DURING THE period (1987-1996) reported by Zito et al,1 researchers from the field of child and adolescent psychiatry and pediatrics conducted studies to refine diagnostic criteria, applied these criteria to determine the prevalence of child psychiatric disorders, and provided the infrastructure for treatment studies. The research also led to greater standardization of an "evaluation" that facilitated an expectation that a formal diagnosis and treatment plan could be achieved in 1 or 2 hours. New medications emerged that were studied in adults but used widely for children as well. This clinical evolution was taking place in the context of dramatic changes in the health care delivery system secondary to managed care cost controls being applied for both general pediatric care and child mental health services.2 The data reported by Zito et al1 are a reflection, an imperfect mirror, of the scientific, clinical, financial, and systems changes that affected the care of children between 1987 and 1996 and continue to be a substantial influence. What can we see in this mirror? How could we understand this data set from a clinical perspective? From a financial and systems perspective? And finally, what are our opportunities and obligations to assure that we are providing comprehensive and high quality treatment to the increasing number of children who are receiving psychotropic medication?