Few studies screen African children for developmental differences, review reveals

A new international review has found that very few studies have examined how young children in sub-Saharan Africa are screened for developmental conditions such as autism, ADHD, learning difficulties, and coordination disorders — despite global evidence that early identification and intervention can dramatically improve children’s lifelong outcomes.

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The review, published in BMC Psychiatry in 2025, was led by Ben Truter of Stellenbosch University and the Gillberg Neuropsychiatry Centre at the University of Gothenburg, together with a group of international researchers Amy Slogrove, Elif Ilhan, Petra Conradie, Lucy Thompson, Christopher Gillberg, and Eva Billstedt.

Out of 732 papers identified across four major scientific databases, only 12 studies met the inclusion criteria — all from just four countries: South Africa (6), Kenya (3), Uganda (2), and Malawi (1).

“Our findings highlight an enormous research and service gap,” said Ben Truter, a clinical neuropsychologist and PhD student at the Gillberg Neuropsychiatry Centre. “Millions of children in Africa are missing out on early screening for developmental conditions that can affect their education, wellbeing, and long-term potential.”

Significance 

Neurodevelopmental disorders (NDDs) — including autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), learning and motor coordination disorders, and global developmental delays — affect about one in ten children worldwide.

However, most child health research in Africa continues to focus on communicable diseases such as malaria and HIV. The authors argue that screening for developmental differences must become a core part of early childhood health in Africa, consistent with the UN Sustainable Development Goal to ensure all children “thrive, not just survive.”

Early screening is crucial for identifying children at risk and connecting them with interventions that support learning, communication, and social development. Without it, many children are only identified much later — often when difficulties are already entrenched.

Study design and methods

The research team conducted a systematic scoping review following the internationally recognised PRISMA-ScR guidelines.

The group searched PubMed, SCOPUS, Web of Science, and PsycInfo for English-language publications registered between 2012 and 2023.

To qualify, studies had to:

• Involve children aged 2-8 years,
• Be conducted in sub-Saharan Africa,
• Use a screening tool (not just a diagnostic assessment), and
• Target one or more neurodevelopmental differences.

The included studies used a wide range of tools and approaches, showing little standardisation across countries.

What the study found

In Uganda, researchers adapted the World Health Organization’s Ten Questions Questionnaire into a “23-Question Screener.” Testing 1,169 children aged 2–8 years, they found that 27% screened positive for potential neurodevelopmental difficulties.

In Kenya, the Neurodevelopmental Screening Tool (NDST) was used in a massive study of 11,223 children, showing strong accuracy (88% sensitivity, 83% specificity) for detecting conditions like autism, ADHD, epilepsy, and cognitive impairment.

South African researchers developed innovative and culturally relevant screening tools — including an isiZulu-language vocabulary test, the “Little DCDQ” for motor coordination, and a smartphone-based version of the Parents’ Evaluation of Developmental Status (PEDS) used in low-income communities around Tshwane.

Two studies found that children living with HIV were up to eight times more likely to experience developmental disabilities than their uninfected siblings.

Other studies linked maternal depression, anxiety, and exposure to adverse childhood experiences (ACEs) to poorer cognitive and socioemotional outcomes in young children.

These show promising local advances. The authors found considerable variations in study design, populations screened, and who performed the screening — from parents and teachers to trained assistants and health workers. Few studies followed up screening with full diagnostic assessment or support services.

Building local capacity

“Training community health workers to carry out screening can help close the gap,” said Ben Truter “But we must also ensure these tools are culturally and linguistically appropriate for African contexts.”

The authors highlight mobile health (mHealth) platforms and community-based screening as promising ways to expand access in structurally disadvantaged areas. However, they stress the need for contextual validation — adapting screening tools to the languages, cultures, and developmental norms of Sub-saharan Africa.

Next steps for implementation

Truter and co-authors conclude that there is an urgent need for:

• Rapid, reliable, and contextually appropriate screening tools,
• Training for non-specialist health and education workers,
• Integration of developmental screening into national child-health programmes, and
• Policy investment to support early identification and intervention for neurodevelopmental differences.

“Screening should be the first step toward early support and inclusive education,” said Truter. “We need more research, more policy attention, and more practical tools to make that possible.”

Reference:

Truter B., Slogrove A.L., Ilhan E., Conradie P., Thompson L., Gillberg C., & Billstedt E. (2025). Screening young children for neurodevelopmental differences in sub-Saharan Africa: a scoping review. BMC Psychiatry, 25:857.

Text by Anna Spyrou, Communications Officer