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Background: Various international laws and guidelines stress the importance of respecting the developing autonomy of children and involving minors in decision-making regarding treatment and research participation. However, no universal agreement exists as to at what age minors should be deemed decision-making competent. Minors of the same age may show different levels of maturity. In addition, patients deemed rational conversation-partners as a child can suddenly become noncompliant as an adolescent. Age, context and development all play a role in decision-making competence. In this article we adopt a perspective on competence that specifically focuses on the impact of brain development on the child's decision-making process. Main body: We believe that the discussion on decision-making competence of minors can greatly benefit from a multidisciplinary approach. We adopted such an approach in order to contribute to the understanding on how to deal with children in decision-making situations. Evidence emerging from neuroscience research concerning the developing brain structures in minors is combined with insights from various other fields, such as psychology, decision-making science and ethics. Four capacities have been described that are required for (medical) decision-making: (1) communicating a choice; (2) understanding; (3) reasoning; and (4) appreciation. Each capacity is related to a number of specific skills and abilities that need to be sufficiently developed to support the capacity. Based on this approach it can be concluded that at the age of 12 children can have the capacity to be decision-making competent. However, this age coincides with the onset of adolescence. Early development of the brain's reward system combined with late development of the control system diminishes decision-making competence in adolescents in specific contexts. We conclude that even adolescents possessing capacities required for decision-making, may need support of facilitating environmental factors. Conclusion: This paper intends to offer insight in neuroscientific mechanisms underlying the medical decision-making capacities in minors and to stimulate practices for optimal involvement of minors. Developing minors become increasingly capable of decision-making, but the neurobiological development in adolescence affects competence in specific contexts. Adequate support should be offered in order to create a context in which minors can make competently make decisions.

AbstractIn domestic violence (DV) shelters, offering psychosocial support services to mothers and children is vital. The program 'Time for Tony the Turtle' has been developed for mothers and children residing in DV shelters in the Netherlands. It aims to foster attachment and regulation skills, which can also prepare for trauma treatment if sought after later on. This qualitative study explores the experiences of mothers, children and professionals with the program and its perceived impact and what components function as facilitators and barriers in the implementation of such a program in DV crisis shelters in the Netherlands. We conducted in‐depth interviews with 15 mothers, 11 children and 18 professionals from three organizations offering DV shelters. We used thematic analysis to identify patterns of meaning in the interviews. Mothers, children and professionals valued that the program provided a calm moment for reflection in hectic times and that the playfulness in which the program addressed trauma‐related topics. However, mothers find it difficult to attend the program in the beginning of their shelter stay, therefore hampering the applicability of the program. Our findings suggest that integrating the topic of discussing father in a program in crisis shelters is complex and deserves more attention.