Editorial: Are we facing an efficacy–effectiveness gap in pediatric psychopharmacology?

The efficacy–effectiveness gap, the attenuation of benefits as interventions move from controlled trials into routine care, has received substantial focus when scrutinizing psychological interventions but has received less attention in pediatric psychopharmacology. Medication trials evaluate more than molecules: they embed systematic titration, frequent assessment, multi‐informant feedback, and adherence support. This Editorial examines whether differences between trial‐based and routine medication management create a comparable gap. Examples from stimulant treatment in the MTA, antidepressant protocols in TADS and TORDIA, and metabolic surveillance during antipsychotic treatment illustrate how dosing, follow‐up, and safety monitoring may diverge in practice, potentially altering both efficacy and the overall benefit–risk balance. Research should characterize how medications are delivered in routine care and identify which elements of trial‐based management materially improve outcomes. Disseminating evidence‐based pediatric psychopharmacology may require preserving essential medication‐management processes while recognizing constraints faced in practice.