To the Editor Analyzing a Medicaid database, Bobo et al1 found an alarming 3-fold increased risk of diabetes in children and youth receiving antipsychotics, compared with those receiving other psychotropic medications. Increased risk was evident within the first treatment year, increased further with cumulative dose, and remained elevated 1 year after antipsychotic discontinuation. The disturbing findings of this landmark study provide strong evidence for an increasing burden of metabolic disease risk for young people treated with antipsychotics, because the impact of early-in-life diabetes on health and life expectancy concerns all. A further sobering issue is that in this study, as in clinical practice,2 patients received antipsychotics for conditions where antipsychotics are either not the sole treatment option or where efficacy is unproven.