This study investigates the relationship between brain pathology and psychiatric disturbance in 37 psychiatric inpatients between 5 and 14 years of age referred for magnetic resonance imaging (MRI). Of 37 images, 13 were categorized as abnormal by neuroradiologists who were blind to the diagnoses of subjects. Three of six children with schizophrenia-related diagnoses had abnormal scans. In contrast, only one of 15 children with a primary disruptive behavior disorder diagnosis had an abnormal magnetic resonance image. A greater proportion of children with schizophrenia spectrum diagnoses had greater left than right frontal horns of the lateral ventricles than children with other diagnoses.