The aim of the research was to test hypotheses concerning the associations between maternal depressive symptoms and child sleep using longitudinal data to examine possible predictive pathways. Data from the National Institute of Child Health and Human Development Study of Early Child Care with 1222 children studied from 1 to 36 months of age were analyzed to examine: effects on trajectories over time, and phase-specific effects over three defined age periods (6 to 15, 15 to 24, and 24 to 36 months). Child sleep was found to influence maternal depressive symptoms only for the 15- to 24-month age period, where, contrary to expectation, longer duration of child awakenings predicted decreased maternal depressive symptoms. Maternal depressive symptoms were found to predict an increased frequency of child awakenings across the 15- to 24-month age period only. In contrast, maternal depressive symptoms were found to significantly predict increased duration of child awakenings both for the 3-year trajectory and across the 15- to 24- and 24- to 36-month age periods. Additional research is needed to clarify the mechanisms by which maternal depressive symptoms predict increased duration of child awakenings.This study was conducted by the NICHD Early Child Care Research Network supported by NICHD through a cooperative agreement that calls for scientific collaboration between the grantees and the NICHD staff. This research was also supported by NIMH Scientist Award for Clinicians MH01532, NIMH R01 MH065938, and National Association for Research in Schizophrenia and Depression grants to the first author (S.L.W.).

In 1990 we advanced the hypothesis that frightened and frightening (FR) parental behavior would prove to be linked to both unresolved (U) adult attachment status as identified in the Adult Attachment Interview and to infant disorganized/disoriented (D) attachment as assessed in the Ainsworth Strange Situation. Here, we present a coding system for identifying and scoring the intensity of the three primary forms of FR behavior (frightened, threatening, and dissociative) as well as three subsidiary forms. We review why each primary form may induce fear of the parent (the infant's primary “haven of safety”), placing the infant in a disorganizing approach-flight paradox. We suggest that, being linked to the parent's own unintegrated traumatic experiences (often loss or maltreatment), FR behaviors themselves are often guided by parental fright, and parallel the three “classic” mammalian responses to fright: flight, attack, and freezing behavior. Recent studies of U to FR, as well as FR to D relations are presented, including findings regarding AMBIANCE/FR+. Links between dissociation, FR, U, and D are explored. Parallel processing and working memory are discussed as they relate to these phenomena.The work described in this paper was supported by a Guggenheim fellowship to the second author and by grants from the William B. Harris Foundation and the Amini Foundation for the Study of Affects. We are grateful to Alberto Amengual, Giovanni Liotti, and John Watson for directing us to varying portions of the literature discussed. Alvin Nye Main first pointed to the relevance of the quotation from Darwin.

To improve the health and well-being of individuals, it has become clear that scientific discoveries must be translated into practical applications (Insel & Fernald, 2004; Moses, Dorsey, Matheson, & Thier, 2005). Historically, such discoveries, particularly in the health sciences, have begun at “the bench,” with basic research at the molecular or cellular level progressing to the “bedside” or clinical venue. Increasingly, both basic researchers and those who are involved directly in patient care recognize that the bench–bedside approach to translational research is best conceptualized as reciprocal in nature (Cicchetti & Hinshaw, 2002; Ialongo et al., 2006). That is, basic scientists can develop new tools for utilization with patients, and clinical researchers and clinicians can make novel assessments about the nature and progression of disease that can stimulate further basic research investigations (Zerhouni, 2005). This bidirectional process is consistent with one of the central tenets of developmental psychopathology, where knowledge on normative and atypical development is considered to be mutually informative (Cicchetti, 1993; Cicchetti & Toth, 1998, 2006; Rutter & Sroufe, 2000).Our work on this Editorial and Special Issue was partially supported by research grants from the National Institute of Drug Abuse, the National Institute of Mental Health, and the Spunk Fund, Inc.

Bipolar disorder (BD) is a chronic, recurrent disorder carrying high morbidity and mortality, leading to health costs of at least $45 billion per year (Kleinman et al., 2003). It is the sixth leading cause of disability among all illnesses (Murray & Lopez, 1996). Between 15 and 28% of bipolar adults experience illness onset before the age of 13, and between 50 and 66% of them experience it before the age of 19 (Leverich et al., 2002, 2003; Perlis et al., 2004). The exact prevalence in children is unknown, but an estimated 420,000–2,072,000 US children have the illness (Post & Kowatch, 2006). Persons with onset of BD in childhood or adolescence have a more severe, adverse, and continuously cycling course of illness than adults, often with a preponderance of mixed episodes, psychosis, suicidal ideation or behaviors, and multiple comorbidities (Geller et al., 2002). Without early intervention, early-onset BD patients can be derailed, sometimes irrevocably, in social, neurobiological, cognitive, and emotional development (Miklowitz et al., 2004).Our work on this Special Issue and editorial was partially supported by grants from the National Institute of Drug Abuse, the National Institute of Mental Health, and the Spunk Fund, Inc.

The degree to which infant regulatory behaviors, together with infant reactivity to novelty, predicted anxious behavior at 2.5 years, and the moderating effect of maternal behavior were tested. Sixty-four low-risk mothers and infants participated. Mothers rated infant negative reactivity and anxious behavior; infant and maternal behaviors were observed at 6 months postpartum. Based on results of hierarchical, multiple regressions, infant regulatory behaviors (i.e., attention control, withdrawal) moderated associations between reactivity to novelty and later anxious behavior, but predictions depended also on maternal behavior. High reactivity to novelty, in conjunction with withdrawal and with poor attention control, predicted anxious behavior only when mothers were less engaged or less sensitive, suggesting that maternal behavior alters developmental trajectories associated with infant temperament.We are grateful to participating families; the Visiting Nurse Association, Beginnings, and Primetime for help recruiting; David Howell and Roger Bakeman for help with data analysis; James Long for his technical assistance; Emma Burrous for help developing and applying coding schemes. We are also grateful to these undergraduates and volunteers: Kerry Modry, David Centerbar, Julie Mulhern, Amanda Werner, Regina Miller, Jeannine Pablo, Maya Carlet, Samantha Thomas, Kerstin Grieshaber, Erica Hendalion, Amanda Heldt, Allyson Stern, Lisa Badanes, Lynne Babchuck, Emily Vilardo, Heather Kline, Michelle Clancy, Gina Berrera, and Shamila Lekka.

Following Main and Hesse's hypothesis, several investigators have affirmed that frightened/frightening (FR) as well as particular atypical maternal behaviors are associated with infant disorganized and adult unresolved attachment. Here, for the first time, FR behavior was observed in (a) middle-class father–infant (n = 25) and independent mother–infant dyads (n = 50) and (b) a brief laboratory play session. In addition, relations between disorganization, unresolved attachment, and the six FR system subscales were explored. Paternal and maternal overall FR behavior was related to infant disorganization (n = 75, φ = .61, p < .001), and for a subsample where Adult Attachment Interviews were available (n = 32), to unresolved adult attachment (φ = .59, p < .001). At the subscale level, disorganized-FR behaviors were related to infant disorganization, but only for mother–infant dyads. Across the whole sample, both dissociative-FR and threatening-FR subscales were associated with infant disorganization. The dissociative-FR subscale emerged as the central predictor of infant disorganization and was the only subscale significantly related to unresolved attachment. The appearance of FR behavior in this 18-min play procedure suggests that FR probably occurs more frequently than previously suspected. The possible role of dissociative processes in unresolved adult attachment, disorganized attachment, and FR parental behavior is discussed.This article is based on a doctoral dissertation completed by the first author (K.A.) in January 2000, in the Department of Psychology at the University of California at Berkeley, supervised by Professor Mary Main, principle investigator of the Berkeley Social Development Project. The Berkeley Social Development Project is an ongoing longitudinal study supported by the William T. Grant Foundation; by a Bio-Medical Support Grant from HEW; by the Institute for Human Development, University of California at Berkeley; by The Harris Foundation; and by the Amini Foundation for the Study of Affects. Archived Adult Attachment Interview data were coded by Anitra DeMoss. The first author acknowledges Through the Looking Glass for their support and encouragement while this manuscript was being completed. We also especially thank Mary Main for providing valuable comments on earlier drafts of this article.

This review addresses the phenomenology of mania/bipolar disorder from a developmental psychopathology perspective and uses cases with longitudinal information to illustrate major points. Beginning with a summary of the phenomenology of bipolar illness as it occurs in adults, the authors identify diagnostic complexities unique to children and adolescents. These include the challenges of characterizing elation and grandiosity; differentiating mania from comorbid symptoms, rages, sequelae of maltreatment, and typical developmental phenomena; and the unique manifestations of psychosis. We conclude with the observation that a significant difference between early and later onset bipolar disorder is that, in the former, there appears to be a global delay or arrest in the development of appropriate affect regulation; whereas in adult-onset bipolar illness, emotion dysregulation generally presents as an intermittent phenomenon. At this juncture, the study of childhood bipolar illness would benefit from a developmental psychopathology perspective to move beyond the level of cross-sectional symptom description to begin to study individuals over time, focusing on developmental, environmental, genetic, and neurobiological influences on manifest behavior.This review was supported in part by funding from NIMH Grant 44801 and grants from Janssen Pharmaceutica and Abbott Laboratories.

The malleability of insecure and disorganized attachment among infants from maltreating families was investigated through a randomized preventive intervention trial. Findings from research on the effects of maltreatment on infant attachment were incorporated into the design and evaluation of the intervention. One-year-old infants from maltreating families (N = 137) and their mothers were randomly assigned to one of three intervention conditions: (a) infant–parent psychotherapy (IPP), (b) psychoeducational parenting intervention (PPI), and (c) community standard (CS) controls. A fourth group of infants from nonmaltreating families (N = 52) and their mothers served as an additional low-income normative comparison (NC) group. At baseline, mothers in the maltreatment group, relative to the nonmaltreatment group mothers, reported greater abuse and neglect in their own childhoods, more insecure relationships with their own mothers, more maladaptive parenting attitudes, more parenting stress, and lower family support, and they were observed to evince lower maternal sensitivity. Infants in the maltreatment groups had significantly higher rates of disorganized attachment than infants in the NC group. At postintervention follow-up at age 26 months, children in the IPP and PPI groups demonstrated substantial increases in secure attachment, whereas increases in secure attachment were not found for the CS and NC groups. Moreover, disorganized attachment continued to predominate in the CS group. These results were maintained when intent to treat analyses were conducted. The findings are discussed in terms of the utility of translating basic research into the design and evaluation of clinical trials, as well as the importance of preventive interventions for altering attachment organization and promoting an adaptive developmental course for infants in maltreating families.This research was supported by grants from the Administration of Children, Youth, and Families, the National Institute of Mental Health (MH54643), and the Spunk Fund, Inc.

The clinical characteristics and adaptive functioning of preschoolers who met DSM-IV criteria for bipolar disorder versus psychiatric and healthy comparison groups were investigated. A community-based sample of 303 preschoolers (3–6 years of age) and their caregivers was ascertained. Diagnostic classification based on parent report of mania symptoms was made using an age-appropriate psychiatric interview. Results indicated that 26 preschoolers met DSM-IV criteria for bipolar disorder who could be identified based the presence of 13 core age-adjusted mania items. These children could be clearly differentiated from children in two psychiatric groups (DSM-IV disruptive disorders, and major depressive disorder) and a “healthy” comparison group based on a specific symptom constellation. Findings indicated that preschoolers in the bipolar group were significantly more (p < .05) impaired than the two psychiatric and healthy groups based on independent measures. Further, even after controlling for comorbid attention-deficit/hyperactivity disorder (81% comorbidity rate), the bipolar group remained significantly (p < .05) more impaired in multiple domains compared to preschoolers with DSM-IV disruptive disorders and healthy controls. Findings suggested that children as young as 3 years can manifest DSM-IV bipolar disorder when age adjusted symptom descriptions are employed, and that these children can be distinguished from healthy and disruptive disordered preschoolers. Recommendations for future research in this area that integrates developmental and mental health models are made.We gratefully acknowledge Edward Spitznagel for his statistical consultation. We are also grateful to the The Early Emotional Development Program staff, our preschool participants and their parents, and community recruiting sites whose participation and cooperation made this research possible. Funding for the study of preschool depression was provided by NIMH Grant NIMH R01 MH64769-01 (to J.L.).

A major focus in developmental psychopathology is on understanding developmental mechanisms and, armed with this information, intervening to improve children's outcomes. Translational research attempts to bridge the distance between understanding and intervention. In the collaborations that have formed the core of our research network on early experience, stress, and prevention science, we have focused on translating basic research on early experiences and stress neurobiology into preventive interventions for neglected and abused children. Our experiences in attempting to move from bench to bedside have led us to recognize the many challenges that face translational researchers. This review provides a brief synopsis of the animal model literature on early experience and stress neurobiology from which we glean several key bridging issues. We then review what is currently known about the impact of childhood neglect and abuse on stress neurobiology in human adults and children. Next, we describe how this work has informed the evaluation of our preventive interventions with maltreated children. Finally, we discuss several considerations that should facilitate a more complete integration of basic research on early experience and stress neurobiology into preventive intervention strategies.This paper reflects the work of the Early Experience, Stress and Prevention Science Network (R21 MH65046), whose members are Mary Dozier, Philip Fisher, Nathan Fox, Megan Gunnar, Seymour Levine, Charles Neal, Seth Pollak, Paul Plotsky, Mar Sanchez, and Delia Vazquez. Preparation of this manuscript was supported by a Senior Scientist Award (K05 MH66208) to Megan Gunnar, and by MH59780 and MH65046, NIMH, U.S. PHS; MH46690, NIMH and ORMH, U.S. PHS; and DA17592, NIDA, NIH, U.S. PHS to Philip Fisher.

This prospective, longitudinal study explored the relationship between mothers unresolved/disorganized (U/d) attachment status and frightened/frightening (FR) maternal behavior and investigated possible variations due to whether mothers were U/d for loss versus abuse. The role of other factors that might predict maternal FR behavior was also examined. Pregnant women (n = 116) were administered the Adult Attachment Interview and later observed at home for 30–40 min interacting with their first-born 8-month-olds. Women classified as U/d with respect to loss and/or abuse displayed substantially higher levels of FR behavior with their infants than did mothers who were not classified as U/d (i.e., secure/autonomous, dismissing, or preoccupied), but these groups did not differ on maternal sensitivity. Mothers classified as U/d who had a secondary secure/autonomous classification also showed FR behavior but at low levels than U/d-insecure mothers. Independent of U/d status, mothers who had lost a parent, versus those who did not, more often displayed FR behavior with their infants. Finally, U/d loss fully mediated the association between loss of an attachment figure other than the parent and FR behavior, and partially mediated the relationship between loss of a parent and FR behavior.This research was supported by the National Science Foundation and the Hogg Foundation for Mental Health. We are grateful to the mothers and infants for investing time and energy in this project. We also appreciate the thoughtful comments provided by the three reviewers.

Using a multisite community sample of 585 children, this study examined how protective and vulnerability factors alter trajectories of teacher-reported externalizing and internalizing behavior from kindergarten through Grade 8 for children who were and were not physically abused during the first 5 years of life. Early lifetime history of physical abuse (11.8% of sample) was determined through interviews with mothers during the prekindergarten period; mothers and children provided data on vulnerability and protective factors. Regardless of whether the child was abused, being African American; being male; having low early social competence, low early socioeconomic status (SES), and low adolescent SES; and experiencing adolescent harsh discipline, low monitoring, and low parental knowledge were related to higher levels of externalizing problems over time. Having low early social competence, low early SES, low adolescent SES, and low proactive parenting were related to higher levels of internalizing problems over time. Furthermore, resilience effects, defined as significant interaction effects, were found for unilateral parental decision making (lower levels are protective of externalizing outcomes for abused children), early stress (lower levels are protective of internalizing outcomes for abused children), adolescent stress (lower levels are protective of internalizing outcomes for abused children), and hostile attributions (higher levels are protective of internalizing outcomes for abused children). The findings provide a great deal of support for an additive or main effect perspective on vulnerability and protective factors and some support for an interactive perspective. It appears that some protective and vulnerability factors do not have stronger effects for physically abused children, but instead are equally beneficial or harmful to children regardless of their abuse status.The Child Development Project was funded by Grants MH42498, MH56961, MH57024, and MH57095 from the National Institute of Mental Health and HD30572 from the National Institute of Child Health and Human Development. We are grateful for the ongoing dedication of the Child Development Project participants and research staff. Portions of these results were presented at the 2002 American Psychological Society convention in New Orleans, LA.

Little effort has been made to characterize the developmental anatomic phenotype of autism; although there is evidence of an increased head circumference and brain size, few other physical characteristics have been studied. The head circumference, body length/height, and weight measurements of infants, who were later diagnosed with high-functioning autism (HFA, n = 16) and Asperger disorder (AsD, n = 12), were extracted from health records over the first 3 years of life and compared to the measurements of a matched normal control group (n = 19). Using linear mixed-effects models, no differences were found in the average growth rate for head circumference, stature, or weight between the children with HFA and AsD. However, a significantly higher growth rate in body length/height and weight was found for the combined group of children with HFA and AsD compared to the normal control group. A trend toward higher growth rate in head circumference was also found among the former group. The results indicate that growth dysregulation in autism is not specific to the brain but also involves growth in stature.We acknowledge the assistance of Dr. Chenyang Wang and Ms. Chelsea Cornell in data collection and collation for this study. We also thank the parents for giving us permission to obtain participants Maternal and Child Health (MCH) records, from which the data were derived, and the MCH nurses for assisting us in accessing these records.

The goal of this paper is to review assessment research of bipolar disorder in children and adolescents. The review addresses numerous themes: the benefits and costs of involving clinical judgment in the diagnostic process, particularly with regard to diagnosis and mood severity ratings; the validity of parent, teacher, and youth self-report of manic symptoms; how much cross-situational consistency is typically shown in mood and behavior; the extent to which a parent's mental health status influences their report of child behavior; how different measures compare in terms of detecting bipolar disorder, the challenges in comparing the performance of measures across research groups, and the leading candidates for research or clinical use; evidence-based strategies for interpreting measures as diagnostic aids; how test performance changes when a test is used in a new setting and what implications this has for research samples as well as clinical practice; the role of family history of mood disorder within an assessment framework; and the implications of assessment research for the understanding of phenomenology of bipolar disorder from a developmental framework.We thank the families who participated in this program of research. This work was supported in part by NIMH R01 MH066647, as well as a Center Grant from the Stanley Medical Research Institute.

Foster care is a protective intervention designed to provide out of home placement to children living in at-risk home environments. This study employs prospective longitudinal data (N = 189) to investigate the effects of foster care on the development of child behavior and psychological functioning taking into account baseline adaptation prior to placement and socioeconomic status at the time of placement. Comparisons were made among three groups: children who experienced foster care, those who were maltreated but remained in the home, and children who had not experienced foster care or maltreatment despite their similarly at-risk demographic characteristics. In the current sample, children placed in out of home care exhibited significant behavior problems in comparison to children who received adequate care, and using the same pre- and postplacement measure of adaptation, foster care children showed elevated levels of behavior problems following release from care. Similarly, children placed into unfamiliar foster care showed higher levels of internalizing problems compared with children reared by maltreating caregivers, children in familiar care, and children who received adequate caregiving. Findings suggest that outcomes related to foster care may vary with type of care and beyond the effects associated with maltreatment history, baseline adaptation, and socioeconomic status.Preparation of the work and the research described herein were supported by a National Institute of Mental Health grant (MN 40864) to Byron Egeland.

Through a translational approach, dynamic skill theory enhances the understanding of the variation in the behavioral and cognitive presentations of a high-risk population—maltreated children. Two studies illustrate the application of normative developmental constructs from a dynamic skills perspective to samples of young maltreated and nonmaltreated children. Each study examines the emotional and cognitive development of maltreated children with attention to their developing world view or negativity bias and cognitive skills. Across both studies, maltreated children demonstrate negativity bias when compared to their nonmaltreated counterparts. Cognitive complexity demonstrated by the maltreated children is dependent upon a positive or negative context. Positive problem solving is more difficult for maltreated children when compared to their nonmaltreated counterparts. Differences by maltreatment type, severity, timing of the abuse, and identity of the perpetrator are also delineated, and variation in the resulting developmental trajectories in each case is explored. This translation of dynamic skill theory, as applied to maltreated children, enhances our basic understanding of their functioning, clarifies the nature of their developmental differences, and underscores the need for early intervention.This research was supported by grants from the National Institute of Mental Health, the Roche Relief Fund, the Spencer Foundation, and the Spunk Fund, Inc. We are especially grateful to Tracy McCabe and Pamela Raya for their assistance and to the child and families who participated in these investigations.

This study examined the relationship between paternal alcoholism and toddler behavior problems from 18 to 36 months of age, as well as the potential moderating effects of 12-month infant–mother attachment security on this relationship. Children with alcoholic fathers had higher levels of internalizing and externalizing behavior than children of nonalcoholic fathers. Simple effects testing of an interaction effect of child age, group, and attachment security with mothers on externalizing behavior suggested that at 24 and 36 months of age mother–infant attachment security moderated the relationship between alcohol group status and externalizing behavior. Namely, within the alcohol group, those children with secure relationships with their mothers had significantly lower externalizing than insecure children of alcoholics. A similar pattern was noted for internalizing behavior at 36 months of age. Implications for intervention are discussed.The authors thank the parents and infants who participated in this study and the research staff who were responsible for conducting numerous assessments with these families. This study was made possible by grants from NIAAA (1RO1 AA-10042-01A1) and NIDA (1K21DA00231-01A1).

This study examined the validity of “weak” central coherence (CC) in the context of multiple cognitive capabilities/deficits in autism. Children with an autism spectrum disorder (ASD) and matched typically developing children were administered tasks tapping visuospatial coherence, false-belief understanding and aspects of executive control. Significant group differences were found in all three cognitive domains. Evidence of local processing on coherence tasks was widespread in the ASD group, but difficulties in attributing false beliefs and in components of executive functioning were present in fewer of the children with ASD. This cognitive profile was generally similar for younger and older children with ASD. Furthermore, weak CC was unrelated to false-belief understanding, but aspects of coherence (related to integration) were associated with aspects of executive control. Few associations were found between cognitive variables and indices of autistic symptomatology. Implications for CC theory are discussed.The authors thank all of the children, families, and teachers for their generous support and participation in this study. Invaluable help with recruitment was provided by Sue Luscombe, Emma Glasson, Kathy Ziatas, various speech pathologists, ISADD, the Autism Association, Therapy Focus, FOCAS, and the Asperger's Syndrome and Second Step support groups. We are also grateful to Western Psychological Services for providing prepublication copies of the SCQ and to the Apex Foundation Trust for Autism for awarding a grant to the first (E.P.) and third authors (K.D.), which funded administration of the Autism Diagnostic Interview—Revised. The second author (M.M.) was supported by Australian Research Council Grant DP0452312.

Understanding why interparental difficulties pose a risk to children in families experiencing domestic violence is an urgent task for ameliorating childhood psychopathology, particularly in light of the paucity of knowledge on the unfolding mediating mechanisms and the potentiating and protective conditions that underlie the multiplicity of pathways between domestic violence and child maladjustment. Toward addressing this significant gap, this paper examines how the emotional security theory (EST) may foster advances in our understanding of the genesis, course, and treatment of children's psychological problems in families experiencing domestic violence. Following an overview of the theoretical assumptions and significance of translating the emotional security theory to high-risk contexts, we address how children's difficulties in preserving security may emerge in the face of domestic violence and accompanying forms of severe family adversity, and illustrate the implications of emotional insecurity for childhood psychopathology in homes characterized by domestic violences. In the final section, we address how the EST may be useful in informing public policy and intervention initiatives designed to reduce the burden of mental illness.This research was supported by a National Institute of Mental Health award (R01 MH071256) to Patrick T. Davies and Dante Cicchetti. Marcia A. Winter was supported by a National Institute of Mental Health fellowship (F31 MH068057).

The longitudinal course of children and adolescents with bipolar disorder (BP) is manifested by frequent changes in symptom polarity with a fluctuating course showing a dimensional continuum of bipolar symptom severity from subsyndromal to mood syndromes meeting full Diagnostic and Statistical Manual of Mental Disorders criteria. These rapid fluctuations in mood appear to be more accentuated than in adults with BP, and combined with the high rate of comorbid disorders and the child's cognitive and emotional developmental stage, may explain the difficulties encountered diagnosing and treating BP youth. Children and adolescents with early-onset, low socioeconomic status, subsyndromal mood symptoms, long duration of illness, rapid mood fluctuation, mixed presentations, psychosis, comorbid disorders, and family psychopathology appear to have worse longitudinal outcome. BP in children and adolescents is associated with high rates of hospitalizations, psychosis, suicidal behaviors, substance abuse, family and legal problems, as well as poor psychosocial functioning. These factors, in addition to the enduring and rapid changeability of symptoms of this illness from very early in life, and at crucial stages in their lives, deprive BP children of the opportunity for normal psychosocial development. Thus, early recognition and treatment of BP in children and adolescents is of utmost importance.This work was supported in part by grant MH59929 from the National Institute of Mental Health. The authors thank Carol Kostek for her assistance with manuscript preparation and Editha Nottelmann, PhD, and Regina James, MD, for their continued support.