Two widely used second-generation antipsychotic drugs were not superior to a first-generation antipsychotic in treating 116 patients ages 8–19 with schizophrenia, schizoaffective disorder, or schizophreniform disorder. Over 8 weeks, 50% of those taking the first-generation antipsychotic molindone were ”much“ or ”very much“ improved, compared to 46% of the risperidone group and 34% of the olanzapine group. Sikich et al. (p. 1420) also examined adverse effects. These included an 18% rate of akathisia in the molindone group, despite prophylactic benztropine. The youth taking olanzapine gained an average of 6.1 kg, and those taking risperidone gained 3.6 kg. The olanzapine group also had significant increases in cholesterol, low-density lipoprotein, insulin, and liver transaminases. The olanzapine treatment arm was discontinued part way through the study because of concerns about these adverse effects. Findling et al. (p. 1432) compared a different second-generation antipsychotic, aripiprazole, with placebo for treating adolescents with schizophrenia. Both 10 and 30 mg/day of aripiprazole produced greater decreases than placebo in the total score on the Positive and Negative Syndrome Scale at week 6. The difference for the 30-mg dose was evident at week 1. The most common adverse events linked to aripiprazole were extrapyramidal disorder, somnolence, and tremor. Low prolactin levels were found in 34% and 26% of the 10- and 30-mg/day aripiprazole groups, respectively, compared to 8% of the placebo group. An editorial by Dr. Randal Ross on p. 1369focuses on issues unique to children and adolescents with schizophrenia.