A Manhattan judge reaffirmed his finding in Yoselyn (YOH'-sih-lihn) Ortega's case Tuesday.
Police say Ortega killed 6-year-old Lucia Krim and 2-year-old Leo Krim in October while their mother was out picking up her third child from a swimming lesson. Authorities say Ortega also cut her throat in a suicide attempt.
She has pleaded not guilty to murder.
Defense lawyer Valerie Van Leer-Greenberg says Ortega's delusions and injuries mean she cannot understand the case.
Doctors offered diverging views of Ortega's mental state.
State Supreme Court Justice Gregory Carro also heard recorded phone calls Ortega made from jail to relatives. She sounded coherent while discussing everyday matters.