Psychopharmacological treatments have been used with increased frequency to treat a variety of internalizing and externalizing disorders in children. Given the potential impact that medication has on children's school performance, school psychologists should be involved in helping physicians and families make effective decisions by assisting with (a) diagnostic decision-making and determining the need for medication; (b) evaluating medication effects and determining optimal dosage; and (c) integrating medical, psychosocial, and educational interventions. Potential barriers to the adoption of these roles are discussed as well as clinical, ethical, training, and legal implications.