‘Falling Through the Cracks’: Study calls for urgent reform in FASD and ADHD support
One of our top Māori researchers and a Master of Applied Practice student in the School of Social Practice are calling attention to critical gaps in how neurodevelopmental conditions are identified and supported in Aotearoa New Zealand through a new article published in MAI Journal.
The article, Falling Through the Cracks – The Toll of Mis- and Missed Diagnosis in FASD and ADHD: A Call to Action, emerged from a 2024–2025 internship hosted by Ngā Wai a Te Tūī and Tūāpapa Rangahau, where Reverend Deb Cole was the intern and Associate Professor Byron Rangiwai her supervisor.
The article focuses on the ongoing problem of people being misdiagnosed, or not diagnosed at all, with fetal alcohol spectrum disorder (FASD) and attention-deficit/hyperactivity disorder (ADHD).
It shows how these gaps in diagnosis can delay access to the right support, leaving individuals and their whānau to navigate complex systems with limited guidance.
A key issue identified is the overlap in symptoms between FASD and ADHD. This overlap can make it difficult for clinicians and educators to distinguish between the two conditions, particularly in settings where resources are limited or awareness is low.
The article notes that this confusion is compounded for Māori, who often face additional barriers linked to inequities in the health, education, and social service systems.
Rev. Cole brings a strong personal perspective to the work. As a caregiver and long-time advocate, her insights are shaped by lived experience as well as academic research.
The article highlights how mis- and missed diagnosis can have serious consequences, including increased mental health challenges, difficulty accessing services, and a higher risk of contact with the justice system.
It also shows how these pressures extend to whānau, who often carry the burden of seeking support and navigating fragmented services.
The authors argue that change is needed at a system level. They call for formal recognition of FASD as a disability in Aotearoa New Zealand, alongside investment in Māori-led approaches to diagnosis and support.
These approaches would centre whānau and draw on mātauranga Māori to provide care that is both effective and culturally appropriate.
This article highlights the scale of the issue and the urgency of responding to it. It points to the need for clearer pathways to diagnosis, better resourcing, and stronger
coordination across services. Without these changes, many individuals and their whānau will continue to miss out on the support they need.
