Feasibility of neurodevelopmental disorder screening for pre-school children in rural South Africa
A new study shows that community-based screening using ESSENCE-Q is a promising way to identify neurodevelopmental disorders early in rural South Africa, despite resource and trauma-related challenges.
Currently, South Africa does not have a standard public health screening for neurodevelopmental disorders/NDDs in early childhood, and challenges such as limited resources and high levels of trauma in rural areas make implementation difficult.
In a groundbreaking effort to address the lack of screening for neurodevelopmental disorders in South Africa, a new study carried out by PhD student Ben Truter at the Gillberg Neuropsychiatry Centre, and Director at the Neurodiversity Centre in South Africa, has explored the feasibility of introducing a public health screening model for pre-school children in the rural Western Cape. The research, conducted by a team of health professionals, examined the practicality of using a simple two-stage screening process to identify children at risk for ESSENCE/NDDs, conditions such as autism, Attention-Deficit/Hyperactivity Disorder, Speech and Language Disorder.
The study used the ESSENCE-Q, a globally used, brief screening tool developed by Professor Christopher Gillberg in 2010. The ESSENCE-Q was translated into several local languages such as Afrikaans and isiXhosa, and administered through verbal interviews by community-based research assistants. These assistants, who did not have formal health training, engaged directly with mothers in their communities, seeking feedback and assessing child development concerns. The research team also gathered valuable insights from focus group interviews and feedback from participating mothers.
Despite logistical challenges, such as low literacy levels among mothers and delays in providing results, the response to the screening tool was overwhelmingly positive. Mothers appreciated the accessibility of the tool and the flexibility of the screening process, which included visual aids and in-person engagement. However, the study highlighted the importance of providing ongoing support, particularly addressing the trauma experienced by many families and ensuring that those administering the screenings are adequately trained and supported. Despite these challenges, the study reveals promising findings that could lead to improvements in early detection and intervention, crucial for long-term health outcomes.
The study's findings suggest that with the right resources and training, community members could play a key role in identifying neurodevelopmental disorders early. This, in turn, could lead to timely interventions that improve the lives of children and families. Long-term sustainability of such a screening program, however, will require consistent supervision, psychological support for both participants and administrators, and careful planning to integrate the program into existing healthcare structures.
In conclusion, the study underscores the importance of community-driven approaches to health screening in resource-poor settings. With the right support and preparation, rural areas in South Africa may soon have a vital tool to identify and assist children with neurodevelopmental disorders—helping to ensure that all children have a fair start in life.
Text by Anna Spyrou (Communications Officer)
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Truter B, Gillberg C, Slogrove AL, Conradie P, Billstedt E, Thompson L. Neurodevelopmental problems in pre-school children in rural Western Cape, South Africa: is community screening feasible? BMC Psychiatry. 2025 Apr 8;25(1):348. doi: 10.1186/s12888-025-06791-7. PMID: 40200233; PMCID: PMC11980325.
