Several controlled clinical trials of medications in youth make it clear that psychopharmacology can significantly contribute to rehabilitation and possibly recovery. This chapter summarizes the clinical indications for pharmacological interventions that may help in reducing pathology in this population. The combined knowledge of clinical care, clinical trials, and the recommendations generated by consensus in practice guidelines suggests that the most appropriate approach to using medications in juvenile offenders requires employing a cautious and supportive attitude, and always weighing risks and benefits. The chapter proposes that clinicians should use the integrated provision of services, including medication, to attempt to target the subtype of aggression that may be underpinning the delinquent behaviors of the juvenile. It summarizes the trials where the primary recruitment target was a disorder of aggression, conduct disorder (CD), oppositional-defiant disorder (ODD), and intermittent explosive disorder (IED). In all cases, clinicians should strive to use evidenced-based principles for treatment.