From my understanding, they have a court appointed psychiatrist that will examine your child, ask certain questions to determine whether or not he is competent enough to know right from wrong in the situation, whatever it was, that got him into trouble. If he is found competent, they will fully prepare to hold him responsible for his actions. Depending on what state you are in, they usually have different options to persue if found that your child could NOT be held accountable for his actions. Our state I think, depending on the offense, they could sentence him to house arrest, with ankle bracelet so that he has to be home where you can keep an eye on him so he can't get in trouble....things like that. For more severe offenses, this competency exam can mean the difference between being sent to doctor JUVIE or being sent to a mental Residential Treatment Center (RTC) instead.