Well-tolerated and inexpensive alternative to second-generation antipsychotics, especially when trying to avoid EPS and metabolic side effects; however, efficacy data in kids are more limited compared to newer agents.

The only drug with convincing evidence based on years of clinical experience to help treatment-resistant schizophrenia, but only minimal data in children. Consider in severe cases, after failure of other agents.

The only drug with convincing evidence based on years of clinical experience to help treatment-resistant schizophrenia, but only minimal data in children. Consider in severe cases, after failure of other agents.

This drug offers some advantages, including no need for titration, once-daily dosing, relatively low-moderate metabolic profile, and relatively low QT prolongation risk. 

Haloperidol is an effective, inexpensive first-generation antipsychotic with a long history of experience and use even in kids, but clinical utility is limited due to potential for EPS, prolactin elevation, and TD.

The only drug with convincing evidence based on years of clinical experience to help treatment-resistant schizophrenia, but only minimal data in children. Consider in severe cases, after failure of other agents.

Not commonly used in children, but may be considered in those with severe behavioral disturbances who may benefit from sedation.

Brexpiprazole is a cousin of aripiprazole and is also a partial dopamine agonist. It has a very similar efficacy profile (including efficacy for depression in adults) and a similar side effect profile, but is much more expensive and has less data and experience in children. We recommend choosing the cheaper, generic aripiprazole.

Since there are no clear advantages over other second-generation antipsychotics and minimal evidence for efficacy in children, the only reason to prescribe Saphris or Secuado is if your patient can’t or doesn’t want to swallow a pill.

The diagnosis of bipolar disorder in youth has shifted over time; while still largely reserved for post-pubertal adolescents, some studies (mostly in the US) include a broader age range, even preschool-aged children.