This paper presents Peter, an 11-year-old boy, with brief self-limited hallucinations and persecutory ideation (if not frank delusions) on a background of a gradual deterioration in overall functioning. Affective symptoms are not prominent, and there is little to suggest an organic contribution. This raises the possibility that he has, or is on the verge of developing, a psychotic disorder, perhaps childhood-onset schizophrenia (COS), defined by the presence of symptoms before his 13th birthday. Atypical psychosis, usually classified as psychosis not otherwise specified, is another common diagnosis. Pervasive developmental disorders and childhood disintegrative disorder can often be mistaken for psychosis because they show severe impairment in reciprocal communication, social interactions, and odd stereotyped behaviors. Thus, the author states that such severe and complex disorder as childhood schizophrenia is well served by an approach based on evidence with the least bias. Although patients such as Peter present complex treatment issues, in the authors' experience, a multidisciplinary team approach, which matches optimal pharmacotherapy with attention to educational needs and the family environment, is a highly effective intervention that can ameliorate the course of this devastating illness. (Contains 1 table and 1 figure.)