This article provides an "autism vignette" and then poses an evaluative question to several autism specialists, documenting their varied responses to the scenario and question posed. A 13-year-old boy with autism and severe mental retardation presented to the inpatient psychiatric unit due to a recent increase in agitation and physical aggression. Following the closure of his group home, he moved to a similar one. He has not adjusted well to the changes in setting and staff. A behavioral specialist began working with the patient and the group home staff to address his increased pacing, anger outbursts, and minor physical aggression. When he struck a staff member, he was transported to the emergency department and psychiatrically hospitalized. Current medications include paroxetine 20 mg each morning, divalproex sodium 250 mg twice daily, and quetiapine 50 mg twice daily. The physicians are asked how they would address this scenario pharmacologically. The documented responses in this article are given by: Robert L. Findling, M.D.; Christopher J. McDougle, M.D.; Lawrence Scahill, M.S.N., Ph.D.; and Stephanie Hamarman, M.D.