Key Points: (1) Compared to their non-Latino white counterparts, children and adolescents from racial-ethnic minority groups in the U.S. are less likely to receive prescriptions for psychoactive medication; (2) Racial-ethnic minority children and adolescents are also significantly less likely to receive mental health care; (3) Controlling for access to mental health care and for geographic variation reduces but does not eliminate variations in psychoactive prescriptions by race and ethnicity; (4) Controlling for mental health need and level of impairment does not eliminate variations in psychoactive prescriptions by race and ethnicity; (5) Reducing disparities will require coordinated efforts to educate families and providers, promotion of evidence-based practices, steps to overcome geographic and language barriers, and additional research for understanding the underlying reasons for variations in prescription patterns.