This paper presents a case of an 11-year-old boy who was admitted to an acute inpatient psychiatric setting because of a recent exacerbation of physical aggression, accompanied by long-standing problems with verbal aggression, irritability, dysphoria, and sleep disturbance. His family history was notable for domestic violence, substance abuse by his father, depression in his mother, and divorce. This case illustrates an increasingly common approach to psychiatric care in youths, in which a child with a disruptive behavior and mood symptomatology is treated progressively with both increasing doses of individual medications as well as polypharmacy.