Decision-making in childhood is acquired through autonomy, which is linked to emotional, moral, and cognitive maturity.
Joaquín Díaz Atienza
INTRODUCTION
During the previous three posts we have focused on describing moral development in childhood and adolescence following the three models that I have considered most relevant (I am aware that the one of Vygotsky (simply to avoid excessively lengthening this series of posts and because it is somewhat less well known, without diminishing its importance in the slightest): the model Piaget's cognitive theory, Kohlberg's and his critics y the psychoanalytic.
In this we will talk about concept of maturity in childhood and adolescence with the aim of defining when a minor is ready to exercise their autonomy in decision-making.
The concept of a mature minor This refers to the circumstance in which a minor possesses the cognitive, emotional, and moral capacity to make their own decisions, based on their own criteria, acting in their daily life in accordance with those criteria, and with sufficient cognitive ability to correctly weigh the consequences of their decisions. As can be easily deduced, maturity is determined by life experience of the child, because of his cognitive development, its moral development (what is right or wrong, what is correct, what values are, etc.) and Emotional development.
Maturity is a dynamic and evolutionary process involving multiple variables, both related to internal factors, including the genetic ones, of the individual, as a wide variety of external factors. Hence the enormous difficulty in its assessment. Although a specific age is determined within the legal framework, maturity correlates less with chronological age than with a person's cognitive, moral, emotional, and experiential development. It is precisely experience that endows individuals with prudence which Aristotle spoke of in his Nicomachean Ethics.
Cognitive development
Cognitive development refers to intellectual development. However, not all researchers unanimously agree on what intelligence is and how to measure it. There is a wide variety of tests to assess intelligence according to different age groups, instruments that are not always comparable, either in what they measure or in their results. Therefore, we will present the Piaget's model of cognitive development, because it would best explain the child's logical-formal analysis abilities based on age.
Piaget describes four periods who in turn will present several stadiums. They are: the sensorimotor period, the preoperational period, the concrete operational period, and the formal operational period.
The sensorimotor periodIt comprises the stages of Reflex Activity (0-1 month), Primary Circular Reactions (1-4 months), Secondary Circular Reactions (4-8 months), Coordination of Secondary Schemes (8-12 months), Tertiary Circular Reactions (12-18 months), with rudimentary inventive capacity being acquired between 18-24 months through the combination of previously acquired mental capacities.
The pre-operational period. It spans from two to seven years of age. During this time, the child acquires the capacity for symbolization, deferred imitation, and language. They are incapable of performing reversible mental operations. Their thinking is egocentric, and their intelligence is purely representational. It ends with the development of concrete operational structures through internalized action schemes.
Period of specific operations. It covers ages seven to eleven. Although the child is capable of logical reasoning, he applies it to present and concrete situations, learning to differentiate reality from fantasy, space and time, classifying objects hierarchically, and acquiring the concepts of series, inclusion, symmetry, conservation and reciprocity.
Period of formal operations. This stage spans from ages 11 to 15. During this time, individuals acquire the ability to formulate hypotheses and deduce the necessary procedures for problem-solving, indicating significant maturity in executive functions. In fact, Piaget describes: a) Hypothetical-deductive reasoning, which involves explaining phenomena based on specific facts. This is hypothetical thinking, moving beyond the concrete thinking of the previous stage. b) Propositional thought, which equips the individual with the linguistic capacity to evaluate the logic of propositions. c) Egocentrism, which is the adolescent's inability to differentiate between their own abstract perspective and that of others.
In short, we would consider a person to Cognitive ability for autonomous decision-making if:
- If they have sufficient ability to express themselves (language development).
- If you have acquired the formal operational capacity that allows you to evaluate the relationships between cause and effect, both in the short, medium and long term (it also implies good executive management of temporality).
- The ability to weigh the consequences of a decision, both in relation to oneself and to others (we are not only dealing with a formal operational capacity, but also with the presence of theory of mind).
- Hypothetical operational capacity that enables it to make abstractions about the benefits and risks of actions.
- Distinguishing reality from fantasy. Formal egocentrism can condition this ability, not so much in the sense of fantasy as in the sense of generalization.
Emotional development
In my humble opinion, if there is no obvious cognitive impairment, this would be the most important factor in the conceptualization of a mature child. Emotions are so powerful that they can included «"to obscure our intelligence."
Historically, excessive importance has been given to instrumental (cognitive) intelligence and very little to emotional intelligence.
It would be as a result of the paradigm of the Garner's multiple intelligences when a huge amount of bibliographic production occurs on two subtypes of intelligenceIntrapersonal and interpersonal intelligence. Recall that Gardner's multiple intelligences are: Linguistic, Logical-mathematical, Musical, Bodily-kinesthetic, Naturalistic, Interpersonal, and Intrapersonal.
is defined as Intrapersonal intelligence The level of a person's ability to understand their own emotions, feelings, and motivations. As Interpersonal intelligence It refers to the level of ability to understand others' feelings, intentions, and motivations, and to respond appropriately. I think a phrase from Aristotle on this topic: «Anyone can get angry, that's easy. But to be angry with the right person, to the right degree, at the right time, for the right purpose, and in the right way—that is not within everyone's power and it is not easy. The closer we get to these Aristotelian maxims, the greater our emotional maturity will be.
Coleman He takes up these two types of intelligence and develops his own theory about emotional intelligence. Today we know that the proper management of emotions is fundamental in decision-making and, even more so, in children due to both inexperience and the emotional immaturity typical of their age.
The assessment of emotions should be imperative in any evaluation process of the mature child.
International standards and Spanish legislation on the autonomy of minors
To avoid making this entry excessively long, I will simply list the international and national regulations related to the autonomy of the minor and decision-making.
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International Standards:
– UN Convention on the Rights of the Child. Art. 12 and Art. 14.
– Regulation (EU) No 536/2014 of the European Parliament and of the Council of 16 April 2014 on clinical trials of medicinal products for human use.
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Spanish Standards
– Organic Law 1/1996 on the legal protection of minors.
– Civil Code. Art 162. On the rights of the personality of the minor.
– Law 41/2002 on patient autonomy. It incorporates the recommendation of
– Oviedo Convention in its Art. 6.2.
Evaluation instruments
Assessing a child's maturity to make independent decisions is uniquely difficult, and the reliability of the results is questionable. This is not surprising given the high complexity of the subject being assessed.
Numerous tests and questionnaires have been used. We will simply list them, focusing more specifically on the MaCAT. The most frequently cited in the literature are:
- Rothm Meisel and Lidz test.
- Appelbaum and Roth test.
- Competency assessment criteria (Canadian Psychiatric Association).
- Drane Mobile Scale. Risk/benefit assessment.
- McArthur Competence Assessment Tool by Appelbaum and Grisso (McCAT).
The MacCAT-T is a semi-structured interview administered by an interviewer to assess treatment decision-making skills. It comprises the following sections: 1) understanding of information related to the disorder; 2) appreciating the significance of the information in the patient's specific situation; 3) reasoning about the treatment decision process; and 4) expressing a choice regarding treatment.
It comprises the following sections and subsections:
– Reasoning:
Consequential
Comparative
Consequences generated
Logical consistency
– Expression of a choice.
This has been validated for the Spanish population by Álvarez Marrodán et al. (2012) and a User manual
Autonomy and decision making
Following Diego Gracia's line of thought, I believe that to assess a minor's level of maturity, a deliberative scenario is needed, supported by what he describes as "Prudential Principles". In other words, it should be relevant, necessary, purposeful, cautious, and proportionate to the decisions that need to be made.
Similarly, for a minor to make an autonomous decision, they must be free, informed, possess sufficient cognitive and emotional capacity to make the decision, act from an ethical framework, have the necessary life experience, and be legally regulated.
Therefore, when we expertly assess the degree of maturity of the minor, it is not only necessary to determine the degree of cognitive, moral and emotional development, but also to assess the level of interference or facilitation of external factors such as the education received and the degree of internalization of social roles, norms and values.
Finally, it should be noted that a minor may be mature enough to make some decisions but not others. The important thing is that the best interests of the child are always taken into account, something especially important today when, when making certain decisions, interests unrelated to this philosophy come into play, including ideological, economic, and anthropological considerations.
