Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 36
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Benarous, Xavier Mikita, Nina Goodman, Robert and Stringaris, Argyris 2016. Distinct relationships between social aptitude and dimensions of manic-like symptoms in youth. European Child & Adolescent Psychiatry, Vol. 25, Issue. 8, p. 831.

    Costa, Lucas da Silva Alencar, Átila Pereira Neto, Pedro Januário Nascimento Santos, Maria do Socorro Vieira dos da Silva, Cláudio Gleidiston Lima Pinheiro, Sally de França Lacerda Teixeira Silveira, Regiane Bianco, Bianca Alves Vieira Pinheiro Júnior, Roberto Flávio Fontenelle de Lima, Marcos Antonio Pereira Reis, Alberto Olavo Advincula and Neto, Modesto Leite Rolim 2015. Risk factors for suicide in bipolar disorder: A systematic review. Journal of Affective Disorders, Vol. 170, p. 237.

    Frías, Álvaro Palma, Cárol and Farriols, Núria 2015. Psychosocial interventions in the treatment of youth diagnosed or at high-risk for pediatric bipolar disorder: A review of the literature. Revista de Psiquiatría y Salud Mental (English Edition), Vol. 8, Issue. 3, p. 146.

    Frías, Álvaro Palma, Cárol and Farriols, Núria 2015. Intervenciones psicosociales en el tratamiento de los jóvenes diagnosticados o con alto riesgo para el trastorno bipolar pediátrico: una revisión de la literatura. Revista de Psiquiatría y Salud Mental, Vol. 8, Issue. 3, p. 146.

    Parikh, Sagar V Hawke, Lisa D Velyvis, Vytas Zaretsky, Ari Beaulieu, Serge Patelis-Siotis, Irene MacQueen, Glenda Young, L Trevor Yatham, Lakshmi N and Cervantes, Pablo 2015. Combined treatment: impact of optimal psychotherapy and medication in bipolar disorder. Bipolar Disorders, Vol. 17, Issue. 1, p. 86.

    Robillard, Rébecca and Hickie, Ian B. 2015. Sleep and Affect.

    Correll, Christoph U Olvet, Doreen M Auther, Andrea M Hauser, Marta Kishimoto, Taishiro Carrión, Ricardo E Snyder, Stephanie and Cornblatt, Barbara A 2014. The Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P): description and validation in a psychiatric sample and healthy controls. Bipolar Disorders, Vol. 16, Issue. 5, p. 505.

    Correll, Christoph U Hauser, Marta Penzner, Julie B Auther, Andrea M Kafantaris, Vivian Saito, Ema Olvet, Doreen Carrión, Ricardo E Birmaher, Boris Chang, Kiki D DelBello, Melissa P Singh, Manpreet K Pavuluri, Mani and Cornblatt, Barbara A 2014. Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode. Bipolar Disorders, Vol. 16, Issue. 5, p. 478.

    Erickson, Jessica A. Kuzmich, Lili Ormond, Kelly E. Gordon, Erynn Christman, Michael F. Cho, Mildred K. and Levinson, Douglas F. 2014. Genetic Testing of Children for Predisposition to Mood Disorders: Anticipating the Clinical Issues. Journal of Genetic Counseling, Vol. 23, Issue. 4, p. 566.

    Singh, Manpreet K Chang, Kiki D Kelley, Ryan G Saggar, Manish Reiss, Allan L and Gotlib, Ian H 2014. Early signs of anomalous neural functional connectivity in healthy offspring of parents with bipolar disorder. Bipolar Disorders, Vol. 16, Issue. 7, p. 678.

    Birmaher, Boris Goldstein, Benjamin I Axelson, David A Monk, Kelly Hickey, Mary Beth Fan, Jieyu Iyengar, Satish Ha, Wonho Diler, Rasim S Goldstein, Tina Brent, David Ladouceur, Cecile D Sakolsky, Dara and Kupfer, David J 2013. Mood lability among offspring of parents with bipolar disorder and community controls. Bipolar Disorders, Vol. 15, Issue. 3, p. 253.

    Diler, Rasim Somer de Almeida, Jorge Renner Cardoso Ladouceur, Cecile Birmaher, Boris Axelson, David and Phillips, Mary 2013. Neural activity to intense positive versus negative stimuli can help differentiate bipolar disorder from unipolar major depressive disorder in depressed adolescents: A pilot fMRI study. Psychiatry Research: Neuroimaging, Vol. 214, Issue. 3, p. 277.

    Gruber, June Gilbert, Kirsten E. Youngstrom, Eric Youngstrom, Jennifer Kogos Feeny, Norah C. and Findling, Robert L. 2013. Reward Dysregulation and Mood Symptoms in an Adolescent Outpatient Sample. Journal of Abnormal Child Psychology, Vol. 41, Issue. 7, p. 1053.

    Miklowitz, David J. Schneck, Christopher D. Singh, Manpreet K. Taylor, Dawn O. George, Elizabeth L. Cosgrove, Victoria E. Howe, Meghan E. Dickinson, L. Miriam Garber, Judy and Chang, Kiki D. 2013. Early Intervention for Symptomatic Youth at Risk for Bipolar Disorder: A Randomized Trial of Family-Focused Therapy. Journal of the American Academy of Child & Adolescent Psychiatry, Vol. 52, Issue. 2, p. 121.

    Van Meter, Anna Youngstrom, Eric A. Demeter, Christine and Findling, Robert L. 2013. Examining the Validity of Cyclothymic Disorder in a Youth Sample: Replication and Extension. Journal of Abnormal Child Psychology, Vol. 41, Issue. 3, p. 367.

    Gielen, R. Geissler, D. Giesler, H. and Bock, T. 2012. Leitlinie Bipolare Störungen und die Bedeutung des Trialogs. Der Nervenarzt, Vol. 83, Issue. 5, p. 587.

    Olsavsky, Aviva K. Brotman, Melissa A. Rutenberg, Julia G. Muhrer, Eli J. Deveney, Christen M. Fromm, Stephen J. Towbin, Kenneth Pine, Daniel S. and Leibenluft, Ellen 2012. Amygdala Hyperactivation During Face Emotion Processing in Unaffected Youth at Risk for Bipolar Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, Vol. 51, Issue. 3, p. 294.

    Schlosser, Danielle A. Miklowitz, David J. O'Brien, Mary P. De Silva, Sandra D. Zinberg, Jamie L. and Cannon, Tyrone D. 2012. A randomized trial of family focused treatment for adolescents and young adults at risk for psychosis: study rationale, design and methods. Early Intervention in Psychiatry, Vol. 6, Issue. 3, p. 283.

    Van Meter, Anna R and Youngstrom, Eric A 2012. Cyclothymic disorder in youth: why is it overlooked, what do we know and where is the field headed?. Neuropsychiatry, Vol. 2, Issue. 6, p. 509.

    Van Meter, Anna R. Youngstrom, Eric A. and Findling, Robert L. 2012. Cyclothymic disorder: A critical review. Clinical Psychology Review, Vol. 32, Issue. 4, p. 229.


Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

  • David J. Miklowitz (a1) and Kiki D. Chang (a2)
  • DOI:
  • Published online: 01 July 2008

This article examines how bipolar symptoms emerge during development, and the potential role of psychosocial and pharmacological interventions in the prevention of the onset of the disorder. Early signs of bipolarity can be observed among children of bipolar parents and often take the form of subsyndromal presentations (e.g., mood lability, episodic elation or irritability, depression, inattention, and psychosocial impairment). However, many of these early presentations are diagnostically nonspecific. The few studies that have followed at-risk youth into adulthood find developmental discontinuities from childhood to adulthood. Biological markers (e.g., amygdalar volume) may ultimately increase our accuracy in identifying children who later develop bipolar I disorder, but few such markers have been identified. Stress, in the form of childhood adversity or highly conflictual families, is not a diagnostically specific causal agent but does place genetically and biologically vulnerable individuals at risk for a more pernicious course of illness. A preventative family-focused treatment for children with (a) at least one first-degree relative with bipolar disorder and (b) subsyndromal signs of bipolar disorder is described. This model attempts to address the multiple interactions of psychosocial and biological risk factors in the onset and course of bipolar disorder.

Corresponding author
Address correspondence and reprint requests to: David J. Miklowitz, Department of Psychology, University of Colorado at Boulder, 345 UCB, Boulder, CO 80309; E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

H. S. Akiskal (1995). Developmental pathways to bipolarity: Are juvenile-onset depressions pre-bipolar? Journal of the American Academy of Child & Adolescent Psychiatry, 34, 754763.

J. Biederman , E. Mick , S. V. Faraone , T. Spencer , T. E. Wilens , & J. Wozniak (2003). Current concepts in the validity, diagnosis and treatment of paediatric bipolar disorder. International Journal of Neuropsychopharmacology, 6, 293300.

B. Birmaher , D. Axelson , M. Strober , M. K. Gill , S. Valeri , L. Chiappetta , (2006). Clinical course of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry, 63, 175183.

H. P. Blumberg , J. Kaufman , A. Martin , D. S. Charney , J. H. Krystal , & B. S. Peterson (2004). Significance of adolescent neurodevelopment for the neural circuitry of bipolar disorder. Annals of the New York Academy of Sciences, 1021, 376383.

S. C. Caetano , R. L. Olvera , D. Glahn , M. Fonseca , S. Pliszka , & J. C. Soares (2005). Fronto-limbic brain abnormalities in juvenile onset bipolar disorder. Biological Psychiatry, 58, 525531.

G. A. Carlson , & S. Weintraub (1993). Childhood behavior problems and bipolar disorder—Relationship or coincidence? Journal of Affective Disorders, 28, 143153.

K. Chang , N. E. Adleman , K. Dienes , D. J. Simeonova , V. Menon , & A. Reiss (2004). Anomalous prefrontal–subcortical activation in familial pediatric bipolar disorder: A functional magnetic resonance imaging investigation. Archives of General Psychiatry, 61, 781792.

K. Chang , M. Howe , K. Gallelli , & D. Miklowitz (2006). Prevention of pediatric bipolar disorder: Integration of neurobiological and psychosocial processes. Annals of the New York Academy of Sciences, 1094, 235247.

K. D. Chang , H. Steiner , & T. A. Ketter (2000). Psychiatric phenomenology of child and adolescent bipolar offspring. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 453460.

D. Cicchetti , & F. A. Rogosch (1999). Psychopathology as risk for adolescent substance use disorders: A developmental psychopathology perspective. Journal of Clinical Child Psychology, 28, 355365.

D. Cicchetti , & S. L. Toth (1998). The development of depression in children and adolescents. American Psychologist, 53, 221241.

C. U. Correll , J. B. Penzner , A. M. Frederickson , J. J. Richter , A. M. Auther , C. W. Smith , (2007). Differentiation in the preonset phases of schizophrenia and mood disorders: Evidence in support of a bipolar mania prodrome. Schizophrenia Bulletin, 33, 703713.

A. L. Coville , D. J. Miklowitz , D. O. Taylor , & K. Low (2008). Correlates of high expressed emotion attitudes among parents of bipolar adolescents. Journal of Clinical Psychology, 64, 438449.

J. A. Egeland , R. L. Blumenthal , J. Nee , L. Sharpe , & J. Endicott (1987). Reliability and relationship of various ages of onset criteria for major affective disorder. Journal of Affective Disorders, 12, 159165.

J. A. Egeland , A. M. Hostetter , D. L. Pauls , & J. N. Sussex (2000). Prodromal symptoms before onset of manic-depressive disorder suggested by first hospital admission histories. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 12451252.

J. A. Egeland , J. A. Shaw , J. Endicott , D. L. Pauls , C. R. Allen , A. M. Hostetter , (2003). Prospective study of prodromal features for bipolarity in well Amish children. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 786796.

S. V. Faraone , J. Biederman , D. Mennin , J. Wozniak , & T. Spencer (1997). Attention-deficit hyperactivity disorder with bipolar disorder: A familial subtype? Journal of the American Academy of Child & Adolescent Psychiatry, 36, 13781387.

E. L. Fergus , R. B. Miller , D. A. Luckenbaugh , G. S. Leverich , R. L. Findling , A. M. Speer , (2003). Is there progression from irritability/dyscontrol to major depressive and manic symptoms? A retrospective community survey of parents of bipolar children. Journal of Affective Disorders, 77, 7178.

J. Garber (2006). Depression in children and adolescents: Linking risk research and prevention. American Journal of Preventive Medicine, 31, S104S125.

B. Geller , B. Zimerman , M. Williams , K. Bolhofner , & J. L. Craney (2001). Bipolar disorder at prospective follow-up of adults who had prepubertal major depressive disorder. American Journal of Psychiatry, 158, 125127.

K. Hashimoto , E. Shimizu , & M. Iyo (2004). Critical role of brain-derived neurotrophic factor in mood disorders. Brain Research Review, 45, 104114.

M. H. Hillegers , C. G. Reichart , M. Wals , F. C. Verhulst , J. Ormel , & W. A. Nolen (2005). Five-year prospective outcome of psychopathology in the adolescent offspring of bipolar parents. Bipolar Disorders, 7, 344350.

K. Kendler (2005). “A gene for … ”: The nature of gene action in psychiatric disorders. American Journal of Psychiatry, 162, 12431252.

E. Y. Kim , & D. J. Miklowitz (2002). Childhood mania, attention deficit hyperactivity disorder and conduct disorder: A critical review of diagnostic dilemmas. Bipolar Disorders, 4, 215225.

F. J. Kochman , E. G. Hantouche , P. Ferrari , S. Lancrenon , D. Bayart , & H. S. Akiskal (2005). Cyclothymic temperament as a prospective predictor of bipolarity and suicidality in children and adolescents with major depressive disorder. Journal of Affective Disorders, 85, 181189.

E. Leibenluft , P. Cohen , T. Gorrindo , J. S. Brook , & D. S. Pine (2006). Chronic vs. episodic irritability in youth: A community-based, longitudinal study of clinical and diagnostic associations. Journal of Child and Adolescent Psychopharmacology, 16, 456466.

J. D. Lish , S. Dime-Meenan , P. C. Whybrow , R. A. Price , & R. M. Hirschfeld (1994). The National Depressive and Manic-Depressive Association (NDMDA) survey of bipolar members. Journal of Affective Disorders, 31, 281294.

T. H. McGlashan , R. B. Zipursky , D. Perkins , J. Addington , T. Miller , S. W. Woods , (2006). Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. American Journal of Psychiatry, 163, 790799.

K. R. Merikangas , H. S. Akiskal , J. Angst , P. E. Greenberg , R. M. A. Hirschfeld , M. Petukhova , (2007). Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Archives of General Psychiatry, 64, 543552.

D. J. Miklowitz , A. Biuckians , & J. A. Richards (2006). Early-onset bipolar disorder: A family treatment perspective. Development and Psychopathology, 18, 12471265.

D. J. Miklowitz , E. L. George , J. A. Richards , T. L. Simoneau , & R. L. Suddath (2003). A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Archives of General Psychiatry, 60, 904912.

D. J. Miklowitz , T. L. Simoneau , E. L. George , J. A. Richards , A. Kalbag , N. Sachs-Ericsson , (2000). Family-focused treatment of bipolar disorder: One-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biological Psychiatry, 48, 582592.

C. Moreno , G. Laje , C. Blanco , H. Jiang , A. B. Schmidt , & M. Olfson (2007). National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Archives of General Psychiatry, 64, 10321039.

L. Murray , C. Kempton , M. Woolgar , & R. Hooper (1993). Depressed mothers' speech to their infants and its relation to infant gender and cognitive development. Journal of Child Psychology and Psychiatry, 34, 10831101.

R. A. O'Connell , J. A. Mayo , L. Flatow , B. Cuthbertson , & B. E. O'Brien (1991). Outcome of bipolar disorder on long-term treatment with lithium. British Journal of Psychiatry, 159, 132–129.

M. N. Pavuluri , B. Birmaher , & M. W. Naylor (2005). Pediatric bipolar disorder: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 846871.

R. H. Perlis , S. Miyahara , L. B. Marangell , S. R. Wisniewski , M. Ostacher , M. P. DelBello , (2004). Long-term implications of early onset in bipolar disorder: Data from the first 1000 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Biological Psychiatry, 55, 875881.

M. L. Phillips , W. C. Drevets , S. L. Rauch , & R. Lane (2003). Neurobiology of emotion perception II: Implications for major psychiatric disorders. Biological Psychiatry, 54, 515528.

R. M. Post (2002). Do the epilepsies, pain syndromes, and affective disorders share common kindling-like mechanisms? Epilepsy Research, 50, 203219.

G. Rajkowska (2000). Postmortem studies in mood disorders indicate altered numbers of neurons and glial cells. Biological Psychiatry, 48, 766777.

M. M. Rea , M. Tompson , D. J. Miklowitz , M. J. Goldstein , S. Hwang , & J. Mintz (2003). Family focused treatment vs. individual treatment for bipolar disorder: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 71, 482492.

J. A. Shaw , J. A. Egeland , J. Endicott , C. R. Allen , & A. M. Hostetter (2005). A 10-year prospective study of prodromal patterns for bipolar disorder among Amish youth. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 1104–1011.

M. K. Singh , M. P. DelBello , R. A. Kowatch , & S. M. Strakowski (2006). Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children. Bipolar Disorders, 8, 710720.

D. K. Snyder , A. M. Castellani , & M. A. Whisman (2006). Current status and future directions in couple therapy. Annual Review of Psychology, 57, 128.

S. M. Strakowski , M. P. Delbello , & C. M. Adler (2005). The functional neuroanatomy of bipolar disorder: A review of neuroimaging findings. Molecular Psychiatry, 10, 105116.

T. Suppes , G. S. Leverich , P. E. Keck , W. A. Nolen , K. D. Denicoff , L. L. Altshuler , (2001). The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. Journal of Affective Disorders, 67, 4559.

R. Tillman , B. Geller , J. L. Craney , K. Bolhofner , M. Williams , & B. Zimerman (2004). Relationship of parent and child informants to prevalence of mania symptoms in children with a prepubertal and early adolescent bipolar disorder phenotype. American Journal of Psychiatry, 161, 12781284.

M. Wals , M. H. J. Hillegers , C. G. Reichart , F. C. Verhulst , W. A. Nolen , & J. Ormel (2005). Stressful life events and onset of mood disorders in children of bipolar parents during 14-month follow-up. Journal of Affective Disorders, 87, 253263.

L. J. Yan , C. Hammen , A. N. Cohen , S. E. Daley , & R. M. Henry (2004). Expressed emotion versus relationship quality variables in the prediction of recurrence in bipolar patients. Journal of Affective Disorders, 83, 199206.

D. A. Yurgelun-Todd , S. A. Gruber , G. Kanayama , W. D. Killgore , A. A. Baird , & A. D. Young (2000). fMRI during affect discrimination in bipolar affective disorder. Bipolar Disorders, 2(3, Part 2), 237248.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Development and Psychopathology
  • ISSN: 0954-5794
  • EISSN: 1469-2198
  • URL: /core/journals/development-and-psychopathology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *