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Chapter 14Early Identification and Preventionof Early-Onset Bipolar DisorderKiki Chang, Kim Gallelli, and Meghan HoweBipolar disorder (BD) is a chronic, recurrent disorder carrying high morbidity andmortality, leading to annual health costs of $45 billion (Kleinman et al., 2003).Up to 4% of the U.S. population may be affected by bipolar spectrum disorders(Akiskal et al., 2000). Twenty-five to 50% of individuals with BD attempt suicideat least once, and 8.6–18.9% die due to completed suicide (Y. W. Chen &Dilsaver, 1996). Suicidal risk, along with increased substance use and comorbidity,is likely greatest in childhood compared to adult-onset BD (Bellivier, Golmard,Henry, Leboyer, & Schurhoff, 2001; Carter, Mundo, Parikh, & Kennedy, 2003).In the last decade, there has been a flurry of research targeting more effectivepharmaco- and psychotherapies to treat BD in children and adults. However, giventhe severe morbidity and mortality associated with BD, it seems imperative todevelop interventions designed to prevent individuals from ever developing BD.Appropriate interventions early in the development of the illness may accomplishthe following: (1) prevent inappropriate interventions that may worsen or hastendevelopment of BD, (2) delay the onset of first depressive or manic episode, and/or (3) prevent development of full BD.Prevent Inappropriate Treatments. Recent studies have reported an approximate5- to 10-year lag between the onset of BD symptoms and appropriate diagnosisand treatment in individuals with BD (Egeland et al., 2000; Lish et al., 1994).Inappropriate or inadequate treatment early in the course of the illness may have315