Standardised capacity measures and cognition in the assessment of capacity in children and adolescents: a systematic review

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While there is increasing use of standardised tools to assist in determining decision-making capacity in adults, there is limited literature evaluating these tools in children/adolescents. The current PRISMA guided systematic review aimed to evaluate standardised capacity assessment tools used in the child/adolescent population, and to examine the relationship between these capacity assessment tools and cognition. Inclusion criteria comprised: (1) validation of a new/existing tool to assess capacity or competence; (2) participants < 18 years; (3) involved validation on normative or non-normative populations; (4) published in English in a peer review journal. Ten studies were included. The majority applied a version of the Macarthur Competence Assessment Tool. Findings suggest capacity assessment tools demonstrate sound psychometric properties, but research into capacity assessment in children is still in its infancy. Limitations include the lack of diagnostic gold standard of capacity and the inconsistent and minimal incorporation of cognitive functioning into standardised capacity assessment.