The use of psychotropic medications in youth has significantly increased in recent years. Moreover, the use of multiple medications, or polypharmacy, has seen a corresponding increase. The use of medications is largely based on diagnostic impressions and the targeted symptom. However, due to the dearth of applied research with severely troubled youth, there is very little “evidence base” to guide this practice. The Survey of Adolescent Treatment Experience study surveyed youth, currently placed in residential care, on their impressions of medication effectiveness on a wide-range of symptom categories. Youth report only mediocre effectiveness in their medication across a range of symptom questions. Approximately one third of youth indicated that they felt positive about taking medications. On average, slightly less than 50 % of youth reported benefits from medications across symptom categories. It is argued that these findings should inform the efforts toward individualized treatment models.