In Australia, oral olanzapine and diazepam are commonly used to manage acute severe behavioral disturbances in children presenting to emergency departments. Bourke et al., conducted a multicenter randomized controlled trial (RCT) (October 2021-November 2023) across nine Australian emergency departments to compare the efficacy of oral olanzapine versus diazepam for behavioral sedation. The trial enrolled 348 patients aged 9-17 whose symptoms persisted despite nonpharmacologic interventions. Dosing was weight-based: patients < 40 kg received 5 mg, and those ≥ 40 kg received 10 mg of their assigned study drug. A successful sedation was defined as behavior containment without additional sedatives within one hour of administration. Successful sedation was achieved in 103 patients (61%) in the olanzapine group and in 90 patients (57%) in the diazepam group (p = 0.49). Secondary outcomes, including adverse effects, staff-directed aggression, length of stay, and satisfaction with care, did not differ significantly between groups. Notably, 40% of patients did not reach successful sedation within the first hour. The authors note that a success rate of approximately 60% may be suboptimal for clinical practice. They advocate for protocols to ensure timely recognition of acute behavioral disturbances and consideration of alternative or additional pharmacological agents when needed.