Treatment Decision-Making Capacity in Children and Adolescents Hospitalized for an Acute Mental Disorder: The Role of Cognitive Functioning and Psychiatric Symptoms

Abstract

Objective: This study was conducted to assess treatment decision-making capacity (TDMC) in a child and adolescent psychiatric sample and to verify possible associations between TDMC, psychiatric symptom severity, and cognitive functioning.Methods: Twenty-two consecutively recruited patients hospitalized for an acute mental disorder, aged 11–18 years, underwent measurement of TDMC by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). The MacCAT-T interview focused on patients' current treatment, which comprised second-generation antipsychotics (45.5%), first-generation antipsychotics (13.6%), antiepileptic drugs used as mood stabilizers or lithium carbonate (45.5%), selective serotonin reuptake inhibitors (32%), and benzodiazepines (18%). We moreover measured cognitive functioning (Wechsler Intelligence Scale for Children III) and psychiatric symptom severity (Brief Psychiatric Rating Scale v 4.0).Results: Patients' TDMC varied within the sample, but MacCAT-T scores were good in the sample overall, suggesting that children and adolescents with severe mental disorders could be competent to consent to treatment. The TDMC proved independent of psychiatric diagnosis while being positively associated with cognitive functioning and negatively with excitement.Conclusion: The MacCAT-T proved feasible for measuring TDMC in a child and adolescent psychiatric sample. TDMC in minors with severe mental disorders was not necessarily impaired. These results deserve reconsidering the interplay between minors and surrogate decision-makers as concerning treatment decisions.

An Argument for Expanding the Role of Pediatric Decision-Making and Preference in Child Abuse/Neglect Assessments and Plan

“…In the United States, competency to make medical decisions is currently determined by age with the exception of emancipation. However, there are multiple studies indicating that preadolescent children have the capacity to make informed decisions, which involve understanding, appreciating, reasoning, and expressing their choice [ 5 , 6 ]. In the case of our 12-year-old patient, she was able to communicate her comprehension of placement, perceive outcomes of placement options, weigh the risks and benefits of living in different settings, and express her choice.…”

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“…10 Note, however, that it is not always an easy task to fully engage minors in a surrogate decision making about their psychiatric treatment. 37 When the surrogate is a parent, their parenting capacity plays a crucial role in a decision on the involuntary psychiatric hospitalization of the child. Involuntary admission of adolescents is said to be associated with distinctive conflicts between these adolescents and their parents.…”

Bariatric Surgery Needs a Seat at the Children's Table: Bridging the Perception and Reality of the Role of Bariatric Surgery in the Treatment of Obesity in Adolescents

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