Optimal management of schizophrenic illness in children and adolescents requires the successful differentiation of schizophrenia from a number of other psychotic and nonpsychotic disorders with similar presentations. Given the challenges posed by differential diagnoses, and the changing course of the various psychotic illnesses, structured interviews may be fruitfully employed to produce a semiquantitative profile of symptoms at presentation, and to follow these symptoms as the illness evolves. The causal factors of this group of syndromes are unknown, but a number of different models have been proposed. Current thinking favors various biologic hypotheses, with some synthesis between biochemical, genetic, neuropathologic, and developmental factors. In the past 10 years, a group of atypical neuroleptics have emerged, the prototype of which has been clozapine. This medication has proved to have efficacy in controlling positive symptoms in one-third to one-half of the sufferers who had been previously refractory to typical antipsychotic therapy.