MACS can be used for children of different ages (4-18 years), but the interpretation of the levels needs to be related to the age of the child. Obviously, children handle different objects at age four years, compared to adolescent age. The same point concerns independence, as a young child needs more help and supervision than an older child but their handling of objects is the primary focus of MACS.
To date we have not investigated the stability of the classification over time, but our belief is that most children will stay at the same level.