Nevertheless, on the basis of the design and sample size of published studies and diagnoses from claims data, these investigators rated the strength of evidence for each initial prescription of a second-generation antipsychotic for 11,700 children between 2001 and 2005. During this period none of these agents were approved for pediatric use by the Food and Drug Administration (FDA), and the majority of published reports that included children were open-label studies involving risperidone. One medication, aripiprazole, was approved for adult use in November 2002. Was the study premature to apply ratings of evidence strength? Or by applying the ratings at a time when the evidence base was not strong, did the study simply reflect the fact that prescribers were exercising their clinical judgment in making medication decisions for high-risk children?