It would be incredibly difficult to effectively manage both schizophrenia and autism without antipsychotics. The extensive research data and strong evidence of efficacy clearly supports the use of antipsychotics in these youth subpopulations. However, we start to run into some serious problems when we start using antipsychotics off-label in youth. We now have more information on the possible direct neurotoxicity of antipsychotic medications. How to sort through this and maximize the help while minimizing the risks?