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One hundred children\/adolescents with affective illness (72 boys and 28 girls; age range 2-20 years; mean age 10 years), who were consecutively referred to the Pediatric Behavioral Neurology Program, Children's Medical Center at Dallas, were evaluated for the pattern and course of affective illness symptoms, family history, and pubertal stage. Seven patterns of affective illness were identified. In the 65 prepubertal children (Tanner stage 1), disorders with hypomanic\/manic symptomatology were most common (47\/65, 72%): mania (2\/65, 3%), hypomania (8\/65, 12%), cyclothymia (11\/65, 17%), juvenile rapid-cycling bipolar disorder\/ultradian cycling bipolar disorder (8\/65, 12%), and dysthymia with bipolar features (18\/65, 28%). In contrast, the 26 fully pubertal adolescents (Tanner stages 3-5) had a predominance of patterns with only depressive symptomatology (16\/26, 61%): dysthymia (4\/26, 15%) and depression (12\/26, 46%), along with juvenile rapid-cycling bipolar disorder\/ultradian cycling bipolar disorder (6\/26, 23%). Affective illness, alcoholism, and drug abuse were prominent in the family histories, regardless of the child's pattern of symptoms. Family histories of character disorder and Briquet's syndrome were also common, but thought disorder, suicide, and homicide were infrequent. This study supports the clinical observation that the presentation of affective illness changes with age: manic features predominate in younger children, whereas depressive symptomatology is more evident with pubertal maturation. 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