Objectives: Early psychopathology in children diagnosed with Bipolar Disorder (BD) remains
poorly characterized. Parental retrospective reports provide helpful details on the earliest manifestations
and their evolution over time. These symptoms occur early in the course of BD, often before a formal
diagnosis is made and/or treatment is implemented, and are of great importance to early recognition and
Methods: Parents of pre-pubertal children and adolescents with DSM-IV diagnoses of BD attending an
outpatient mood disorders clinic provided retrospective ratings of 37 symptoms of child psychopathology.
Stability and comorbidity of diagnoses were evaluated, and severity of symptoms for each subject was
assessed by identifying the earliest occurrence of the reported symptoms causing impairment.
Results: Severe mood instability, temper tantrums, anxiety symptoms, sleep disturbances and aggression
were among the most common signs of psychopathology reported in children diagnosed with BD before
puberty. Symptoms were already apparent in the first three years in 28%, and formal diagnoses were
made before the age of 8 y in the majority of cases.
Conclusions: Retrospective parental reports of early symptoms of psychopathology in pre-pubertal
children with BD revealed a very early occurrence of affective precursors (irritability and mood
dysregulation) and clinical risk factors like impulsive aggression and anxiety that can precede the
syndromal onset of mania by several years. These findings support previous reports suggesting a
progression of symptoms from abnormal, non-specific presentations to sub-threshold and finally
syndromal BD. The importance of early identification and intervention is discussed.