Reflecting the fact that regulatory agencies recently required companies to initiate a pediatric drug development plan earlier in the drug development sequence for compounds first developed for adults, most psychiatric drugs for children still remain the offspring of adult drug development programs, viz., except for the psychostimulants, very few psychiatric medications have been developed for children and adolescents by first intent . However, two irreversible trends are gradually shifting intervention development for psychiatric disorders away from a focus on adult organisms to a focus on developing organisms. First, epidemiological data indicate that the great majority of mentally ill adults were first mentally ill as children , and that this effect is evident as early as two years of age . Second, recent advances in translational developmental neuroscience have shown that mental illness of all types can be referenced directly to the developing central nervous system and its interactions with the environment . The knowledge that mental disorders are early onset, trajectory-based brain illnesses has enormous implications for the nature and organization of how we understand interventions for psychiatric patients of all ages [5,6]. Put succinctly, to preempt, prevent and cure psychiatric disorders, it will be necessary to translate insights about molecular pathways for mental illness into druggable targets that directly reflect key neurodevelopmental processes that form trajectories of atypical as contrasted to typical development . To this end, this commentary will describe drug development in pediatric psychiatry with reference to three converging perspectives: fundamental biology and target identification, early phase clinical pharmacology, and the importance of biomarkers in the shift to personalized medicine.