds.com/about-usOASIS @ MAAPhttp://www.aspergersyndrome.orgThe National Autistic Societyhttp://www.autism.org.ukNational Institute of Child Health and Human Developmenthttp://www.nichd.nih.gov/autismNational Institute of Mental Healthhttp://www.nimh.nih.govOhio Center for Autism and Low Incidencehttp://www.autisminternetmodules.orgOrganization for Autism Researchhttp://www.researchautism.orgTalk About Curing Autismhttp://www.talkaboutcuringautism.orgUS Autism & Asperger Associationhttp://www.usautism.orgUnderstanding Autism in the Yale Seminar on Autism and Related Disorders Onlinehttp://autism.yale.eduASDs, autism spectrum disorders; OASS @ MAPP, Online Asperger Syndrome Information and Support Center + MAAP Services for Autism and Asperger Syndrome.∗ Debate on autism cure: http://www.autismspeaks.org/whatisit/cure_intro.php† Discussion of autism recovery: http://www.autism.com/fam_recovery.asp Open table in a new tab ASDs, autism spectrum disorders; OASS @ MAPP, Online Asperger Syndrome Information and Support Center + MAAP Services for Autism and Asperger Syndrome. Reichow et al., 2010Reichow, B., Halpern, J, and Volkmar, F. R. (2010). Presence of quality indicators on autism websites. (Abstract Book of the International Meeting for Autism Research). Retrieved from http://imfar.confex.com/imfar/2010/webprogram/start.htmlGoogle Scholar found that commercial interests and bias were prominent on many of the sites they reviewed. Significant debates regarding “autism cure” and discussion about “autism recovery” were apparent on several of the advocacy sites and discussion forums. Two sites provided information regarding these issues: Autism Speaks and the Autism Research Institute (see Table 1). It is important to encourage children and teens with autism and their parents to carefully scan the perimeter of the page for links to “About Us,” “Mission,” “Funding,” or “Editorial Board” to determine the intent of the site and the potential for bias. Three comprehensive informational and educational websites about autism for individuals, families, and health care professionals in the search results include the Centers for Disease Control and Prevention (CDC) website, the Yale University Online Autism Seminars, and the Ohio Center for Autism and Low Incidence: Autism Internet Modules (see Table 2). Kidshealth (http://kidshealth.org) remains the top website for parents, kids, and teens about health and development. This website includes interactive technology that reads aloud the content of selected pages, highlighting the sentences and individual words as they are read. Enter the site by clicking the “Parents site,” and then enter autism into the search bar. The search results are indexed using the following categories: Parents (P), Kids (K), Teens (T), Educators (E), and News (N). Compare the information and resources on autism provided at a link for Parents and a link for Kids. Examples of two autism centers on the web include WebMD: Autism Spectrum Disorders and the About.com: Autism website. The About.com website was mentioned in many discussion forums by parents of children with autism as being informative and sensitive to the daily challenges of living on the autism spectrum. Both websites include autism support communities. The ABC News/Health OnCall+ Autism Center includes current information, research, and interactive resources from top medical experts in the country. All of the aforementioned sites are easily located by entering the above web titles into the search box of a search engine. The About.com website was mentioned in many discussion forums by parents of children with autism as being informative and sensitive to the daily challenges of living on the autism spectrum.The Internet allows people with autism to control their environment and interact with others on their own terms (Grandin, 2010Grandin T. Thinking in pictures: My life with autism.expanded edition. Vintage Books, New York2010Google Scholar). WrongPlanet (http://www.wrongplanet.net) opened in 2004 and is one of the largest online communities (more than 37,000 members) for individuals with autism, Asperger's Syndrome, and other neurological differences. Family members, friends, and health care professionals also may participate in this web community. The website includes discussion forums, articles, guides, blogs, and a real-time chat room. The About.com website was mentioned in many discussion forums by parents of children with autism as being informative and sensitive to the daily challenges of living on the autism spectrum. Second Life (http://secondlife.com) is an online virtual environment that gives individuals with autism the opportunity to practice social skills through avatars rather than through face-to-face interactions with others (Danilovic, 2009Danilovic S. Autism and second life—an introduction.Journal of Developmental Disabilities. 2009; 15: 125-127Google Scholar). It includes virtual locations focused on support and advocacy for users with autism and other disabilities. Some of the locations for users with autism include Brigadoon, Autistic Liberation Front, and the Autism Awareness Center (Danilovic, 2009Danilovic S. Autism and second life—an introduction.Journal of Developmental Disabilities. 2009; 15: 125-127Google Scholar). Several autism organizations have launched video channels through the YouTube Nonprofit Program (YouTube. (n.d.)YouTube. (n.d.). Nonprofit program. Retrieved from http://www.youtube.com/nonprofitsGoogle Scholar). These are primarily advocacy organizations that feature such things as expert interviews, information about fundraising events, conference proceedings, and much more. Examples of these groups include: (a) Autism Speaks (http://www.youtube.com/AutismSpeaksVids), (b) the Autism Society http://www.youtube.com/TheAutismSociety), and (c) the National Autistic Society (http://www.youtube.com/user/NationalAutisticSoc). The University of California television (http://www.uctv.tv/autism) (also available on YouTube) is a wonderful resource covering a wide variety of topics related to autism. Videos by children, teens, and adults with autism as well as those by parents and teachers of children with autism are also found on YouTube. They provide a platform to help others understand what it is like to grow up and live with autism. It is important to mention to individuals with autism and their families that there are also negative videos about autism and very distressing videos regarding how others may treat children with autism found on YouTube. There are so many places to go on the web to learn about autism. For me, the most exciting places to go were the online communities where I could learn from people with autism how they think and feel. The Internet provides them with a voice to educate us, not about autism, but about the unique challenges of living with their differences (Brownlow and O'Dell, 2009Brownlow C. O'Dell L. Representations of autism: Implications for community healthcare practice.Community Practitioner: The Journal of the Community Practitioners' & Health Visitors' Association. 2009; 82: 18-21PubMed Google Scholar). Jennifer P. D'Auria, Associate Professor, The University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC.