Development and Psychopathology

Research Article

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

David J. Miklowitza1 c1 and Kiki D. Changa2

a1 University of Colorado, Boulder

a2 Stanford University School of Medicine


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.


c1 Address correspondence and reprint requests to: David J. Miklowitz, Department of Psychology, University of Colorado at Boulder, 345 UCB, Boulder, CO 80309; E-mail:


Preparation of this manuscript was supported by Grants MH62555, MH073871, and MH077856 (to D.J.M.), a Faculty Fellowship from the University of Colorado, a Distinguished Investigator Award from the National Alliance for Research on Schizophrenia and Depression (to D.J.M.), and an NIMH K-Award (to K.D.C.).