Non-radiological* Methods for Age Assessment

When a person lacking legal documentation indicating their age applies for asylum in Sweden, age determination may be used to verify or refute the age-statement made by the asylum-seeker. According to the United Nations Convention on the Rights of the Child, everyone under the age of eighteen has extended rights to social services and protection, including a right to good quality health care, and the right to primary education [1]. In addition, unaccompanied minors seeking asylum in the EU have the right to a legal guardian, cannot be detained unless it is for their own safety, and cannot be deported to their country of origin unless it is deemed to be in the best interest of the child and a safe reintegration process is in place [2] (ref - see note). Thus an asylum-seekers status as a minor may have a significant impact on their application for asylum in Sweden.

Question

What is the scientific evidence regarding the reliability of non-radiological age assessment techniques?

Summary

SBU’s Enquiry service was unable to find any systematic reviews or primary studies that reliably address the accuracy of non-radiological age assessment techniques. In general, the literature indicates that the variation between individuals is too large to allow an individual’s age to be estimated based on physical traits (i.e. height or stage of puberty). Neither were any studies identified that assessed psychosocial methods for assessing an individual’s age.

SBU has taken no position in this issue. We present only the conclusions as interpreted by the authors of the individual studies included.

Background

The Swedish Migration Agency currently has the responsibility to conduct an initial age assessments when a person lacking legal documentation indicating their age applies for asylum in Sweden. The case officer may alter an applicant’s age in the Swedish Migration Agency database if he or she does not accept the applicant’s age-claim. The applicant may then choose to have a medical age assessment. The Swedish Migration Agency can change an age assessment if presented with approved documentation of age [3].

Medical age assessments are usually based on a thorough analysis of the individual’s medical history combined with height and weight measurements, and an assessment of maturity based on a physical examination. These measurements may be supplemented with radiological exams that estimate the degree of maturity of a person’s bones or teeth [4,5]. Medical age assessment is regarded as controversial and ethically unacceptable by some medical professionals [6,7].

SBU’s Enquiry Service has only focused on non-radiological methods for age assessment in its Response.

Methods

We searched PubMed, SocIndex, PsycInfo, Scopus, ProQuest (Social Services Abstracts, Sociological Abstracts, ERIC) as well as Campbell Collaboration.

The search strategy was done in two steps. First we conducted a broad search for systematic reviews assessing any kind of age assessment technique (Search I). Subsequently, the search was altered to include any study type, but narrowed to exclude radiological methods (Search II). The complete search strategy is presented in the section “Literature search.”

Identified abstracts and articles were largely read by only one person. No attempt was made to assess the quality of the identified articles.

Results

The search strategy identified 16,234 records (15,347 from Search I, and 887 from Search II) (See Figures 1 and 2). The abstracts of all of the articles identified by the literature search were read. Of these, 73 articles (32 from Search I, and 41 from search II) were judged to be potentially assessing the accuracy of non-radiological age assessment methods, and were read in full text.

Identified studies

After all of the potentially relevant studies were read, no systematic reviews or scientific studies were identified that assessed the accuracy of non-radiological age assessment techniques. Only studies that discussed or described certain aspects of non-radiological age assessments such as height or puberty status were identified.

Neither were any scientific studies identified that assessed any psychosocial method for assessing the age of refugees.

References

1. Förenta nationerna (FN). Barnkonventionen. FN:s konvention om barnets rättigheter. 1989.
2. European Parliament Resolution. Multi-annual programme 2010-2014 regarding the area of freedom, security and justice (Stockholm programme). Availabile via European Parliament Resolution. Nedladdad 2016-10-24.
3. Migrationsverket. Assessment of your age as a part of your identity. Last updated: November 11, 2015.
4. Hjern A, Ascher A. Svårt att säkert fastställa ålder hos asylsökande barn. Medicinska metoder håller inte måttet – psykosocial bedömning bör prövas. Läkartidningen. 2015;112:DRFZ.
5. Socialstyrelsen. Medicinsk åldersbedömning för barn i övre tonåren. 2012-06-26. Dnr 31156/2011. Artikelnummer: 2012-6-54.
6. Dahl AS. Läkaresällskapet vill att medicinsk åldersbedömning av barn ses över. 2015-11-25. Läkartidningen. 2015;112:DTM9
7. Svenska Läkaresällskapet. I debatten: Åldersbedömning av ensamkommande flyktingbarn.
8. Smith T, Brownlees L. Age assessment practices: a literature review & annotated bibliography. A discussion paper. UNICEF. 2011.
9. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291-303.
10. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child 1970;45:13-23.
11. Svenska Barnläkarföreningen. Medicinsk åldersbedömning av barn i övre tonåren – instruktioner för barnläkarundersökning. 2014-01-16.
12. Garamendi PM, Landa MI, Ballesteros J, Solano MA. Reliability of the methods applied to assess age minority in living subjects around 18 years old. A survey on a Moroccan origin population. Forensic Sci Int 2005;154:3-12.
13. Aynsley-Green A, Cole TJ, Crawley H, Lessof N, Boag LR, Wallace RM. Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control. Br Med Bull 2012;102:17-42.
14. Santoro V, De Donno A, Marrone M, Campobasso CP, Introna F. Forensic age estimation of living individuals: a retrospective analysis. Forensic Sci Int 2009;193:129.e1-4.
15. Australian Human Rights Commission. An age of uncertainty. Inquiry into the treatment of individuals suspected of people smuggling offences who say that they are children (2012).
16. Association of Directors of Children's Services (ADCS). Age assessment guidance. Guidance to assist social workers and their managers in undertaking age assessments in England. October 2015.