title: Women’s and girls’ ADHD diagnosis journeys: A mother-daughter autoethnography

authors: Wheaton, Belinda

subjects: Health policy

abstract: Attention-deficit/hyperactivity disorder (ADHD) remains underidentified, underdiagnosed and undertreated in women and girls. Research exploring their diagnostic experiences across national contexts is limited, despite an urgent need for experience-based knowledge to address epistemic injustices in healthcare. Using a collaborative autoethnographic approach, this study examines the diagnosis journeys of a mother and daughter, both with ADHD. We focus on critical incidents in the daughter’s ADHD/dyslexia diagnosis journey over a decade, spanning childhood to adulthood and two health systems: England and Aotearoa New Zealand. Findings reveal how limited understanding of ADHD in girls/women, combined with co-occurring conditions, contributed to repeated missed or misdiagnoses by teachers, education psychologists, psychiatrists, paediatricians and general practitioners. A network of professionals across health and education settings acted as gatekeepers, often unintentionally hindering access to support. Moreover, the experiential knowledge of both women was frequently sidelined, perpetuating epistemic injustice. We discuss implications for policy and practice and highlight the value of lived experience in addressing systemic barriers to ADHD diagnosis, recognition and understanding for women and girls.

text: Women’s and girls’ ADHD diagnosis journeys: A mother-daughter autoethnography Attention-deficit/hyperactivity disorder (ADHD) remains underidentified, underdiagnosed and undertreated in women and girls. Research exploring their diagnostic experiences across national contexts is limited, despite an urgent need for experience-based knowledge to address epistemic injustices in healthcare. Using a collaborative autoethnographic approach, this study examines the diagnosis journeys of a mother and daughter, both with ADHD. We focus on critical incidents in the daughter’s ADHD/dyslexia diagnosis journey over a decade, spanning childhood to adulthood and two health systems: England and Aotearoa New Zealand. Findings reveal how limited understanding of ADHD in girls/women, combined with co-occurring conditions, contributed to repeated missed or misdiagnoses by teachers, education psychologists, psychiatrists, paediatricians and general practitioners. A network of professionals across health and education settings acted as gatekeepers, often unintentionally hindering access to support. Moreover, the experiential knowledge of both women was frequently sidelined, perpetuating epistemic injustice. We discuss implications for policy and practice and highlight the value of lived experience in addressing systemic barriers to ADHD diagnosis, recognition and understanding for women and girls.

year: 2026

title: Regional Security Complex Theory: Southeast Asia and the South Pacific

authors: Cruden, Michaela

subjects: Regionalism

abstract: The changing shape of the international system in the post-Cold War era has demanded that theorists and practitioners re-evaluate the nature of security in the analysis of International Relations in the modern world. While realist conceptions of security are still pivotal in determining the actions of states, the increasing prevalence of transnational threats and security interdependence has facilitated the rise of regionally coherent subsystems within which the pursuit of security cannot be achieved in the absence of cooperation. Despite modern advancements in technology and transportation, the reality remains that security threats have a higher capability to travel over short distances rather than long, and the capacity of most states to project power beyond their own regional sphere is relatively limited. Consequently, the interplay between geography and anarchy in the current international system has facilitated the rise of regional security complexes (RSCs), whereby geographically proximate states are bound within a distinct regional dynamic; be it conflict or cooperation. The regionalist perspective has sought to emphasize that security at the regional level is autonomous and distinguishable from the dynamics of the global and domestic levels and that, whilst each regional space is unique, particular variables are comparable and highlight interactions that would not occur were it not for the existence of a RSC.

The purpose of this thesis is to utilise the theoretical framework of Regional Security Complex Theory (RSCT) in order to cross-compare two different regions; Southeast Asia and the South Pacific. Southeast Asia has been widely accepted as an autonomous regional construct and experiences a web of security interdependence which ensures that the security concerns of its units cannot be analysed or resolved apart from one another. The South Pacific, by contrast, has been largely ignored in the literature on regional security and has otherwise been categorized as being unstructured and too weak in its dynamic to constitute a security complex in its own right. The objective of this thesis is to outline the variables of the essential structure of a RSC so as to ascertain whether the characterization of the South Pacific as being unstructured holds true. The additional objective of this thesis is to map and cross-compare the regional security architecture of the South Pacific to that of Southeast Asia in order to highlight and pinpoint what differences exist, what they say about the region itself, and how they may be explained.

text: Regional Security Complex Theory: Southeast Asia and the South Pacific The changing shape of the international system in the post-Cold War era has demanded that theorists and practitioners re-evaluate the nature of security in the analysis of International Relations in the modern world. While realist conceptions of security are still pivotal in determining the actions of states, the increasing prevalence of transnational threats and security interdependence has facilitated the rise of regionally coherent subsystems within which the pursuit of security cannot be achieved in the absence of cooperation. Despite modern advancements in technology and transportation, the reality remains that security threats have a higher capability to travel over short distances rather than long, and the capacity of most states to project power beyond their own regional sphere is relatively limited. Consequently, the interplay between geography and anarchy in the current international system has facilitated the rise of regional security complexes (RSCs), whereby geographically proximate states are bound within a distinct regional dynamic; be it conflict or cooperation. The regionalist perspective has sought to emphasize that security at the regional level is autonomous and distinguishable from the dynamics of the global and domestic levels and that, whilst each regional space is unique, particular variables are comparable and highlight interactions that would not occur were it not for the existence of a RSC.

The purpose of this thesis is to utilise the theoretical framework of Regional Security Complex Theory (RSCT) in order to cross-compare two different regions; Southeast Asia and the South Pacific. Southeast Asia has been widely accepted as an autonomous regional construct and experiences a web of security interdependence which ensures that the security concerns of its units cannot be analysed or resolved apart from one another. The South Pacific, by contrast, has been largely ignored in the literature on regional security and has otherwise been categorized as being unstructured and too weak in its dynamic to constitute a security complex in its own right. The objective of this thesis is to outline the variables of the essential structure of a RSC so as to ascertain whether the characterization of the South Pacific as being unstructured holds true. The additional objective of this thesis is to map and cross-compare the regional security architecture of the South Pacific to that of Southeast Asia in order to highlight and pinpoint what differences exist, what they say about the region itself, and how they may be explained.

year: 2011

title: He Pikinga Waiora Implementation Framework: A tool for chronic disease intervention effectiveness in Maori and other indigenous communities

authors: Oetzel, John G.

subjects: Science & Technology

abstract: Introduction: Health outcomes for Māori are significantly worse than non-Maori in New Zealand; these inequities mirror those found in indigenous communities elsewhere. Evidence-based interventions with established efficacy may not be effective in indigenous communities without addressing specific implementation challenges. We present an implementation framework for chronic condition interventions for Māori.

Theory/Methods: The He Pikinga Waiora Implementation Framework has indigenous self-determination at its core and consists of four elements: cultural-centeredness, community engagement, systems thinking, and integrated knowledge translation.  All elements have demonstrated evidence of positive implementation outcomes.  A coding scheme derived from the Framework was applied to 13 studies of diabetes prevention in indigenous communities from a systematic review.

Results: Cross-tabulations demonstrated that culture-centeredness (p=.008) and community engagement (p=.009) explained differences in diabetes outcomes and community engagement (p=.098) explained difference in blood pressure outcomes.

Discussion and Conclusions: The He Pikinga Waiora Implementation Framework is well suited to advance implementation science for Māori and other indigenous communities. The framework has promise as a policy and planning tool to evaluate and design effective interventions for chronic disease prevention.

Lessons Learned: We needed to revise the coding framework in order to make the implication framework concrete.

Limitations: This study has a limitation in that we coded information about interventions from the published articles and not the interventions themselves. Additionally, the study only included 13 interventions.

Suggestions for Future Direction: Further research should provide stronger evidence of the usefulness of the framework particularly with Māori end-users. There will also be a need to understand the differential contribution of each of the four elements to health outcomes.

text: He Pikinga Waiora Implementation Framework: A tool for chronic disease intervention effectiveness in Maori and other indigenous communities Introduction: Health outcomes for Māori are significantly worse than non-Maori in New Zealand; these inequities mirror those found in indigenous communities elsewhere. Evidence-based interventions with established efficacy may not be effective in indigenous communities without addressing specific implementation challenges. We present an implementation framework for chronic condition interventions for Māori.

Theory/Methods: The He Pikinga Waiora Implementation Framework has indigenous self-determination at its core and consists of four elements: cultural-centeredness, community engagement, systems thinking, and integrated knowledge translation.  All elements have demonstrated evidence of positive implementation outcomes.  A coding scheme derived from the Framework was applied to 13 studies of diabetes prevention in indigenous communities from a systematic review.

Results: Cross-tabulations demonstrated that culture-centeredness (p=.008) and community engagement (p=.009) explained differences in diabetes outcomes and community engagement (p=.098) explained difference in blood pressure outcomes.

Discussion and Conclusions: The He Pikinga Waiora Implementation Framework is well suited to advance implementation science for Māori and other indigenous communities. The framework has promise as a policy and planning tool to evaluate and design effective interventions for chronic disease prevention.

Lessons Learned: We needed to revise the coding framework in order to make the implication framework concrete.

Limitations: This study has a limitation in that we coded information about interventions from the published articles and not the interventions themselves. Additionally, the study only included 13 interventions.

Suggestions for Future Direction: Further research should provide stronger evidence of the usefulness of the framework particularly with Māori end-users. There will also be a need to understand the differential contribution of each of the four elements to health outcomes.

year: 2018