OBJECTIVES : (1) To ascertain the use rates of specific pharmacotherapy strategies for child psychiatric inpatients with aggressive behavior from preadmission care through 12 months after discharge, and (2) To examine the associations between these strategies and postdischarge outcomes. METHOD : Prospective follow-up of eighty-three 5- to 13-year-old children admitted to acute inpatient care for aggressive behavior in the context of a disruptive behavior disorder. Treatment and symptom severity data were obtained at admission, discharge, and 3, 6, and 12 months after discharge between 1998 and 2001. RESULTS : Utilization. The number of concurrent medications increased over assessment times. Changes in children's pharmacotherapy occurred most frequently during hospitalization and from discharge to 3 months after discharge. Treatment with antipsychotics and mood stabilizers increased over assessment times, whereas selective serotonin reuptake inhibitor (SSRI) treatment decreased. Outcomes. Children treated with stimulants and risperidone 3 months after discharge had significantly improved behavioral ratings, adjusted for admission scores and concurrent medications. Children treated with SSRIs at 6 months after discharge had higher problem severity ratings. Those who maintained lithium and SSRI treatment between 6 and 12 months showed improvements. CONCLUSIONS : The complexity of pharmacotherapy for child inpatients ratchets upwards from admission through 1 year after discharge. Hospital-initiated treatment is commonly altered soon after discharge. Within the limitations of observational methodology, the postdischarge outcomes seem related to specific pharmacotherapy regimens.